Decline in Effort Capacity with Age: Echocardiographic Stress Analysis in the Elderly

Background Aging is associated with a decline in effort capacity. It is unclear whether this decline is related to systolic or diastolic dysfunction with associated reduced cardiac output (CO) or to regression of peripheral muscles associated with diminished arteriovenous difference (A-V diff).

Methods This is a retrospective analysis of 574 consecutive patients >65 years old with an ejection fraction ≥60% and no ischemia who underwent stress echo between 1/2012-12/2015. The patients were divided into three age groups (60`s, 70`s, and >80`s), and their echo characteristics at rest and peak exercise (diastolic parameters, stroke volume, CO, calculated peak VO₂ and calculated A-V diff) were compared.

Results Diastolic function at rest declined significantly: the E/E` was 8.9, 9.5, and 11.1 for age groups 60`s, 70`s, and >80`s, respectively (P80’s group was entirely due to reduction in A-V diff (P<0.05).

Conclusion The cardiovascular system undergoes several age-related changes. The decline in effort capacity with age is due to attenuated SV and HR responses between the 60-70 decades of life, and caused mostly by the decline in the ability of the muscles to extract enough oxygen for the necessary effort in the oldest patients.