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Cardiac Structure and Function and Dependency in the Oldest Old


Address correspondence to David Leibowitz, Coronary Care Unit, Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem 91240, Israel. E-mail:


OBJECTIVES: To examine the association between cardiac function and activities of daily living (ADLs) in an age-homogenous, community-dwelling population born in 1920 and 1921.

DESIGN: Cross-sectional analysis of a prospective cohort study.

SETTING: Community-dwelling elderly population.

PARTICIPANTS: Participants were recruited from the Jerusalem Longitudinal Cohort Study, which has followed an age-homogenous cohort of Jerusalem residents born in 1920 and 1921. Four hundred eighty-nine of the participants (228 male, 261 female) from the most recent set of data collection in 2005 and 2006 underwent echocardiography at their place of residence in addition to structured interviews and physical examination.

MEASUREMENTS: A home-based comprehensive assessment was performed to assess health and functional status, including performance of ADLs. Dependence was defined as needing assistance with one or more basic ADLs. Standard echocardiographic assessment of cardiac structure and function, including ejection fraction (EF) and diastolic function as assessed using early diastolic mitral annular tissue velocity measurements obtained using tissue Doppler, was performed.

RESULTS: Of the participants with limitation in at least one ADL, significantly more had low EF (<55%) than the group that was independent (52.6 % vs 39.1%; P=.01). In addition, participants with dependence in ADL had higher left ventricular mass index (LVMI) (129.3 vs 119.7 g/m2) and left atrial volume index (LAVI) (41.3 vs 36.7 mL/m2). There were no differences between the groups in percentage of participants with impaired diastolic function or average ratio of early diastolic transmitral flow velocity to early diastolic mitral annular tissue velocity (11.5 vs 11.8; P=.64).

CONCLUSION: In this age-homogenous cohort of the oldest old, high LVMI and LAVI and indices of systolic but not diastolic function as assessed according to Doppler were associated with limitations in ADLs.