Cardiac Structure and Function as Predictors of Mortality in Persons 85 Years of Age

Leibowitz, David; Stessman-Lande, Irit; Jacobs, Jeremy M.; Cohen, Aaron M.; Ein-Mor, Eliana; Stessman, Jochanan; Gilon, Dan

doi:10.1016/j.amjcard.2011.10.055

Cited by 13 publications

(16 citation statements)

References 23 publications

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“…Our findings have similarities to other studies that have not found independent associations between diastolic function and outcomes or had conflicting observations 25,26 . Leibowitz et al noted that diastolic indices were not independent predictors of 5-year mortality in older adults, with only reduced LV systolic function predictive of long-term survival 25 .…”

Section: Discussionsupporting

confidence: 86%

“…Leibowitz et al noted that diastolic indices were not independent predictors of 5-year mortality in older adults, with only reduced LV systolic function predictive of long-term survival 25 . Our study assessed diastolic properties on relevant outcomes other than mortality, and used the novel approach of studying patients with a normal ExEcho to reduce confounding from clinically important ischemia.…”

Section: Discussionmentioning

confidence: 99%

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Left Ventricular Diastolic Function and Long-Term Outcomes in Patients With Normal Exercise Echocardiographic Findings

Gharacholou

Scott

Takahashi

et al. 2013

The American Journal of Cardiology

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The objective of this study was to determine whether diastolic dysfunction (DD) is associated with outcomes in the absence of myocardial ischemia. We studied 2,835 patients undergoing exercise echocardiography (ExEcho) from January 2006 through December 2006 who had normal systolic function (ejection fraction ≥50%) and absence of exercise-induced wall motion abnormalities. Diastolic function was graded as normal, mild DD, or moderate/severe DD. Medical record review and patient contact was undertaken to determine mortality, cardiovascular events (i.e., death, myocardial infarction (MI), or stroke), incident heart failure (HF) and hospitalization. Mean (SD) age was 58.9 (12.8) years; 54.0% were female. DD was present in 40.0% of participants; 28.2% had mild DD and 11.8% had moderate/severe DD. Over a median follow-up of 4.4 years there were 81 deaths and 114 cardiovascular events, and DD was associated with higher rates of mortality, cardiovascular events, and HF events or hospitalizations (all p<0.001). In multivariate analysis, mild or moderate/severe DD (referent; normal) was associated with HF or hospitalization (HR 1.45 (95% CI 1.18–1.78; p<0.001 for mild DD; HR 1.75 (95% CI 1.37–2.24; p<0.001 for moderate/severe DD) but was not independently associated with death or cardiovascular events. The diastolic index of filling pressure (E/e′) was independently associated with mortality, cardiovascular events, and HF or hospitalizations. In conclusion, among patients without demonstrable myocardial ischemia, left ventricular DD was associated with higher event rates over long-term follow up but did not independently predict hard endpoints other than HF or hospitalization. E/e′ was independently associated with clinical outcomes and may be an important echo-derived parameter to identify in patients undergoing ExEcho.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Left Ventricular Diastolic Function and Long-Term Outcomes in Patients With Normal Exercise Echocardiographic Findings

Gharacholou

Scott

Takahashi

et al. 2013

The American Journal of Cardiology

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“…We previously demonstrated that E:e' itself is not predictive of mortality in this population, suggesting that this association is not directly related to elevated left-sided pressures [26]. In the study by Shapiro et al [23], the survival of elderly patients with unexplained pulmonary hypertension was worse in the setting of normal LA wedge pressure; this supports the contention that the effect of elevated RVSP on mortality is unrelated to elevated left-sided pressures.…”

Section: Discussionsupporting

confidence: 73%

Pulmonary Artery Systolic Pressure and Mortality in the Oldest Old

et al. 2014

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Objectives: The objectives of the study were to assess pulmonary artery systolic pressure, its association with clinical and echocardiographic variables and its impact on 5-year mortality in a community-dwelling population of the oldest old. Methods: Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed at home, with standard measurements being taken including tricuspid regurgitation (TR) velocity (n = 300). Survival status at 5-year follow-up was assessed via the centralized population registry. Results: The mean TR gradient in the study population as a whole was 30.5 ± 9.4 mm Hg. A significant relationship was noted between right-ventricular systolic pressure (RVSP) and left-atrial (LA) volume (r = 0.27, p < 0.0001), left-ventricular (LV) mass index (r = 0.26, p < 0.0001) and the ratio E/e (r = 0.19, p < 0.03). At the 5-year follow-up, 71 of the 300 subjects (23.7%) had died. TR gradient was significantly associated with mortality in both the unadjusted (HR 1.036, 95% CI 1.015-1.058; p < 0.007) and adjusted (HR 1.036, 95% CI 1.012-1.061; p < 0.0029) models. Conclusions: We demonstrate that RVSP is elevated and related to LV mass, LA volume and reduced diastolic function in the oldest old. An elevated RVSP is significantly associated with mortality in this population.

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“…Indeed, the increase in afterload can explain the left atrial enlargement found in this group. In the Jerusalem Longitudinal Cohort Study, 29 both LVM and LAV indexes were predictors of total mortality in individuals older than 85 years. Hence, these structural changes in the heart could represent a link between PTH and increased cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Enhanced parathyroid hormone levels are associated with left ventricle hypertrophy in very elderly men and women

Soares

Freitas

Japiassú

et al. 2015

Journal of the American Society of Hypertension

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Cardiac Structure and Function as Predictors of Mortality in Persons 85 Years of Age

Cited by 13 publications

References 23 publications

Left Ventricular Diastolic Function and Long-Term Outcomes in Patients With Normal Exercise Echocardiographic Findings

Left Ventricular Diastolic Function and Long-Term Outcomes in Patients With Normal Exercise Echocardiographic Findings

Pulmonary Artery Systolic Pressure and Mortality in the Oldest Old

Enhanced parathyroid hormone levels are associated with left ventricle hypertrophy in very elderly men and women

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