Background-For the large and growing population of elderly patients with cardiovascular disease, it is important to identify clinically relevant measures of biological age and their contribution to risk. Frailty is an emerging concept in medicine denoting increased vulnerability and decreased physiological reserves. We analyzed the manner in which the variable frailty predicts short-term outcomes for elderly non-ST-segment elevation myocardial infarction patients. Methods and Results-Patients aged Ն75 years, with diagnosed non-ST-segment elevation myocardial infarction were included at 3 centers, and clinical data including judgment of frailty were collected prospectively. Frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale. The impact of the comorbid conditions on risk was quantified by the coronary artery disease-specific index. Of 307 patients, 149 (48.5%) were considered frail. By multiple logistic regression, frailty was found to be strongly and independently associated with risk for the primary composite outcome (death from any cause, myocardial reinfarction, revascularization due to ischemia, hospitalization for any cause, major bleeding, stroke/transient ischemic attack, and need for dialysis up to 1 month after inclusion) (odds ratio, 2.2; 95% confidence interval, 1.3-3.7), in-hospital mortality (odds ratio, 4.6; 95% confidence interval, 1.3-16.8), and 1-month mortality (odds ratio, 4.7; 95% confidence interval, 1.7-13.0). Conclusions-Frailty is strongly and independently associated with in-hospital mortality, 1-month mortality, prolonged hospital care, and the primary composite outcome. The combined use of frailty and comorbidity may constitute an ultimate risk prediction concept in regard to cardiovascular patients with complex needs. Clinical Trial Registration-http://www.clinicaltrials.gov.

Frailty is independently associated with 1-year mortality for elderly patients with non-ST-segment elevation myocardial infarction, 2014, European Journal of Preventive Cardiology, (21) For the large population of elderly patients with cardiovascular disease, it is crucial to identify clinically relevant measures of biological age and their contribution to risk. Frailty is denoting decreased physiological reserves and increased vulnerability. We analyzed the manner in which the variable frailty is associated with one-year outcomes for elderly non-ST-segment elevation myocardial infarction (NSTEMI) patients.

Lindenberger M, Olsen H, Lä nne T. Lower capacitance response and capillary fluid absorption in women to defend central blood volume in response to acute hypovolemic circulatory stress. Am J Physiol Heart Circ Physiol 295: H867-H873, 2008; doi:10.1152/ajpheart.00332.2008.-Acute hemorrhage is a leading cause of death in trauma, and women are more susceptible to hypovolemic circulatory stress than men. The mechanisms underlying the susceptibility are not clear, however. The aim of the present study was to examine the compensatory mechanisms to defend central blood volume during experimental hypovolemia in women and men. Twentytwo women (23.1 Ϯ 0.4 yr) and 16 men (23.2 Ϯ 0.5 yr) were included. A lower body negative pressure (LBNP) of 11-44 mmHg induced experimental hypovolemic circulatory stress. The volumetric technique was used to assess the capacitance response (redistribution of peripheral venous blood to the central circulation) as well as to assess net capillary fluid transfer from tissue to blood in the arm. Plasma norepinephrine (NE) and forearm blood flow were measured before and during hypovolemia, and forearm vascular resistance (FVR) was calculated. LBNP created comparable hypovolemia in women and men. FVR increased less in women during hypovolemic stress, and no association between plasma NE and FVR was seen in women (R 2 ϭ 0.01, not significant), in contrast to men (R 2 ϭ 0.59, P Ͻ 0.05). Women demonstrated a good initial capacitance response, but this was not maintained with time, in contrast to men [e.g., decreased by 24 Ϯ 4% (women) vs. 4 Ϯ 5% (men), LBNP of 44 mmHg, P Ͻ 0.01], and net capillary fluid absorption from tissue to blood was lower in women (0.086 Ϯ 0.007 vs. 0.115 Ϯ 0.011 ml ⅐ 100 ml Ϫ1 ⅐ min Ϫ1 , P Ͻ 0.05). In conclusion, women showed impaired vasoconstriction, reduced capacitance response with time, and reduced capillary fluid absorption during acute hypovolemic circulatory stress, indicating less efficiency to defend central blood volume than men.gender; orthostatic tolerance; baroreceptor sensitivity ACUTE HEMORRHAGE is a leading cause of death in trauma (2, 41). Women are more susceptible to hypovolemic circulatory stress than men (6,13,17,18,48), and clinical studies have found decreased survival in women after penetrating injury as well as burn injuries (19,35). The mechanisms underlying the susceptibility are not entirely clear and are probably multifactorial (17).Lower body negative pressure (LBNP) is an excellent model for acute hemorrhage and hypovolemic circulatory stress, by inducing central hypovolemia and unloading of baroreceptors (8). A decreased baroreceptor sensitivity has been proposed in women by several authors (13,27,42), and women seem to respond with diminished arterial vasoconstriction to the infusion of ␣-receptor agonists (4, 14, 26). Furthermore, a more pronounced decrease in stroke volume and cardiac output has been postulated as the main mechanism for the susceptibility to hypovolemic circulatory stress, due to smaller and functionally stiffer hearts and ...

Recent studies in humans have suggested sex differences in venous compliance of the lower limb, with lower compliance in women. Capillary fluid filtration could, however, be a confounder in the evaluation of venous compliance. The venous capacitance and capillary filtration response in the calves of 12 women (23.2 Ϯ 0.5 years) and 16 men (22.9 Ϯ 0.5 years) were studied during 8 min lower body negative pressure (LBNP) of 11, 22, and 44 mmHg. Calf venous compliance is dependent on pressure and was determined using the first derivative of a quadratic regression equation that described the capacitance-pressure relationship [compliance ϭ ␤ 1 ϩ (2 ⅐ ␤2 ⅐ transmural pressure)]. We found a lower venous compliance in women at low transmural pressures, and the venous capacitance in men was increased (P Ͻ 0.05). However, the difference in compliance between sexes was reduced and not seen at higher transmural pressures. Net capillary fluid filtration and capillary filtration coefficient (CFC) were greater in women than in men during LBNP (P Ͻ 0.05). Furthermore, calf volume increase (capacitance response ϩ total capillary filtration) during LBNP was equivalent in both sexes. When total capillary filtration was not subtracted from the calf capacitance response in the calculation of venous compliance, the sex differences disappeared, emphasizing that venous compliance measurement should be corrected for the contribution of CFC. lower body negative pressure; capillary filtration coefficient; venous capacitance THE VENOUS SECTION OF THE cardiovascular system can be looked upon as a voluminous blood reservoir (70% of total blood volume), designed to preserve a proper inflow of blood into the heart during various cardiovascular adjustments. Thus central venous pressure and filling of the heart may be maintained at a fairly stable level, despite variations in venous blood volume (49). During upright posture, however, the pooling of blood in the veins of the lower part of the body decreases central blood volume and venous return (4, 5, 16). The venous compartment in the legs, rather than the pelvic or abdominal region, seems to have a hemodynamic impact during lower body negative pressure (LBNP) (16), and in studies on men, a greater calf venous compliance has been linked to an increased venous capacitance response with a concomitant reduction in central blood volume (44,56). This, in turn, elicits an increased sympathetic response with higher peripheral resistance and increased heart rate (4, 5, 10, 16, 44, 58). Thus venous compliance of the lower limb may have an impact on cardiovascular responses to orthostatic stress and orthostatic tolerance, although there might be differences between sexes confounding such a link (4).Women are more susceptible to orthostatic stress than men (4,10,13,40,51,58), and in accordance with some findings in the arterial tree, it may be hypothesized that women have greater venous compliance in the lower limbs predisposing to orthostatic intolerance (52). This seems to be refuted however, by recent fi...

Turbulent blood flow is implicated in the pathogenesis of several aortic diseases but the extent and degree of turbulent blood flow in the normal aorta is unknown. We aimed to quantify the extent and degree of turbulece in the normal aorta and to assess whether age impacts the degree of turbulence. 22 young normal males (23.7 ± 3.0 y.o.) and 20 old normal males (70.9 ± 3.5 y.o.) were examined using four dimensional flow magnetic resonance imaging (4D Flow MRI) to quantify the turbulent kinetic energy (TKE), a measure of the intensity of turbulence, in the aorta. All healthy subjects developed turbulent flow in the aorta, with total TKE of 3-19 mJ. The overall degree of turbulence in the entire aorta was similar between the groups, although the old subjects had about 73% more total TKE in the ascending aorta compared to the young subjects (young = 3.7 ± 1.8 mJ, old = 6.4 ± 2.4 mJ, p < 0.001). This increase in ascending aorta TKE in old subjects was associated with age-related dilation of the ascending aorta which increases the volume available for turbulence development. Conversely, age-related dilation of the descending and abdominal aorta decreased the average flow velocity and suppressed the development of turbulence. In conclusion, turbulent blood flow develops in the aorta of normal subjects and is impacted by age-related geometric changes. Non-invasive assessment enables the determination of normal levels of turbulent flow in the aorta which is a prerequisite for understanding the role of turbulence in the pathophysiology of cardiovascular disease.

Background. Percutaneous pericardiocentesis guided by 2-D echocardiography has been used at Linköping Heart Centre since 1983. Aim. To evaluate our experience of this method including a follow-up and also to determine the aetiology of pericardial effusion. Methods. A retrospective study including 120 of 252 consecutive patients punctured.Results. The two most common aetiologies were cardiac surgery (77% valve surgery), followed by malignant disease. The postsurgical effusions became

There are sex-related differences in venous compliance and capillary filtration in the lower limbs, which to some extent can explain the susceptibility to orthostatic intolerance in young women. With age, venous compliance and capacitance are reduced in men. This study was designed to evaluate age-related changes in venous compliance and capillary filtration in the lower limbs of healthy women. Included in this study were 22 young and 12 elderly women (23.1 Ϯ 0.4 and 66.4 Ϯ 1.4 yr). Lower body negative pressure (LBNP) of 11, 22, and 44 mmHg created defined transmural pressure gradients in the lower limbs. A plethysmographic technique was used on the calf to assess venous capacitance and net capillary filtration. Venous compliance was calculated with the aid of a quadratic regression equation. No age-related differences in venous compliance and capacitance were found. Net capillary filtration and capillary filtration coefficient (CFC) were lower in elderly women at a LBNP of 11 and 22 mmHg (0.0032 vs. 0.0044 and 0.0030 vs. 0.0041 ml ⅐ 100 ml Ϫ1 ⅐ min Ϫ1 ⅐ mmHg Ϫ1 , P Ͻ 0.001). At higher transmural pressure (LBNP, 44 mmHg), CFC increased by ϳ1/3 (0.010 ml ⅐ 100 ml Ϫ1 ⅐ min Ϫ1 ⅐ mmHg Ϫ1 ) in the elderly (P Ͻ 0.001) but remained unchanged in the young women. In conclusion, no age-related decrease in venous compliance and capacitance was seen in women. However, a decreased CFC was found with age, implying reduced capillary function. Increasing transmural pressure increased CFC in the elderly women, indicating an increased capillary susceptibility to transmural pressure load in dependent regions. These findings differ from earlier studies on age-related effects in men, indicating sex-specific vascular aging both in the venous section and microcirculation. capillary filtration coefficient; lower body negative pressure; age A TRANSITION FROM the supine to standing posture leads to a progressive pooling of blood in the compliant veins in the lower part of the body, which produces an immediate circulatory challenge due to the concomitant decrease in thoracic blood volume (5,6,39). Subjects with increased limb venous compliance have been shown to have greater orthostatic intolerance, probably due to an increased venous capacitance (24,36,46), although this relationship has recently been challenged by Hernandez and Franke (18). Venous compliance in the lower limbs decreases with age in men (33,38,39,49), but there is no reason to believe that venous compliance and capacitance are similar in men and women, since a sex difference has been established in young adults (26,30,34). Furthermore, age-related changes might be sex specific, in accordance with age-related changes of arteries, with women having a slower decrease in arterial compliance with age compared with men, an effect probably attributed to estrogen (9, 48). Estrogen has been shown to affect cellular transcription of elastin and collagen, and estrogen-receptors are known to exist in vascular smooth muscle cells (21,22,32).There is a marked capillary fluid filtratio...

P cuff is an adequate substitute for P iv in the lower limb. F filt is associated with an underestimation of C calf and differences in the effect of F filt during VOP can be accounted for with the correction model. Thus, our model seems to be a valuable tool in future studies of venous wall function.