Background: Frailty is a state of vulnerability and a decreased physiological response to stressors. As the population ages, the prevalence of frailty is expected to increase. Thus, identifying tools and resources that efficiently predict frailty among the Saudi population is important. We aimed to describe the prevalence and predictors of frailty among Saudi patients referred for cardiac stress testing with nuclear imaging. Methods: We included 876 patients (mean age 60.3 ± 11 years, women 48%) who underwent clinically indicated cardiac nuclear stress testing between January and October 2016. Fried Clinical Frailty Scale was used to assess frailty. Patients were considered frail if they had a score of four or higher. Multivariate adjusted logistic regression models were used to determine the independent predictors of elderly frail patients. Results: In this cohort, the median age of the included patients was 61 years, and the prevalence of frailty was 40%. The frail patients were older, more frequently women, and had a higher body mass index. Additionally, frailty was associated with a higher prevalence of cardiovascular risk factors: hypertension (85% vs. 70%) and diabetes (75% vs. 60%). In a fully adjusted logistic regression model, women, hypertension, and obesity (BMI ≥ 30 kg/m2) were independent predictors of elderly frail patients. Conclusions: With the aging of the Saudi population, frailty prevalence is expected to increase. Elderly, obesity, hypertension, and female gender are risk factors of frailty. Interventions to reduce frailty should be focused on this high-risk population.
Background:
Impaired coronary flow reserve (CFR) is an early manifestation of coronary artery disease (CAD), even in vessels free of angiographic stenosis. The aim of this analysis is to determine the differential role peak myocardial blood flow (MBF) or noninvasive CFR in predicting future events.
Methods:
We included 3,003 consecutive patients with known or suspected CAD (mean age 61±11years, 42% females) who underwent rubidium-82 rest/stress positron emission tomography (PET) for clinical indications. Rest and peak MBF were calculated with factor analysis and a 2-compartment kinetic model and were used to calculate CFR. Patients were followed up for a median duration of 1.4 years (interquartile range, 0.5-1.8 years) for the incidence of cardiac death or myocardial infarction. (CDMI). Multiple Cox regression models were used to determine the prognostic value of peak MBF and CFR and the incremental value of peak MBF over CFR.
Results:
The included cohort has prevalence of CAD risk factors: Diabetes (60%), hypertension (87%) and dyslipidemia (85%). A total of 40% patients had evidence of perfusion defects (Sum stress score>3). After a median follow up duration of 1.4 years, 140 patients (4.7%) experienced CD/MI. In multivariate Cox regression adjusted for Duke clinical risk score, resting ejection fraction and SSS, both CFR (Hazard Ratio 0.70, 95% CI 0.54 -0.89, p=0.005) and peak MBF (Hazard Ratio 0.71, 95% CI 0.57 -0.89, p=0.003) were independent predictors of CDMI. (Adding peak MBF added incremental prognostic value over CFR. (Area under the curve increased from 0.776 to 0.793, p=0.021).
Conclusion:
Noninvasively measured MBF and CFR are independent predictors of CDMI in patients with known or suspected CAD. Peak MBF adds incremental prognostic value over noninvasive CFR.
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