Strain and Myocardial Work Analysis in Nonagenarian Women Without Significative Structural Damage

Background/Objectives: Cardiac mechanics in nonagenarian women remain poorly characterized. This study assessed cardiac structure, diastolic function, and mechanics in women aged ≥90 years with preserved left ventricular ejection fraction (LVEF). Methods: This retrospective observational study evaluated the echocardiograms of 69 nonagenarian women patients, obtained between November 2021 and August 2026. Of 69 patients, 21 women in sinus rhythm, without significant structural damage or heart disease and with analyzable images, were included. Ventricular geometry, Doppler indices, ventricular and atrial strain, and myocardial work were assessed. Exploratory associations were analyzed using Spearman’s correlation without adjustment for multiple comparisons. Results: Mean age was 93 ± 2.4 years and LVEF was 63 ± 4%. Concentric remodeling and concentric hypertrophy were observed in 57% and 24%, respectively. Ten patients had E/e′ >15 and 13 had an E/left atrial strain ratio >3. Global work index was 1934 ± 170.6 mmHg% and global work efficiency was 93 ± 2.8%. Left atrial strain correlated inversely with age (ρ = −0.51; p = 0.019) and indexed left atrial volume (ρ = −0.48; p = 0.028). Relative wall thickness correlated positively with constructive work (ρ = 0.63; p = 0.0023). Conclusions: In this selected cohort, concentric geometry coexisted with generally preserved myocardial work indices relative to reference ranges from other age groups. Left atrial strain was inversely associated with age and indexed atrial volume. These exploratory findings support integrated echocardiographic assessment but do not establish age-specific normality thresholds.