Left Ventricular Systolic Function in a Population Sample of Elderly Men.

Abstract

BACKGROUND: The present study was designed to evaluate the usefulness and discriminatory power of different echocardiographic indices of left ventricular (LV) systolic function in a healthy screening sample of 584 men who were 70 years old. METHODS: Ejection fraction (EF), fractional shortening (FS), stroke index (SI), left ventricular diameter in systole (LVESD), and cardiac index (CI) were evaluated, in addition to LV wall motion score and atrioventricular plane displacement (AVPD). RESULTS: Subjects with hypertension or coronary heart disease (CHD), but not those with diabetes mellitus, showed impairments in EF, FS, LVESD, AVPD, and LV wall motion scores compared with the healthy subjects in the sample (P < 0.01-0.001). SI and CI findings in those with hypertension or CHD were, however, no different from those in the healthy group. The index of LV systolic function that discriminated best between diseased and healthy subjects was LV wall motion score, being correlated with EF, LVESD, and AVPD but only poorly with SI and CI. SI evaluated with use of the Teichholz formula was correlated to LV end-diastolic diameter (r = 0.72, P < 0.0001), whereas the corresponding correlation between SI measured with Doppler (aortic flow) and LVEDD was weak. The difference between the Teichholz and Doppler evaluations of SI was dependent on LV end-diastolic diameter (r = 0.51, P < 0.001) but not on LV systolic function. An index, the systolic two-dimensional index, which takes into account both the longitudinal motion (AVPD) and movement along the short axis (LVESD) during systole, was suggested by the formula AVPD + 5/LVESD. CONCLUSIONS: Impaired LV systolic function was found in both elderly men with hypertension and those with CHD. SI was normal in these groups, however, although overestimated when measured with the Teichholz formula in this population with a large proportion of subjects with LV dilatation. AVPD appears to be applicable in the present population, and a new systolic index consisting of LVESD and AVPD is suggested for the evaluation of LV systolic function in two dimensions.