Robert N. Butler

Atrial kinetics and left ventricular diastolic filling in the healthy elderly

A delay of left ventricular isovolumic relaxation and decrease in myocardial compliance may result in a decline of measured early filling rates in elderly subjects. Previous studies of diastolic function, however, have not excluded coronary artery disease or addressed the contribution of atrial contraction to diastole. The present study evaluated radionuclide-derived diastolic variables in 13 healthy elderly volunteers aged 75 +/- 6 years without symptoms or risk factors for coronary disease who had normal findings on the stress electrocardiogram, stress gated blood pool imaging and two-dimensional echocardiogram. Results were compared with those of a group of 10 healthy young volunteers aged 26 +/- 5 years. High count, 32 frame, double-buffered gated blood pool acquisitions were obtained at rest in the left anterior oblique view with an RR interval variation less than 5%. Left ventricular time-activity curves were analyzed and flow-volume loops for each group were constructed. In the healthy elderly: peak early diastolic filling rate is decreased, time of peak early filling and time to first third of diastolic filling are delayed, and peak late left ventricular filling rate and percent of atrial filling volume are augmented, suggesting an adaptive response of the atria to diminished left ventricular compliance.

The Aging Populace

As a result c^ the 1936 passage of Sodal Security and the 1965 passage of Medicare, there have been considerable improvements in the lot of the elderly, a population conventionally defined as those 65 or older. A1988 census report indicated that if the elderly did not receive government transfer payments (primarily Social Security benefits), the 1986 poverty rate for the elderly would have been 485 percent instead of 12.4 percent1 Medicare, the nations health insurance entitlement for the elderly, also provides economic security because it protects the elderly against expensive short-term hospitalization and physicians costs. However, the agenda for the economic and health security of older Americans remains incomplete. Medicare was not designed to handle chronic incapacity and the requisite need for long-term careA3 Social Security and Medicare do not even meet basic needs for substantial numbers of people. All Americans, young and old, are confronted with our failure to adopt an effective long-term care policy that provides home, community, and institutional services.