Effect of Age on the Response of the Left Ventricular Ejection Fraction to Exercise

To assess the effects of age on the left ventricular ejection fraction (LVEF), we performed radio nuclide angiocardiography at rest and during upright bicycle exercise in 77 healthy volunteers 20 to 95 years of age. Radionuclide measurements included left ventricular ejection fraction, end-diastolic volume, and regional wall motion. Age did not appear to influence any of these indexes at rest. However, during exercise the ejection fraction was less than 0.60 in 45 per cent of subjects over age 60 as compared with 2 per cent of younger subjects (P<0.0001). In addition, there was a decline in the change in LVEF (exercise LVEF minus rest LVEF) with increase in age (r = -0.71). Wall-motion abnormalities during exercise occurred with increasing frequency in patients who were 50 and older. In the older subjects these age-related changes in ejection fraction during exercise were not associated with differences in end-diastolic volume or blood pressure. (N Engl J Med. 1980; 303:1133–7.) THE influence of advancing age on the cardiovascular response to exercise has been the subject of considerable study for many years. As early as 1929, Master and Oppenheimer described an age-related decline in the foot-pounds of work performed in the two-step test.1 Subsequently, decreases in maximum heart rate, 2,3 maximum stroke volume and cardiac output, 4,5 and maximum oxygen uptake6 7 8 have been documented in longitudinal studies of aging and in studies comparing cardiovascular function of older healthy subjects with that of younger subjects. An age-related decline in the myocardial contractile response to exercise has been postulated as one possible cause of these.