The ageing heart

The ageing heart is faced with age-related structural alterations of the coronary circulation, myocardium, valves, conductive system, and aorta, as well as the cumulative exposure to various cardiovascular risk factors over a lifetime. Coronary ageing in terms of atherosclerosis and coronary calcifications and the resulting ischaemic heart disease, imply specific diagnostic and therapeutic challenges in the elderly. In addition to a higher risk of ischaemic damage, the myocardial ageing per se is associated with left ventricular hypertrophy and increased stiffening, resulting in typical diastolic filling patterns with ageing. The myocardium may be further affected by the consequences of valvular ageing and an increased prevalence of either stenotic or regurgitant valvular heart disease. The conductance system also experiences age-related changes resulting in conduction abnormalities and arrhythmias. It should be emphasized that age-dependent arterial stiffening and hypertension may account for a heart–vessel coupling to further deteriorate the ageing heart. Ultimately all those factors participate in an age-related increased risk of cardiovascular events and heart failure. Finally, it is important to also consider extra-cardiac co-morbidities, frailty, and the cognitive and functional status of the older patient when evaluating the ageing heart.