An echocardiographic assessment of asymptomatic elderly women with radiological cardiac enlargement

Abstract

To determine the significance of increased cardiothoracic ratio in elderly women without hypertension, symptoms or signs of cardiac disease, echocardiographic measurements from 22 elderly women (mean age 75.1 ± 3.9 years) with increased cardiothoracic ratio (mean ratio 0.59 ± 0.04), were compared with those from 21 women (mean age 75.3 ± 5.6 years) with normal cardiothoracic ratio using M-mode, cross-sectional and Doppler echocardiography. Subjects with increased cardiothoracic ratio had greater left ventricular end diastolic dimension and volume, and greater right ventricular diastolic dimension ( P < 0.05). There was no difference in all other cardiac dimensions, nor in the ejection fraction and fractional shortening. Thirty-three to sixty-four percent of subjects in both groups had increased thickness of the septum and left ventricular posterior wall. Regurgitation at one or more valves on Doppler examination occurred in 91% of subjects with abnormal and 86% of subjects with normal cardiothoracic ratio. Compared to a group of 43 healthy young female subjects (mean age 27.9 ± 6.3 years), elderly subjects had thicker interventricular septum and left ventricular posterior wall, increased left atrial and aortic root size, greater mitral valve A:E ratio, and higher frequency of valvular regurgitation detected by Doppler. The ejection fractions in elderly and young subjects, however, were similar. It is concluded that, in the majority of cases, increased cardiothoracic ratio in asymptomatic normotensive elderly women with normal physical examination and electrocardiogram is unlikely to represent cardiac pathology. Age-related differences in echocardiographic measurements observed in this study are in agreement with other studies, and emphasizes the importance of using age-related reference ranges in assessing cardiac dimension and function in the elderly.