Potential role of conventional and speckle-tracking echocardiography in the screening of structural and functional cardiac abnormalities in elderly individuals
Flemming Javier Olsen, SørenZögaDiederichsen, Peter GodskJørgensen, Magnus T. Jensen, Anders Dahl, Nino Emmanuel Landler, Claus Graff, Axel Brandes, Derk Krieger, KetilHaugan, Lars Køber, SørenHøjberg, JesperHastrupSvendsen , Tor Biering-Sørensen
The global population is experiencing a significant increase in the number of elderly individuals, leading to a rise in cardiovascular disease burden. Transthoracic echocardiography, including conventional and speckle-tracking techniques, has the potential to aid in risk stratification for cardiac abnormalities in this population. This study aimed to evaluate the usefulness of conventional and speckle-tracking echocardiography for screening cardiac abnormalities in the elderly.
The aging population presents a challenge for healthcare systems worldwide, with cardiovascular diseases contributing substantially to the burden of age-related chronic conditions. Atrial fibrillation (AF), a common cause of stroke, is of particular interest due to its increased prevalence with age. The LOOP study aimed to assess the effectiveness of continuous rhythm monitoring for subclinical AF and subsequent anticoagulation. This echocardiographic substudy within the LOOP study aimed to characterize the cardiac phenotype of high-risk elderly participants and identify structural and functional cardiac abnormalities associated with AF and stroke.
Participants: This echocardiographic substudy was part of the LOOP study, a multicenter, randomized controlled trial. Participants aged 70 years or older with cardiovascular risk factors were recruited. Exclusion criteria included a history of AF or implanted cardiac electronic devices. The study enrolled participants from four centers in Denmark between May 2014 and November 2017.
A total of 1,441 participants were included in the substudy, with clinical characteristics summarized in Table 1. The participants had a mean age of 74±4 years, and the majority had hypertension (91%) and diabetes mellitus (29%). The main echocardiographic findings are presented in Figure 1.
This report provides a comprehensive characterization of the echocardiographic phenotype of elderly individuals at high risk of stroke and AF. While clinically relevant structural heart disease and reduced left ventricular ejection fraction were observed in a minority of participants, advanced echocardiographic techniques detected systolic dysfunction more frequently than conventional measures. Abnormal left atrial (LA) size and function were not frequently observed together, suggesting that assessing both parameters could enhance the evaluation of the LA.
Cardiac abnormalities, including valvular calcification, left ventricular geometrical changes, and aortic regurgitation, are frequently observed in high-risk elderly participants. Left ventricular systolic dysfunction is more accurately detected using advanced echocardiographic techniques. LA remodeling is also prevalent. These findings emphasize the need for comprehensive evaluation, including LA assessment, in high-risk elderly individuals. Future studies should investigate the relationship between these findings and incident subclinical AF, AF burden, and cardiovascular outcomes.
The authors would like to acknowledge associate professor Christian Kronborg from the Department of Business and Economics, University of Southern Denmark, for his contributions to the LOOP study as a steering committee member.
Citation: Olsen FJ, Diederichsen SZ, Jørgensen PG, Jensen MT, Dahl A, Landler NE, et al. (2022) Potential role of conventional and speckle-tracking echocardiography in the screening of structural and functional cardiac abnormalities in elderly individuals: Baseline echocardiographic findings from the LOOP study. PLoS ONE 17(6): e0269475. https://doi.org/10.1371/journal.pone.0269475
Editor: Daniel A. Morris, CharitéUniversitätsmedizin Berlin - Campus Virchow-Klinikum: ChariteUniversitatsmedizin Berlin - Campus Virchow-Klinikum, GERMANY
Received: October 7, 2021; Accepted: May 22, 2022; Published: June 3, 2022
Copyright: © 2022 Olsen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The data underlying this work cannot be publicly shared for ethical and legal reasons. Danish legislation does not allow for the sharing of data, including de-identified data that may include potentially identifying details. Access to data may be granted by the Danish Data Protection Agency (Videnscenter for Dataanmeldelser: firstname.lastname@example.org).
Funding: The LOOP study received funding from the Innovation Fund Denmark (Innovationsfonden), the Research Foundation for the Capital Region of Denmark (Region Hovedstaden), the Danish Heart Foundation (Hjerteforeningen), Aalborg University Talent Management Programme, and the Arvid Nilsson Foundation and Medtronic. Dr. Olsen received funding from the Copenhagen University Hospital - Herlev and Gentofte, Kong Christian den Tiendes Fond, FruAsta Florida Bolding Mindelegat, and the Danish Heart Foundation (Hjerteforeningen) (Grant no.: 18-R125-A8534-22083). Dr.Biering-Sørensen received funding from the Copenhagen University Hospital - Herlev and Gentofte, Fondsbørsvekselerer Henry Hansen ogHustrusHovedlegat, the Lundbeck foundation (Lundbeckfonden), and the Novo Nordisk Foundation (Novo Nordisk fonden). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: Dr.Jørgensen: Speaker Honoraria from Novo Nordisk and Astra Zeneca. Dr.Køber: Speaker honoraria from Novo, Novartis, AstraZeneca and Boehringer. Dr.Diederichsen: Advisor for Vital Beats. Dr.Haugan: travel and educational grants from Medtronic, Abbott, and BIOTRONIK. Speaker honoraria from Boehringer-Ingelheim not related to this work. Dr.Brandes: Research grant from the Region of Southern Denmark, the Region of Zealand, Canadian Institutes of Health Research, and Theravance. Speaker honoraria from Bayer, BoehringerIngelheim, and Bristol-Myers Squibb. Travel grant from Biotronik. Dr.Biering-Sørensen: Steering Committee member of the Amgen financed GALACTIC-HF trial and Steering Committee of the Boston Scientific financed LUX-Dx TRENDS trial. Advisory Board for Sanofi Pasteur and Amgen. Speaker Honoraria from Novartis and Sanofi Pasteur. Research grants from GE Healthcare and Sanofi Pasteur. This does not alter our adherence to PLOS ONE policies on sharing data and materials.