Author + information
- Received August 11, 2016
- Revision received October 20, 2016
- Accepted October 21, 2016
- Published online April 24, 2017.
- Emil Wolsk, MD, PhDa,∗ (, )
- Rine Bakkestrøm, MDb,
- Jacob H. Thomsen, MDa,
- Louise Balling, MDa,
- Mads J. Andersen, MD, PhDa,
- Jordi S. Dahl, MD, PhDb,
- Christian Hassager, MD, DMSca,
- Jakob E. Møller, MD, DMScb and
- Finn Gustafsson, MD, DMSca
- aDepartment of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- bDepartment of Cardiology, Odense University Hospital, Odense, Denmark
- ↵∗Address for correspondence:
Dr. Emil Wolsk, Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Objectives In this study, the authors sought to obtain hemodynamic estimates across a wide age span and in both sexes for future reference and compare these estimates with current guideline diagnostic hemodynamic thresholds for abnormal filling pressure and pulmonary hypertension.
Background At present, the influence of age on hemodynamic function is largely unknown. Because many diseases with proposed cardiac impact are more prevalent in the older population, it is pivotal to know how hemodynamic parameters are affected by age itself to discern the influence of disease from that of physiological aging.
Methods Sixty-two healthy participants, evenly distributed with respect to age (20 to 80 years) and sex (32 women/30 men), were prospectively enrolled in the study. Participants were all deemed healthy by medical history, echocardiography, exercise test, spirometry, blood tests, and electrocardiogram. Participants had hemodynamic parameters measured using right heart catheterization during rest, passive leg raise, and incremental exercise.
Results During rest, all hemodynamic parameters were similar between age groups, apart from blood pressure. During leg raise and incremental exercise, there was augmented filling pressure (p < 0.0001) and diminished cardiac output (p = 0.001) and hence a higher pressure:flow ratio (pulmonary artery pressure/capillary wedge pressure to cardiac output) with progressive age, evident from the earliest ages. All indexed hemodynamic measures were similar between sexes. The diagnostic threshold (pulmonary capillary wedge pressure ≥25 mm Hg) currently used during exercise testing to diagnose abnormal left ventricular filling pressure was measured in 30% of our healthy elderly participants.
Conclusions Cardiac aging was progressive without sex differences in healthy participants. The hemodynamic reference values obtained suggest that the diagnostic threshold for abnormal filling pressure should be individually determined according to age of the patient.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 11, 2016.
- Revision received October 20, 2016.
- Accepted October 21, 2016.
- 2017 American College of Cardiology Foundation