Heart disease and aging

CAD is the most common cause of death in older persons and was present in 43% of 1,160 men and in 41% of 2,464 women, mean age 81 years. Hypertension was present in 60% of these older women and in 57% of these older men. The prevalence of valvular aortic stenosis, aortic regurgitation, mitral regurgitation, and MAC increases with age in older men and in older women. The prevalence and incidence of CHF increase with age. CHF is the most common cause of hospitalization in persons aged 65 years and older. The prevalence of normal LV ejection fraction associated with CHF increases with age and is higher in older women than in older men. The prevalence of chronic atrial fibrillation increases with age and was present in 16% of 1,160 older men and in 13% of 2,464 older women. Atrial fibrillation is an independent predictor of new coronary events and thromboembolic stroke in older persons. Older persons who have unexplained syncope should have 24-hour ambulatory electrocardiograms to determine whether pauses of longer than 3 seconds are present that require permanent pacemaker implantation.     

彩色多普勒超声在老年退行性心脏瓣膜病诊断中的应用价值

目的:探讨彩色多普勒超声在老年退行性心脏瓣膜病诊断中的应用价值。方法:本研究选取2017年11月-2019年11月我院收治的876例心脏病患者,均接受心脏彩色多普勒超声检查,对其临床资料进行回顾性分析。结果:本组876例心脏病患者共检出老年退行性心脏瓣膜病281例,总检出率为32.08%;男性检出率显著高于女性(P<0.05)。80岁以上年龄段疾病检出率最高,显著高于70~79岁及60~69岁人群(P<0.05)。281例患者中单纯主动脉瓣受累占比61.57%,单纯二尖瓣受累占比18.86%,主动脉瓣、二尖瓣同时受累19.57%。主动脉瓣狭窄49例,二尖瓣狭窄7例;瓣膜功能障碍87例,主动脉瓣反流占70.11%,二尖瓣反流18.39%。结论:心脏超声检查在老年退行性心脏瓣膜病诊断中具有重要应用价值,可作为疾病诊断检查的重要手段。     

家族性高胆固醇血症患者的临床表现和超声心动图特征

目的 分析家族性高胆固醇血症（FH）患者的临床表现和超声心动图特征.方法 经我院动脉粥样硬化研究室确诊的FH患者41例,女23例,男18例,年龄3～62岁,平均（19.94±14.87）岁.另选取健康人39例作为对照组.采用彩色多普勒超声仪观察两组受检查心脏、瓣膜、主动脉的形态结构和功能.结果 FH患者血清总胆固醇为（13.24±4.36）mmol/L,低密度脂蛋白胆固醇为（10.57±4.41）mmol/L.35例患者皮肤出现黄色瘤,33例为首发症状.二尖瓣反流19例,主动脉瓣反流13例,主动脉瓣钙化6例,主动脉瓣狭窄3例,主动脉根部狭窄8例.FH患者心脏收缩和舒张功能基本正常.结论 FH以高胆固醇血症、特征性黄色瘤、早发的心血管疾病和阳性家族史为主要临床表现.超声心动图检查有瓣膜反流、主动脉口狭窄等表现,能为FH患者动脉粥样硬化的形态和功能变化提供重要依据.     

ICD implantation and arrhythmia-free survival in patients with depressed LV function following surgery for valvular heart disease

Background: Although prophylactic implantable cardioverter‐defibrillator (ICD) implantation is beneficial in patients with severe ischemic cardiomyopathy, it is unclear whether patients with cardiomyopathy due to valvular heart disease have a similar benefit. Methods: We followed 17 patients (14 men/three women, age 62 ± 13 years, left ventricular ejection fraction [LVEF] 29 ± 10%) who had nonischemic valvular cardiomyopathy, underwent valvular heart surgery (aortic valve replacement, mitral valve replacement, and/or mitral valve repair), and subsequently had an electrophysiology study (EPS), for a median of 2.8 years. These patients were compared with 34 patients with prior myocardial infarction and no significant valvular heart disease, who were matched (1:2) for age, gender, LVEF, EPS result, T‐wave alternans result, and ICD placement. Occurrence of arrhythmias was ascertained from ICD device clinic follow‐up and vital status was determined using the National Death Index. Results: There were no differences between the groups in overall survival (P = 0.24) or arrhythmia‐free survival (P = 0.38), and the 2‐year arrhythmia‐free survival was 82% for the valvular patients versus 73% for the ischemic patients. Among patients with ICDs, there was no difference between the groups in overall survival (P = 0.34), time to first appropriate ICD therapy (P = 0.54), and arrhythmia‐free survival (P = 0.51). Conclusion: Patients with valvular cardiomyopathy and residual left ventricular dysfunction following valvular surgery who underwent a tailored approach to ICD implantation had similar overall and arrhythmia‐free survival as patients with ischemic cardiomyopathy.     

Prevalence and Natural History of Mitral Annulus Calcification and Related Valve Dysfunction

ObjectiveTo evaluate the prevalence and natural history of mitral annulus calcification (MAC) and associated mitral valve dysfunction (MVD) in patients undergoing clinically indicated echocardiography.MethodsA retrospective review was conducted of all adults who underwent echocardiography in 2015. Mitral valve dysfunction was defined as mitral regurgitation or mitral stenosis (MS) of moderate or greater severity. All-cause mortality during 3.0 (0.4 to 4.2) years of follow-up was compared between groups stratified according to the presence of MAC or MVD.ResultsOf 24,414 evaluated patients, 5502 (23%) had MAC. Patients with MAC were older (75±10 years vs 60±16 years; P<.001) and more frequently had MVD (MS: 6.6% vs 0.5% [P<.001]; mitral regurgitation without MS: 9.5% vs 6.1% [P<.001]). Associated with MS in patients with MAC were aortic valve dysfunction, female sex, chest irradiation, renal dysfunction, and coronary artery disease. Kaplan-Meier 1-year survival was 76% in MAC+/MVD+, 87% in MAC+/MVD?, 86% in MAC?/MVD+, and 92% in MAC?/MVD?. Adjusted for age, diabetes, renal dysfunction, cancer, chest irradiation, ejection fraction below 50%, aortic stenosis, tricuspid regurgitation, and pulmonary hypertension, MAC was associated with higher mortality during follow-up (adjusted hazard ratio, 1.40; 95% CI, 1.31 to 1.49; P<.001); MVD was associated with even higher mortality in patients with MAC (adjusted hazard ratio, 1.79; 95% CI, 1.58 to 2.01; P<.001). There was no significant interaction between MAC and MVD for mortality (P=.10).ConclusionIn a large cohort of adults undergoing echocardiography, the prevalence of MAC was 23%. Mitral valve dysfunction was more than twice as prevalent in patients with MAC. Adjusted mortality was increased in patients with MAC and worse with both MAC and MVD.     

性别因素对心力衰竭住院患者病因和预后的影响

目的调查不同性别对心力衰竭住院患者病因和预后的影响。方法 1993年1月至2007年12月初次住院有效诊断充血性心力衰竭患者6949例(男4344例,女2605例),按照性别不同分成2组,比较各组间的病因及30 d在院病死率。结果心力衰竭住院患者中,男性病因以冠心病(49.6%)、高血压(39.3%)和心肌病(8.0%)为主。而女性以瓣膜性心脏病(37.5%),肺心病(10.6%)和甲亢(1.0%)为主。在18～29岁人群组,女性的死亡率几乎为男性的3倍(4.8%vs 1.7%);在≥80岁以上人群组,女性死亡率显著高于男性(16.1%vs 11.4%)。随着年龄增长,男性和女性死亡率均增加。结论性别不同,心力衰竭住院患者的病因和在院死亡率不同。     

Diet drug-related cardiac valve disease: the Mayo Clinic echocardiographic laboratory experience

OBJECTIVE: To describe the prevalence of diet drug-related valvular disease among our referral population and the association of valvular disease with duration of exposure to fenfluramine and phentermine in combination and to dexfenfluramine alone. PATIENTS AND METHODS: In this retrospective review of clinical and echocardiographic data, charts of patients referred for treatment of toxic effects of diet drugs were reviewed, and telephone interviews were conducted. RESULTS: Between June and December 1997, 191 patients (164 women, 27 men; mean age, 47 years) were referred for possible diet drug-related valvular disease. Twenty-eight (28%) of the 99 asymptomatic patients and 40 (43%) of the 92 symptomatic patients had abnormal echocardiographic findings. Valvular lesions among the 68 patients with abnormal echocardiographic findings included mild (or greater) aortic regurgitation in 55 patients (81%), moderate (or greater) mitral regurgitation in 12 (18%), and moderate (or greater) tricuspid regurgitation in 7 (10%). The Food and Drug Administration case definition of diet drug-related valvulopathy was noted in 31 % of this referral population. Of patients with valvulopathy, mean duration of therapy with fenfluramine and phentermine in combination and dexfenfluramine alone was 9 months and 5 months, respectively. Duration of therapy was not associated with presence or absence of disease. Five patients had surgical intervention for severe valvulopathy: 3 had mitral valve repair, 1 had mitral valve replacement, and 1 had aortic valve replacement. Pulmonary hypertension (>40 mm Hg) was found in 24 patients (13%), and 17 (71 %) had pulmonary hypertension in association with valvulopathy. CONCLUSION: This study demonstrated a 31% (60/191) prevalence of valvulopathy in patients with a history of diet drug exposure who were referred for echocardiographic evaluation. The most common finding was mild aortic regurgitation. Twenty-eight percent of asymptomatic patients had abnormal echocardiographic findings. This study emphasizes the spectrum of diet drug-related cardiac disease and the potential for valvulopathy in asymptomatic patients.     

上海市淞南社区中老年人群冠状动脉粥样硬化患病率CCTA调查结果及相关因素分析

目的：探讨上海市宝山区淞南社区中老年人群冠状动脉病变的现况及相关因素。方法：随机选取上海市宝山区淞南社区中,40~60岁、无冠心病临床症状的糖调节正常人群及糖尿病前期或病程低于5年的糖尿病患者,采用调查问卷收集其既往病史和生活方式等信息,测量身高、体重、腰围、血压等,并行口服75 g葡萄糖耐量试验及冠状动脉计算机断层血管造影（coronary computed tomography angiography,CCTA）检查,观察冠状动脉的病变情况,当冠状动脉管腔狭窄 ≥50%时定义为冠状动脉显著狭窄,当冠状动脉出现狭窄且冠状动脉钙化积分 >0时定义为冠状动脉钙化,并分析其影响因素。结果：排除因移动伪影导致无法分析的图像之后,共有228名糖调节正常人群、191例糖尿病前期患者和130例糖尿病患者纳入分析,其中男性有233名（42.4%）。上海市宝山区淞南社区549名中老年社区居民的冠状动脉狭窄、冠状动脉显著狭窄和冠状动脉钙化患病率分别为51.4%、10.7%和14.8%。多元Logistic回归分析显示,年龄≥53岁和高血压显著增加了冠状动脉狭窄的发生风险;男性显著增加了冠状动脉显著狭窄的发生风险;年龄≥53岁和糖尿病显著增加了冠状动脉钙化的发生风险。结论：上海市宝山区淞南社区中老年居民的冠状动脉狭窄患病率为51.4%,男性、年龄≥53岁、高血压及糖尿病均与冠状动脉疾病发生风险的增加密切相关。     

Percutaneous transluminal balloon valvuloplasty and balloon angioplasty in congenital heart defects with left heart obstruction in childhood

Balloon dilation was performed in 31 patients with congenital left heart obstructions. In 16 patients with aortic stenosis aged 2 days to 16.3 years (mean 10.03 +/- 4.79 years) the peak systolic gradient decreased significantly from 80 +/- 21 mmHg to 23 +/- 13 mmHg immediately after dilation, and remained low at the time of follow up (6 months to 3 years), namely 30 +/- 12 mmHg (p less than 0.0001). Mild aortic regurgitation (I degrees) was already present before the procedure in 56%, increased in 3 patients, and reached haemodynamic significance in 1 (III degrees). Half of the 14 patients with coarctation, aged 2 months to 16.75 years (mean 4.98 +/- 5.15 years), had undergone previous surgery 2 months to 7.9 years before the balloon dilation; coarctation was native in the remainder. Peak systolic gradient across the coarctation site was reduced from 46 +/- 10 mmHg to 5 +/- 5 mmHg, and was 9 +/- 7 mmHg at the time of follow up (6 months-3.6 years) (p less than 0.0001). Aneurysms were not detected. In a 6-year-old girl with congenital mitral stenosis the gradient fell from 13 mmHg to 7 mmHg immediately after the procedure. There were no serious complications. Peripheral arterial lesions required medical or surgical treatment in 16% of cases. Our report suggests that balloon valvuloplasty and angioplasty is a safe and well-tolerated procedure in childhood. It can reduce the gradient in congenital left heart obstructions with good short-term and intermediate-term results.     

1377例社区老年人群高血压现况调查

目的:了解顺德容桂地区老年人群高血压的现况。方法:对顺德区容桂街道整群随机抽样,随机抽取2个社区,对60岁以上的常住人口全部进行调查,总人数1503人,被调查且资料完整的1377人。调查的项目有年龄、性别、血压、身高、体重、腰围(WC)、臀围(HC)、空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、既往史,并计算出体重指数(BMI)、腰臀围比(WHR)和腰围身高比(WHtR)。结果:(1)高血压总现患率为72.84%,男性现患率为73.37%,女性现患率为72.47%;60～69岁组现患率为66.82%,70～79岁组现患率为80.62%,80岁以上组现患率为92.78%。男女之间差异不明显(P>0.05),不同年龄组间差异明显(P<0.01)。(2)与非高血压者相比,高血压者年龄、FPG,TG,BMI,WC,WHR,WHtR更高,差别有统计学意义(P<0.05)。(3)相关性分析发现,高血压与年龄、TG,BMI,WC,WHR明显相关(P<0.01),与WHtR及TC无相关(P>0.05)。结论:高血压病年龄越大现患率越高。高血压与血糖、血脂、肥胖相关,在关注血压的同时也要关注相伴情况,这样才能真正做到降低总体的心血管风险。     

Adult valvular heart disease: a practical approach

The diagnosis and management of valvular heart disease is an important element of primary care practice. This article reviews the essential elements of four common valvular disorders, including signs and symptoms. The disorders reviewed are aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation. The article places an emphasis on practical aspects of care.     

Differentiation of athlete's heart from pathological forms of cardiac hypertrophy by means of geometric indices derived from cardiovascular magnetic resonance.

PURPOSE: Determination of the underlying etiology of left ventricular hypertrophy (LVH) is a common, challenging, and critical clinical problem. The authors aimed to test whether pathological LVH, such as occurs in hypertrophic cardiomyopathy (HCM), hypertensive heart disease, or aortic stenosis, and physiological LVH in athletes, can be distinguished by means of left ventricular volume and geometric indices, derived from cardiovascular magnetic resonance imaging. METHODS: A total of 120 subjects were studied on a 1.5 Tesla MR (Sonata, Siemens Medical Solutions, Erlangen, Germany) scanner, comprising healthy volunteers (18), competitive athletes (25), patients with HCM (35), aortic stenosis (24), and hypertensive heart disease (18). Left ventricular mass index, ejection fraction, end-diastolic, end-systolic and stroke volume index, diastolic wall thickness, wall thickness ratio and diastolic and systolic wall-to-volume ratios were determined. RESULTS: Left ventricular (LV) mass indices were similar for all forms of LVH (p > 0.05), which were at least 35% higher than those obtained in healthy volunteers (p < 0.05). Multiple logistic regression showed that the percentage of correctly predicted diagnoses was 100% for athlete's heart, 80% for hypertrophic cardiomyopathy, 54% for aortic stenosis, and 22% for hypertensive heart disease. Using a receiver operating curve-determined cut-off value for diastolic wall-to-volume ratio of less than 0.15 mm x m2 x ml(-1), athletes' hearts could be differentiated from all forms of pathological cardiac hypertrophy with 99% specificity. CONCLUSIONS: Athlete's heart can be reliably distinguished from all forms of pathological cardiac hypertrophy using CMR-derived LV volume and geometric indices, but pathological forms of LVH present with overlapping cardiac hypertrophy phenotypes. This capability of CMR should be of high clinical value.     

Factors Predisposing to the Development of Atrial Fibrillation

Atrial fibrillation (AF) is in most patients (approximately 70%) associated with organic heart disease including valvular heart disease, coronary artery disease, hypertension, hypertrophic cardiomyopathy, dilated cardiomyopathy, and congenital heart disease, mostly atrial septal defect in adults. In many chronic conditions, determining whether AF is the result or is unrelated to the underlying heart disease, remains unclear. The list of possible etiologies also include cardiac amyloidosis, hemochromatosis and endomyocardial fibrosis. Other heart diseases, such as mitral valve prolapse (without mitral regurgitation), calcifications of the mitral annulus, atrial myxoma, pheochomocytoma, and idiopathic dilated right atrium may present with AF. Atrial fibrillation may occur in the absence of detectable organic heart disease, the so-called “lone AF”, in about 30% of cases. The term “idiopathic AF” implies the absence of any detectable etiology including hyperthyroidism, chronic obstructive lung disease, overt sinus node dysfunction, and overt or concealed preexcitation (Wolff-Parkinson-White syndrome), only to mention a few of other uncommon causes of AF. The autonomous nervous system may contribute to the occurrence of AF in some patients. AF occurs commonly. In patients with valvular heart disease, AF is common, particularly when the mitral valve is involved. The occurrence of AF is unrelated to the severity of mitral stenosis or mitral regurgitation but is more common in patients with enlarged left atrium and congestive heart failure. In patients with coronary artery disease, AF occurs predominantly in older patients, males, and patients with left ventricular dysfunction. Important predictive factors of AF include hypertension, left ventricular hypertrophy and diabetes. The risk of the development of AF, in an individual patient, is often difficult to assess. Increasing age, presence of valvular heart disease, and congestive heart failure increase the risk of atrial fibrillation.     

Factors influencing left ventricular diastolic function in elderly patients with chronic heart failure

The purpose of the study was to define factors influencing the diastolic left ventricular (LV) function in elderly patients with chronic heart failure (CHF). Ninety-seven I to IV functional class CHF patients aged 65 to 88 (mean age 76.6+/-5.1 yr), 61 women and 36 men, were examined. CHF was caused by coronary artery disease in 22 (22.7%) patients, by arterial hypertension in 14 (14.4%) patients, and by both in 61 (62.9%) patients. Fourteen (14.4%) patients had type 2 diabetes. Hemoglobin level lower than 130g/l in men or 120g/l in women was considered anemia. Glomerular filtration speed (GFS) was calculated using Cockcroft-Gault formula. EchoCG and Doppler EchoCG were performed in all patients. LV hypertrophy (LVH) was revealed in 90 (92%) of the patients; 52patients had concentric L VH and 38 patients had eccentric LVH. Ejection fraction was less than 45% in 17 (17.5%) patients. Isovolemic relaxation time (IVRT) was over the normal limit in 73 (75.3%) patients; the time of early diastolic flow slowing (DT) changed in different directions and was 211.2+/-55.6 msec. A type of transmitral blood flow with relaxation disorder was found in 58 (59.8%) patients, a pseudonormal type was revealed in 32 (33%), and a restrictive type was found in 7 (7.2%) of patients. The study found a reverse independent correlation between hemoglobin level and the speed of LV filling during atrial systole. An independent correlation between the degree of renal dysfunction (GFS) and disorder of LV relaxation was found: the lower GFS, the longer IVRT and DT. Thus, in addition to age and structural changes in the heart, factors that have adverse effects on diastolic filling parameters are anemia, lowered renal function, and the level of systolic and diastolic pressure.     

Ambulatory blood pressure and left ventricular mass in older age

Background: The purpose of this study was to analyse the association of ambulatory blood pressure (ABP) to left ventricular mass (LVM) in a population aged over 64 years and to describe the level of ABP in subjects with and without left ventricular hypertrophy (LVH) in older age. Methods: ABP measurement and echocardiography for calculation of LVM were assessed in 490 inhabitants (mean age 70.7 years, range 64 - 87 years) of a small town in southwestern Finland who were able to visit an outpatient clinic. Explanatory factors associated with LVM were assessed with linear regression analysis. LVH was defined as calculated LVM-index values exceeding 150 g/m 2 in men and 120 g/m 2 in women adopted from the Framingham Study. Results: Systolic ABP was significantly associated with LVM. No correlation between diastolic ABP and LVM was found. Other factors independently related to LVM were gender, body mass index and age. The prevalence of echocardiographic LVH was 22%. Subjects with LVH had markedly higher systolic ABP levels than those without LVH (mean (SD) 24-h ABP: 132(16)/75(8) mmHg vs. 123(13)/75(8) mmHg). Conclusion: Systolic ABP is associated with LVM in older people. In addition, systolic ABP is superior to diastolic ABP in relation to LVM in the aged.     

Ambulatory blood pressure and left ventricular mass in older age

BACKGROUND: The purpose of this study was to analyse the association of ambulatory blood pressure (ABP) to left ventricular mass (LVM) in a population aged over 64 years and to describe the level of ABP in subjects with and without left ventricular hypertrophy (LVH) in older age. METHODS: ABP measurement and echocardiography for calculation of LVM were assessed in 490 inhabitants (mean age 70.7 years, range 64-87 years) of a small town in southwestern Finland who were able to visit an outpatient clinic. Explanatory factors associated with LVM were assessed with linear regression analysis. LVH was defined as calculated LVM-index values exceeding 150 g/m2 in men and 120 g/m2 in women adopted from the Framingham Study. RESULTS: Systolic ABP was significantly associated with LVM. No correlation between diastolic ABP and LVM was found. Other factors independently related to LVM were gender, body mass index and age. The prevalence of echocardiographic LVH was 22%. Subjects with LVH had markedly higher systolic ABP levels than those without LVH (mean (SD) 24-h ABP: 132(16)/75(8) mmHg vs. 123(13)/75(8) mmHg). CONCLUSION: Systolic ABP is associated with LVM in older people. In addition, systolic ABP is superior to diastolic ABP in relation to LVM in the aged.     

引入循证医学理念治疗老年心力衰竭患者的临床效果

目的分析老年慢性心力衰竭(CHF)患者的个性化治疗效果及其影响因素。方法选年龄在80岁以上的CHF患者86例,同时选65～79岁老年CHF患者作为对照。在对病因、诱因治疗的基础上,实践循证医学的标准治疗,分析个性化治疗效果及影响因素。结果高龄组和老年组治疗显效率分别为40.7%(35例)和65.9%(60例),差异有统计学意义(P=0.005)。两组总有效率分别为88.4%和95.6%,住院死亡率分别为5.8%和1.1%,差异无统计学意义;Logistic回归分析显示:老年CHF患者的疗效与年龄(P=0.047)、入院时心功能(P=0.000)、是否合并高血压(P=0.007)、心律失常(P=0.046)密切相关。结论年龄越大、入院时心功能越差,老年CHF的治疗效果就越差;老年CHF患者合并高血压、心律失常也是影响疗效的主要因素。     

Respective timing of maximal color Doppler jet areas and of peak velocity of jets in left-sided valvular lesions: clinical implications

Time intervals between the R wave of the electrocardiogram and maximal dimension of jet areas of color Doppler and the R wave of the electrocardiogram and peak velocity of valvular jets of continuous-wave Doppler were compared by use of paired and correlative studies for a group of 55 patients with a total of 71 left-sided lesions. Mean values of both time intervals, mean difference, and its standard error were equal to zero for stenoses. Time intervals of 71% for mitral stenosis and 52% for aortic stenosis did not differ by more than 0.01 second; correlation coefficients were 0.96 for mitral stenosis and 0.85 for aortic stenosis. For regurgitations, differences in mean values and a mean difference with a standard error were found but remained unsignificant. However, the percentage of differences in time intervals below or equal to 0.01 second decreased to 35 for aortic regurgitation and 13 for mitral regurgitation, which showed the widest 95% range of differences. Correlation coefficients were 0.84 for the aortic regurgitation and 0.33 for mitral regurgitation. Thus the close relationship of time intervals suggests that standardized timing of area measurements at peak velocity is feasible for stenoses and remains under consideration for aortic regurgitation. Timing of measurements should remain empiric for mitral regurgitation.     

Prevalence of cardiovascular disorders among the elderly in primary care in Estonia

OBJECTIVE: To assess the prevalence of diagnoses of cardiovascular disorders among the elderly in family practice. DESIGN: Cross-sectional study. SETTING: Estonia, population aged 65 years or older (206,915 persons). SUBJECTS: 811 elderly persons selected randomly from the lists of family practitioners. MAIN OUTCOME MEASURES: Prevalence of hypertension, hypotension, coronary heart disease (CHD), myocardial infarction (MI), heart failure (HF) and cardiac arrhythmias; differences between the genders and age groups. RESULTS: The prevalence of cardiovascular disorders was as follows: hypertension 63.2%, hypotension 11.1%, CHD 56.5%, MI 9.8%, HF 41.4% and arrhythmias 37.5%. Women had a significantly higher prevalence of hypertension and men of MI. The prevalence of CHD and hypotension was significantly higher in the oldest elderly persons. CONCLUSION: Among the older population in Estonia, cardiovascular disorders that have broader diagnostic criteria and need expensive methods for verifying (CHD, HF) have a high prevalence and are most likely over-diagnosed. The need for strict and simple diagnostic methods for these disorders in primary care practice continues to be serious.     

Effects of valve dysfunction on Doppler Tei index.

BACKGROUND: Recently proposed Doppler Tei index, defined as the sum of isovolumic contraction time or mitral valve closure to aortic valve opening time and isovolumic relaxation time or aortic valve closure to mitral valve opening time divided by ejection time, is a simple measure which enables noninvasive estimation of combined systolic and diastolic function and prediction of patients' prognosis. However, effects of valve dysfunction on Tei index have not been investigated. This study was designed to compare Tei index before and after surgical valve replacement or repair to evaluate effects of valve dysfunction on Tei index. METHODS: Participants consisted of 76 consecutive patients with aortic or mitral valve surgery (26 patients with aortic stenosis [AS], 16 with aortic regurgitation, 17 with mitral stenosis, and 17 with mitral regurgitation). Doppler Tei index was evaluated before and after the surgery by obtaining (a-b)/b, where a is the interval between the cessation and onset of Doppler mitral filling flow and b is the aortic flow ejection time. RESULTS: Tei index significantly increased after surgery in patients with AS (0.38 +/- 0.07 to 0.49 +/- 0.06, P <.001), aortic regurgitation (0.60 +/- 0.20 to 0.70 +/- 0.18, P <.01), mitral stenosis (0.34 +/- 0.03 to 0.39 +/- 0.04, P <.01), and decreased with no significance in mitral regurgitation (0.50 +/- 0.03 to 0.46 +/- 0.03). Percent change in Tei index after valve surgery was maximal in patients with AS (27 +/- 6 vs 17 +/- 2 vs 16 +/- 6 vs -9% +/- 6%, AS vs aortic regurgitation vs mitral stenosis vs mitral regurgitation, P <.001). CONCLUSION: Tei index significantly changes after valve surgery especially in patients with AS. Considerations for the effects of valve dysfunction on Tei index are required for its application to evaluate ventricular function in patients with valve disease.