American Journal of Geriatric Cardiology最新文献

Atherosclerotic disease represents an enormous burden in the elderly population, yet elderly patients are underrepresented in clinical trials and receive lower standard-of-care treatment compared with similar-risk younger individuals. Magnetic resonance imaging (MRI) is a powerful noninvasive imaging technique that can target atherosclerotic lesions and help better understand the pathophysiologic process of this disease in the elderly. Cholesterol-targeted interventions have improved the outcomes in patients with atherosclerotic disease, but clearly additional efforts are needed. Whether medical therapy can be effectively adjusted based on atherosclerosis progression revealed by MRI is still to be proven, but the technique certainly looks promising.

Coronary artery disease (CAD) is prevalent in the elderly, often leads to disability, and is the number one cause of death in this population. Older adults represent an increasingly important and challenging subset of the population with CAD. They are more likely to have comorbid conditions, atypical presentations, and unfavorable outcomes than their younger counterparts. The available data suggest that standard pharmacologic, thrombolytic, and definitive revascularization techniques have important roles in the treatment of geriatric patients but have been underutilized. Consequently, strategies for optimizing the prevention and treatment of CAD in the elderly are important from both the individual and societal perspectives. Coronary artery calcium has been shown to be highly specific for atherosclerosis, occurring only in the intima of the coronary arteries. There is evidence to show that elevated coronary calcium scores are predictive of future cardiovascular events, both independently of and incrementally to conventional cardiovascular risk factors. This article will review such a screening method, namely coronary calcium scanning, in the field of geriatric cardiology.

The emerging role novel echocardiographic techniques play in the practice of cardiology and how they can specifically impact care of the elderly patient are reviewed. Newer echocardiographic modalities including Doppler tissue and strain/strain rate imaging, contrast echocardiography, 3-dimensional echocardiography, and velocity vector imaging are described. Examples illustrating how these newer echocardiography modalities enhance our ability to make a variety of cardiovascular diagnoses are shown. The way in which these novel echocardiographic techniques allow for improved noninvasive estimation of left ventricular filling pressure, better diagnosis of cardiomyopathy and complications of acute myocardial infarction, better quantification of valvular heart disease, and enhance our understanding of myocardial contractile processes are reviewed. These newer echocardiographic modalities will continue to play an increasing role in the future as applications identifying ways in which they enhance cardiovascular diagnosis are discovered.

Recent technical advances have enabled the use of computed tomography (CT) to visualize the beating heart, including the coronary arteries. This ability to perform noninvasive coronary angiography and to precisely evaluate other cardiovascular structures using CT may be especially valuable in the geriatric population. CT angiography can be used not only to investigate chest pain syndromes in the elderly but also for preoperative evaluation before cardiac and noncardiac surgery to detect intracardiac thrombi and tumors and to evaluate valves, the myocardium, and other cardiovascular structures, including the aorta. The authors present examples of the application of CT angiography in various older adult patients with cardiovascular disease to highlight potential applications.

Stress single photon emission computed tomography (SPECT) and positron emission tomography (PET), the standard clinical methods for measuring myocardial perfusion, have been extensively validated for diagnostic and prognostic purposes in general populations. Published data in the elderly are limited. The available data suggest that in elderly patients, SPECT is as accurate for diagnostic purposes as in younger patients and that stress SPECT is considerably more accurate for prognostic purposes when compared with standard treadmill testing. Pharmacologic stress testing can be performed in conjunction with SPECT and PET, representing another advantage of these techniques because many elderly patients cannot exercise to a high enough workload to provoke ischemia during testing.

Management of coronary artery disease (CAD) is a large and growing challenge for today's burgeoning population of older adults, especially because age is a key risk factor for CAD and because morbidity/mortality from CAD increases with age. Whereas many people look to cardiovascular imaging to enhance CAD management, it often remains difficult to interpret the clinical implications of positive imaging studies. Functional assessment, heart rate and rhythm dynamics, and prognostic scoring tools all provide insights that complement the data provided by high-tech imaging options.