Normal Age-Related Changes in the Heart: Relevance to Echocardiography in the Elderly

Age-appropriate normal reference standards are important for the accurate diagnosis of cardiac disease in the elderly. However, it can be difficult to definitively prove that frequently observed changes are due to primary, biologic aging. A gender differential is frequently observed in normative studies of cardiovascular aging. There are mild age-related increases in left ventricular mass and wall thickness, and a slight decrease in left ventricular internal diastolic and systolic dimensions, particularly in women. The left atrium and aortic root show significant age-related dilation in both genders. The valve leaflets thicken, and there is an age-related increase in physiologic valvular regurgitation. Increased epicardial fat widens the echolucent pericardial stripe, both anterior and posterior, particularly in women. The atrial septum thickens and becomes stiffer. Patent foramen ovale is less prevalent with advancing age but, when present, tends to be larger. There are important alterations in left ventricular diastolic filling, with decreased early and increased atrial filling velocity and mildly prolonged early deceleration and isovolumic relaxation time. These changes in diastolic function are relatively uniform and independent of other age-related changes. There are no significant aging changes in resting left ventricular systolic function. These normal age-related changes decrease cardiovascular reserve and lower the threshold for expression of cardiovascular disease among older persons. An important finding is that echocardiographic image quality is more frequently poor in older patients. Age, gender, and body size should be taken into account when interpreting echocardiographic findings.