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Degenerative, non-atherosclerotic cardiovascular disease in the elderly: A clinico-pathological survey

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Abstract

Cardiovascular disease, the major cause of death in the elderly, is mostly ascribable to complications of coronary atherosclerosis: angina pectoris, myocardial infarction, and sudden death. However, other degenerative diseases involving several cardiac structures exist, and should be distinguished from age-related cardiac changes. Extensive dystrophic calcification determines aortic stenosis, and may affect either a normally tricuspid or a congenitally bicuspid valve. Surgical valve replacement is now a low risk option, even in elderly persons, whereas the efficacy of balloon valvuloplasty is questionable. Aortic incompetence in adults and aged persons is mostly the consequence of aortic tunica media atrophy with anular ectasia, in the setting of nearly normal aortic leaflets. Mitral valve prolapse is the main cause of mitral incompetence; spontaneous cordal rupture is a late complication in the natural history of this disease, thus warranting prompt surgical valve repair or replacement. The entire spectrum of cardiomyopathies is observed in the elderly: dilated, hypertrophie, restrictive, arrhythmogenic. Cardiac amyloidosis is by far the most frequent secondary form and leads to congestive heart failure by impairing ventricular compliance. Idiopathic fibrosis of the specialized AV junction or dystrophic calcification of central fibrous body are the usual substrates of AV block, which requires pace-maker implantation. Nonrheumatic atrial fibrillation, due to fibro-fatty degeneration of the atrial musculature or dilated left atrium, carries a high risk of thromboembolic complications and cerebral accidents; oral anticoagulants have proven to be effective in preventing stroke. Aortic dissecting aneurysm is a spontaneous laceration, and usually a complication of longstanding systemic hypertension; exceptionally, spontaneous dissection may primarily occur in the coronary arteries. In conclusion, longevity at present is mostly threatened by cardiovascular disease, among which the role of degenerative, non-atherosclerotic disorders may be greater than thought. (Aging 2: 231-244, 1990)

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References

  1. Wenger N.K., Furberg CD., Pitt E.: Coronary heart disease in the elderly. Elsevier Science Publishing Company, New York, 1986.

    Google Scholar 

  2. Kennedy R.D., Andrews G.R., Caird F.I.: Ischemic heart disease in the elderly: economic considerations. Br. Heart J. 39: 1121–1127,1977.

    Article  PubMed  CAS  Google Scholar 

  3. Waller B.F., Roberts W.C.: Cardiovascular disease in the very elderly: analysis of 40 necropsy patients aged 90 years or over. Am. J. Cardiol. 51: 403–422,1983.

    Article  PubMed  CAS  Google Scholar 

  4. Linzback A.J., Akuamoa-Boateng E.: The alterations of the aging human heart. I. Heart weight with progressing age. Klin. Wochenschr. 51:156–159,1973.

    Article  Google Scholar 

  5. Hutchins G.M.: Structure of the aging heart. In: Weisfeldt M.L. (Ed.), The aging heart. Raven Press, New York, 1980, Vol. 2, pp. 7–23.

    Google Scholar 

  6. Hansford R.G.: Metabolism and energy production. In: Weisfeldt M.L. (Ed.), The aging heart. Raven Press, New York, 1980, Vol. 2, pp. 25–76.

    Google Scholar 

  7. Lakatta E.G.: Alterations in the cardiovascular system that occur in advanced age. Fed. Proc. 38: 163–167, 1979.

    PubMed  CAS  Google Scholar 

  8. Brandfonbrener M., Landowne M., Shock N.W.: Changes in cardiac output with age. Circulation 12: 557–577,1955.

    Article  PubMed  CAS  Google Scholar 

  9. Grossman W.: Diastolic dysfunction and congestive heart failure. Circulation 81 (Suppl.): 1–7,1990.

    Article  Google Scholar 

  10. Covell J.W.: Factors influencing diastolic function. Possible role of the extracellular matrix. Circulation 81 (Suppl.): 155–158,1990.

    Google Scholar 

  11. Pomerance A.: Pathology of the heart with and without cardiac failure in the aged. Br. Heart J. 27:697–709, 1965.

    Article  PubMed  CAS  Google Scholar 

  12. Waller B.F., Morgan R.: The very elderly heart. Cardiouasc. Clin. 18: 361–410,1987.

    Google Scholar 

  13. Waller B.F.: Hearts of the “oldest old”. Mayo Clin. Proc. 63: 625–627,1988.

    Article  PubMed  CAS  Google Scholar 

  14. Pomerance A.: Cardiac pathology and systolic murmurs in the elderly. Br. Heart J. 30: 687–689,1968.

    Article  PubMed  CAS  Google Scholar 

  15. Pomerance A.: The pathology of senile cardiac amyloidosis. J. Pathol. Bacteriol. 91: 357–367,1966.

    Article  PubMed  CAS  Google Scholar 

  16. Edwards J.E.: Pathology of the aging heart. In: Libow L.S. (Ed.), Cardiovascular aspects of geriatric medicine. Nutley, New Jersey, Hoffman-LaRoche, 1981, vol. 2.

    Google Scholar 

  17. Morley J.E., Reese S.S.: Clinical implications of the aging heart. Am. J. Med. 86: 77–86,1989.

    Article  PubMed  CAS  Google Scholar 

  18. Sobel H.: Aging and age-associated disease (letter to the editor). Lancet II: 1191–1192,1970.

    Article  Google Scholar 

  19. Rose A.G.: Etiology of acquired valvular heart disease in adults. A survey of 18,132 autopsies and 100 consecutive valve replacement operations. Arch. Pathol. Lab. Med. 110: 385–388,1986.

    PubMed  CAS  Google Scholar 

  20. Turri M, Thiene G., Bortolotti U., Mazzucco A., Gallucci V.: Surgical pathology of disease of the mitral valve, with special reference to lesions promoting valvar incompetence. Int. J. Cardiol 22: 213–219,1989.

    Article  PubMed  CAS  Google Scholar 

  21. Passik C.S., Ackermann D.M., Pluth. J.R., Edwards W.D.: Temporal changes in the causes of aortic stenosis: a surgical pathologic study of 646 cases. Mayo Clin. Proc. 62: 119–123,1987.

    Article  PubMed  CAS  Google Scholar 

  22. Davies M.J.: Pathology of cardiac valves. Butterworth, London-Boston, 1980.

    Google Scholar 

  23. Waller B.F., Morrow A.G., Maron B.J., Del Negro A.A., Kent K.M., McGrath F.J., Wallace R.B., Mclntosh C.L., Roberts W.C.: Etiology of clinically isolated, severe, chronic, pure mitral regurgitation: analysis of 97 patients over 30 years of age having mitral valve replacement. Am. Heart J. 104: 276–288,1982.

    Article  PubMed  CAS  Google Scholar 

  24. Hickey A.J., Wilcker D.E.L.: Age and the clinical profile of idiopathic mitral valve prolapse. Br. Heart J. 55: 582–586,1986.

    Article  PubMed  CAS  Google Scholar 

  25. Devereux R.B., Hawkins I., Kramer-Fox R., Lutas E.M., Hammond I.W., Spitzer M.C., Hochreiter C, Roberts R.B., Belkin R.N., Kligfield P., Brown W.T., Niles N., Alderman M.H., Borer J.S., Laragh J.H.: Complications of mitral valve prolapse: disproportionate occurrence in men and older patients. Am. J. Med. 81: 751–758,1986.

    Article  PubMed  CAS  Google Scholar 

  26. Tresch D.D., Siegel R., Keelan M.H., Gross CM., Brooks H.L.: Mitral valve prolapse in the elderly. J. Am. Geriatr. Soc. 27: 421–424, 1979.

    PubMed  CAS  Google Scholar 

  27. Giampalmo A., Buffa D., Caponnetto S., Chiarella F., Pesce C, Sacchetti R.: Myxoid degeneration with prolapse and dystrophic calcification of the annulus fibrous of the mitral valve. Pathological and clinical survey. Appl Pathol 1: 194–208, 1983.

    CAS  Google Scholar 

  28. Simon M.A., Liu S.F.: Calcification of mitral annulus and its relationship to functional valvular disturbance. Am. Heart J. 48: 497–501,1954.

    Article  PubMed  CAS  Google Scholar 

  29. Kirk R.S., Russell J.G.B.: Subvalvular calcification of mitral valve. Br. Heart J. 31: 684–689, 1969.

    Article  PubMed  CAS  Google Scholar 

  30. Roberts W.C.: The senile cardiac calcification syndrome. Am. J. Cardiol. 58: 572–574, 1986.

    Article  PubMed  CAS  Google Scholar 

  31. Lie J.T., Hammond P.I.: Pathology of the senescent heart: anatomic observations on 237 autopsy studies of patients 90 to 105 years old. Mayo Clin. Proc. 63: 552–564,1988.

    Article  PubMed  CAS  Google Scholar 

  32. Turri M., Thiene G., Bortolotti U, Milano A., Mazzucco A., Gallucci V.: Surgical pathology of aortic valve disease: a study based on 602 specimens. Eur. J. Cardio-thorac. Surg. (in press).

  33. Pomerance A.: Pathogenesis of aortic stenosis and relationship to age. Br. Heart J. 29: 222–231,1967.

    Article  PubMed  CAS  Google Scholar 

  34. Cheitlin M.D.: Severe aortic stenosis in the sick octogenarian. A clear indicator for balloon valvuloplasty as the initial procedure. Circulation 80:1906–1908,1989.

    Article  PubMed  CAS  Google Scholar 

  35. Vollebergh F.E.M.G., Becker A.E.: Minor congenital variations of cusp size in aortic valves, possible link with isolated aortic stenosis. Br. Heart J. 39: 1006–1011, 1977.

    Article  PubMed  CAS  Google Scholar 

  36. Roberts W.C.: The congenitally bicuspid aortic valve. A study of 85 autopsy cases. Am. J. Cardiol. 26:72–83, 1970.

    Article  PubMed  CAS  Google Scholar 

  37. Roberts W.C.: Living with a congenitally bicuspid aortic valve. Am. J. Cardiol. 64: 1408–1409,1989.

    Article  PubMed  CAS  Google Scholar 

  38. Fenoglio J.J., McAllister H.A., DeCastro CM., Davia J.E., Cheitlin M.D.: Congenital bicuspid aortic valve after age 20. Am. J. Cardiol 39: 164–169,1977.

    Article  PubMed  Google Scholar 

  39. Brandenburg R.O., Tajik A.J., Edwards W.D., Reeder G.S., Shub C, Seward J.B.: Accuracy of 2-dimensional echocardiographic diagnosis of congenitally bicuspid aortic valve: echocardiographic-anatomic correlation in 115 patients. Am. J. Cardiol. 51:1469–1473, 1983.

    Article  PubMed  Google Scholar 

  40. Levinson J.R, Akins C.W., Buckley M.J., Newell J.B., Palacios I.F., Block P.C., Fifer M.A.: Octogenarians with aortic stenosis. Outcome after aortic valve replacement. Circulation 80: 149–156,1989.

    Google Scholar 

  41. Guiney T.E., Davies M.J., Parker D.J., Leech G.J., Leatham A.: The etiology and course of isolated severe aortic regurgitation: a clinical, pathological, and echocardiographic study. Br. Heart J. 58: 358–368, 1987.

    Article  PubMed  CAS  Google Scholar 

  42. Olson L.J., Subramanian R., Edwards W.D.: Surgical pathology of pure aortic insufficiency: a study of 225 cases. Mayo Clin. Proc. 59: 835–841,1984.

    Article  PubMed  CAS  Google Scholar 

  43. Roberts W.C, Ferrans V.J.: Pathologic anatomy of the cardiomyopathies. Hum. Pathol 66: 287–342, 1975.

    Article  Google Scholar 

  44. Thiene G., Calabrese F., Faggian G., Carraro R., Bortolotti U., Livi U., Mazzucco A., Valente M., Gallucci V.: Native heart pathology in cardiac transplantation. In: Gallucci V., Bortolotti U., Faggian G., Mazzucco A. (Eds.), Heart and heart lung transplantation update. Uses, Firenze, 1988, pp. 133–154.

    Google Scholar 

  45. Varani E., Magelli C, Bassein L., Truncellito L., Ribani M.A., Rubino I., Fini M., Ferretti R.M., Magnani B.: Caratteristiche cliniche e fattori prognostici dello scompenso cardiaco cronico secondario a miocardiopatia dilatativa primitiva e a cardiopatia ischemica. G. Ital. Cardiol. 19: 1–6,1989.

    PubMed  CAS  Google Scholar 

  46. Lever H.M., Karam R.F., Currie P.J., Healy B.P.: Hypertrophic cardiomyopathy in the elderly. Distinctions from the young based on cardiac shape. Circulation 79: 580–589, 1989.

    CAS  Google Scholar 

  47. Goor D., Lillehei C.W., Edwards J.E.: The “sigmoid septum”: variation in the contour of the left ventricular outlet. Am. J. Roentgenol. 107: 366–376, 1969.

    Article  CAS  Google Scholar 

  48. Ferrans V.J., Morrow A.G., Roberts W.C: Myocardial ultrastructure in idiopathic hypertrophic subaortic stenosis: a study of operatively excised left ventricular outflow tract muscle in 14 patients. Circulation 45: 769–792,1972.

    Article  PubMed  CAS  Google Scholar 

  49. Roberts W.C: Congenital cardiovascular abnormalities usually “silent” until adulthood. In: Roberts W.C. (Ed.), Congenital heart diseases in adults. F.A. Davis Company, Philadelphia, 1979, pp. 407–453.

    Google Scholar 

  50. McKenna W., Deanfield J., Faruqui A., England D., Oakley C, Goodwin J.: Prognosis in hypertrophic cardiomyopathy: role of age in clinical, electrocardiographic and hemodynamic features. Am. J. Cardiol. 47: 532–538,1981.

    Article  PubMed  CAS  Google Scholar 

  51. Thiene G., Valente M, Angelini A., Boffa G.M., Razzolini R., Livi U., Faggian G., Gallucci V.: Primary restrictive cardiomyopathy: the paradox of a small heart requiring transplantation. Eur. Heart J. 10:251,1989, (Abstract).

    Google Scholar 

  52. Boffa G.M., Chioin R., Pellegrino P.A., Scognamiglio R., Fasoli G., Razzolini R., Milanesi O., Thiene G.: Cardiomiopatia restrittiva primaria. Rev. Lat. Cardiol. 4: 263–275,1983.

    Google Scholar 

  53. Lie J.T.: Pathology of amyloidosis and amyloid heart disease. Appl. Pathol. 2: 341–356, 1984.

    PubMed  CAS  Google Scholar 

  54. Smith T.J., Kyle R.A., Lie J.T.: Clinical significance of histopathologic patterns of cardiac amyloidosis. Mayo Clin. Proc. 59: 547–555,1984.

    Article  PubMed  CAS  Google Scholar 

  55. Arbustini E., Dander B., Buonanno C, Zardini P., Thiene G.: Diagnosis of cardiac amyloidosis made by ultrastructural examination of endomyocardial biopsy. G. Ital. Cardiol. 14: 512–516, 1984.

    PubMed  CAS  Google Scholar 

  56. Nava A., Thiene G., Canciani B., Scognamiglio R., Daliento L., Buja G.F., Martini B., Stritoni P., Fasoli G.: Familial occurrence of right ventricular dysplasia: a study involving nine families. JACC 12: 1222–1228, 1988.

    Article  PubMed  CAS  Google Scholar 

  57. Thiene G., Nava A., Corrado D., Rossi L., Pennelli N.: Right ventricular cardiomyopathy and sudden death in young people. N. Engl. J. Med. 318: 129–133, 1988.

    Article  PubMed  CAS  Google Scholar 

  58. Fisch C: Electrocardiogram in the aged: an independent marker of heart disease? Am. J. Med. 70:4–6,1981.

    Article  PubMed  CAS  Google Scholar 

  59. Stason W.B., Sanders C.A., Smith H.C.: Cardiovascular care of the elderly: economic considerations. J. Am. Coll. Cardiol. 10: 18A–21A, 1987.

    Article  PubMed  CAS  Google Scholar 

  60. Petersen P.: Thromboembolic complications of atrial fibrillation and their prevention: a review. Am. J. Cardiol. 65: 24C–28C, 1990.

    Article  PubMed  CAS  Google Scholar 

  61. Stroke Prevention in Atrial Fibrillation Study Group Investigators. Preliminary report of the Stroke Prevention in Atrial Fibrillation Study. N. Engl. J. Med. 322: 863–868, 1990.

    Google Scholar 

  62. Wolf P.A., Abbot R.D., Kannel W.B.: Atrial fibrillation: a major contribution to stroke in the elderly. Arch. Intern. Med. 147: 1561–1564,1987.

    Article  PubMed  CAS  Google Scholar 

  63. Petersen P., Boysen G., Godtfredsen J., Andersen E.D., Andersen B.: Placebocontrolled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFA-SAK Study. Lancet 1:175–179, 1989.

    Article  PubMed  CAS  Google Scholar 

  64. De Bakey M.E., Henly W.S., Cooley D.A., Morris G.C., Crawford S.E., Beall A.C.: Surgical management of dissecting aneurysms of the aorta. J. Thorac. Cardiovasc. Surg. 49: 130–149, 1965.

    Google Scholar 

  65. Hirst A.E., Gore I.: Is cystic medionecrosis the cause of dissecting aortic aneurysm? Circulation 53:915–916, 1976.

    Article  PubMed  CAS  Google Scholar 

  66. Carlson R.G., Lillehei C.W., Edwards J.E.: Cystic medial necrosis of the ascending aorta in relation to age and hypertension. Am. J. Cardiol. 25: 411–415, 1970.

    Article  PubMed  CAS  Google Scholar 

  67. Schalatmann T.J.M., Becker A.E.: Pathogenesis of dissecting aneurysm of aorta. Comparative histopathologic study of significance of medial changes. Am. J. Cardiol. 39: 21–26,1977.

    Article  Google Scholar 

  68. Anagnostopoulos C.E., Prabhakar M.J.S., Kittle C.F.: Aortic dissections and dissecting aneurysm. Am. J. Cardiol. 30: 263–273,1972.

    Article  PubMed  CAS  Google Scholar 

  69. Thiene G., Rossi L., Becker A.E.: The atrioventricular conduction system in dissecting aneurysm of the aorta. Am. Heart J. 98: 447–452,1979.

    Article  PubMed  CAS  Google Scholar 

  70. Cocco P., Thiene G., Corrado D., Lodovichetti C, Pennelli N.: Ematoma (aneurisma) dissecante spontaneo delle coronarie: un’altra causa di occlusione coronarica e morte improvvisa. G. Ital. Cardiol. (in press).

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  1. Institute of Pathological Anatomy, University of Padova Medical School, Padova, Italy

    Gaetano Thiene (M.D.) & M. Valente

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  1. Gaetano Thiene
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Thiene, G., Valente, M. Degenerative, non-atherosclerotic cardiovascular disease in the elderly: A clinico-pathological survey. Aging Clin Exp Res 2, 231–244 (1990). https://doi.org/10.1007/BF03323924

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