Olsen Flemming Javier, Diederichsen Søren Zöga, Jørgensen Peter Godsk, Jensen Magnus T, Dahl Anders, Landler Nino Emmanuel, Graff Claus, Brandes Axel, Krieger Derk, Haugan Ketil, Køber Lars, Højberg Søren, Svendsen Jesper Hastrup, Biering-Sørensen Tor
Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
Department of Cardiology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark.
PLoS One. 2022 Jun 3;17(6):e0269475. doi: 10.1371/journal.pone.0269475. eCollection 2022.
Elderly individuals occupy an increasing part of the general population. Conventional and speckle-tracking transthoracic echocardiography may help guide risk stratification in these individuals. The purpose of this study was to evaluate the potential utility of conventional and speckle-tracking echocardiography in the screening of cardiac abnormalities in the elderly population.
Two cohorts of elderly individuals (sample size: 1441 and 944) were analyzed, who were part of a randomized controlled clinical trial (LOOP study) and of an observational study (Copenhagen City Heart Study), recruiting participants from the general population >70 years of age with cardiovascular risk factors (arterial hypertension, diabetes mellitus, heart failure, or prior stroke) and sinus rhythm. Participants underwent a comprehensive transthoracic echocardiographic examination, including myocardial speckle tracking. Cardiac abnormalities were defined according to the ASE/EACVI guidelines.
Structural cardiac abnormalities such as left ventricular (LV) remodeling, mitral annular calcification (MAC), and aortic valve sclerosis (with or without stenosis) were highly prevalent in the LOOP study (40%, 39%, and 27%, respectively). Moreover, a high prevalence of functional cardiac alterations such as LV diastolic dysfunction (LVDD), abnormal LV longitudinal systolic strain (GLS), and abnormal left atrial (LA) reservoir strain was present in the LOOP study (27%, 18%, and 9%, respectively). Likewise, the rate of LVDD, abnormal GLS, and abnormal LA reservoir strain was comparable in the validation sample from the Copenhagen City Heart Study. In line with these findings, subjects with LV remodeling, MAC, and aortic valve changes had a higher prevalence of LVDD, abnormal GLS, and abnormal LA reservoir strain than those without structural cardiac alterations.
The findings of this study highlight the potential clinical utility of conventional and speckle-tracking echocardiography in the screening of structural and functional cardiac abnormalities in the elderly population. Further studies are warranted to determine the prognostic relevance of these findings.
老年人在总人口中所占比例日益增加。传统经胸超声心动图和斑点追踪经胸超声心动图有助于指导这些人群的风险分层。本研究的目的是评估传统超声心动图和斑点追踪超声心动图在筛查老年人群心脏异常方面的潜在效用。
分析了两组老年人群（样本量分别为1441和944），他们分别来自一项随机对照临床试验（LOOP研究）和一项观察性研究（哥本哈根市心脏研究），研究对象为年龄>70岁、有心血管危险因素（动脉高血压、糖尿病、心力衰竭或既往中风）且为窦性心律的普通人群。参与者接受了包括心肌斑点追踪在内的全面经胸超声心动图检查。心脏异常根据美国超声心动图学会/欧洲心血管影像学会（ASE/EACVI）指南进行定义。
在LOOP研究中，左心室（LV）重构、二尖瓣环钙化（MAC）和主动脉瓣硬化（伴或不伴狭窄）等结构性心脏异常非常普遍（分别为40%、39%和27%）。此外，在LOOP研究中，LV舒张功能障碍（LVDD）、LV纵向收缩期应变异常（GLS）和左心房（LA）储存应变异常等功能性心脏改变的发生率也很高（分别为27%、18%和9%）。同样，在哥本哈根市心脏研究的验证样本中，LVDD、异常GLS和异常LA储存应变的发生率相当。与这些发现一致，有LV重构、MAC和主动脉瓣改变的受试者比没有结构性心脏改变的受试者发生LVDD、异常GLS和异常LA储存应变的患病率更高。
本研究结果突出了传统超声心动图和斑点追踪超声心动图在筛查老年人群结构性和功能性心脏异常方面的潜在临床效用。有必要进一步研究以确定这些发现的预后相关性。
