Ostovar Roya, Schröter Filip, Hartrumpf Martin, Kuehnel Ralf-Uwe, Bruch Dunja, Motazedian Farnoosh, Albes Johannes Maximilian
Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences, University Hospital Brandenburg Medical School "Theodor Fontane", 16321 Bernau, Germany.
J Clin Med. 2023 May 31;12(11):3790. doi: 10.3390/jcm12113790.
Advanced age is a risk factor in cardiac surgery contributing significantly to a worse outcome. The reasons are frailty and multimorbidity. In this study, we asked: Is there an aging of the heart which differs from chronological age?
Propensity score matching was performed between 115 seniors ≥ 80 years and 345 juniors < 80 years. After the patients were found to be comparable in terms of cardiac and noncardiac disease and risk profiles, they were further analyzed for cardiac parameters. In addition, the seniors and juniors were compared in terms of cardiac health and postoperative outcome. Furthermore, the patients were subdivided into several age groups (<60 years, 60-69 years, 70-79 years, and >80 years) and compared regarding outcome.
The seniors demonstrated significantly lower tricuspid annular plane systolic excursion (TAPSE), significantly more frequent diastolic dysfunction, significantly higher plasma levels of NT-proBNP, and significantly larger left ventricular end-diastolic and end-systolic diameters and left atrial diameters ( < 0.001, respectively). Furthermore, in-hospital mortality and most postoperative complications were significantly higher in seniors compared with juniors. While old cardiac healthy patients showed better outcome than old cardiac aged patients, the outcome from young cardiac aged patients was better than old cardiac aged patients. The outcome and survival deteriorated with increasing life decades.
The elderly suffer significantly more from cardiac deterioration, i.e., cardiac aging, and show higher multimorbidity. Mortality risk is significantly higher and they suffer more often from a complicated postoperative course compared to younger patients. Further approaches to prevention and treatment of cardiac aging are needed to address the needs of an aging society.
高龄是心脏手术的一个风险因素，对较差的手术结果有显著影响。原因是身体虚弱和多种疾病并存。在本研究中，我们提出疑问：心脏是否存在与实际年龄不同的老化现象？
对115名年龄≥80岁的老年人和345名年龄<80岁的年轻人进行倾向得分匹配。在发现患者在心脏和非心脏疾病及风险特征方面具有可比性后，对他们的心脏参数进行进一步分析。此外，还比较了老年人和年轻人的心脏健康状况及术后结果。此外，将患者细分为几个年龄组（<60岁、60 - 69岁、70 - 79岁和>80岁），并比较其结果。
老年人的三尖瓣环平面收缩期位移（TAPSE）显著降低，舒张功能障碍更为频繁，NT - proBNP血浆水平显著升高，左心室舒张末期和收缩末期直径以及左心房直径显著增大（均P<0.001）。此外，与年轻人相比，老年人的住院死亡率和大多数术后并发症显著更高。虽然心脏健康的老年患者比心脏老化的老年患者手术结果更好，但心脏老化的年轻患者的结果优于心脏老化的老年患者。随着年龄增长，手术结果和生存率恶化。
老年人心脏恶化（即心脏老化）的情况更为严重，且多种疾病并存的情况更为普遍。与年轻患者相比，他们的死亡风险显著更高，术后病程更常出现并发症。需要进一步采取预防和治疗心脏老化的方法来满足老龄化社会的需求。
