Cardiovascular consequences of the aging process.

The normal aging process is associated with a variety of cardiovascular changes. Recognition of these alterations in cardiovascular structure and function that occur in the aging population is essential for assessment of cardiac disease in older patients. For example, a number of studies show that aging is associated with increasing left ventricular wall thickness and mass. However, these changes are gradual and relatively mild, and absolute wall thickness measurements in individual elderly subjects rarely exceed generally accepted normal values. Parameters of left ventricular systolic function (either under basal conditions or with exercise) change little with aging. In contrast, apparent alterations in left ventricular diastolic filling patterns often accompany advancing age. Investigations in normal elderly subjects have shown that the early filling phase is prolonged, and the rate and volume (as well as flow-velocity) of rapid filling are decreased. These alterations are associated with a compensatory increase in late diastolic filling with atrial systole. The aging changes in left ventricular filling identified by noninvasive tests (such as Doppler echocardiography or radionuclide angiography) may mimic in appearance those observed in a number of cardiovascular diseases, making interpretation of their clinical significance difficult in an elderly population.