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Majority of centenarians have abnormal ECG and half have aortic regurgitation

Too young to die?

Non-Invasive Imaging


Barcelona, Spain – Sunday 31 August 2014: The majority of centenarians have an abnormal electrocardiogram (ECG) and half have aortic regurgitation, according to results presented at ESC Congress today by Dr Manuel Martínez-Sellés from Madrid. The 4C prospective registry adds to knowledge about the aging process and highlights areas for treatment and prevention.
Dr Martínez-Sellés said:

“People aged 100 years and over provide valuable information on achieving longevity. The centenarian population has increased rapidly in recent years and it is more common to see centenarians in clinical practice. In 2011 there were 317 000 centenarians globally. This population is projected to grow to 3.2 million by 2050, reaching nearly 18 million by the end of the century.”


He added:

“Cardiovascular diseases are the leading cause of death in very old people, although they are frequently underreported. Data on cardiac anatomy, physiology and pathophysiology in centenarians are scarce. This is the largest multicentre study using standardised echocardiography in centenarians and the largest to define the rate of normal ECG in these subjects.”


The Cardiac and Clinical Characterisation of Centenarians (4C) study was a prospective registry that recruited 118 centenarians (28 men and 90 women) in 9 Spanish centres over a two-year period (April 2011 to March 2013). Mean age was 102 years. Each participant had an ECG, echocardiogram, blood tests and clinical examinations.
The researchers found that most centenarians had ECG alterations. A normal ECG was more frequent in women (31%) than men (9%). Abnormalities in echocardiography were almost universal. For example, one-fifth of participants had atrial fibrillation (the most frequent cardiac arrhythmia) and most had echocardiographic evidence of different heart dysfunctions. Aortic regurgitation was found in half of the centenarians and the more severe it was, the higher the mortality (see figure).
Dr Martínez-Sellés said:

“Our data suggest an age-related effect on the heart that influences functional status and prognosis. This effect should be taken into account when developing strategies to prevent or mitigate the changes that occur with age.”


The clinical examinations revealed a high prevalence of dependency, malnutrition, and cognitive impairment. Some 30% of participants were malnourished and 28% had dementia. However, nearly half of the centenarians considered their health status to be very good, with 45% scoring 8 or more out of 10 on a health rating scale of 1 (worst) to 10 (best).
Dr Martínez-Sellés said:

“The high scores on health status are probably, at least in part, because of the participants’ relatively low comorbidity with 72% achieving a Charlson comorbidity index less than 3 (1). It is also remarkable that more than two-thirds of centenarians had followed healthy lifestyles, doing exercise before and after 65 years of age and not consuming tobacco or alcohol.”


He added:

“Data on cardiac anatomy, physiology and pathophysiology in patients aged 100 years or more are lacking because of the relative scarcity of such individuals and because they are often poorly studied.
Conditions such as myocardial infarction or atrial fibrillation may cause only subtle symptoms in this age group and often go unrecognised.”


Dr Martínez-Sellés concluded:

“The 4C study shows that aging is associated with extensive changes in cardiovascular structure and function that may result in detectable electrocardiographic and echocardiographic findings. Our results add to our knowledge of cardiac anatomy and function in centenarians and help us to better understand the process of aging and exceptional longevity. They also point to areas that can be targeted for prevention and treatment to improve the health of older people.”

Notes to editor

About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
About ESC Congress 2014
The ESC Congress is currently the world's largest international congress in cardiovascular medicine.  The spotlight of this year's event is “innovation and the heart”.  ESC Congress 2014 takes place from 30 August to 3 September at the Fira Gran Via in Barcelona, Spain. For more information on ESC Congress 2014 contact the ESC Press Office.
To access all the scientific resources from the sessions during the congress, visit ESC Congress 365
This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2014. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.