Myocardial oxygen supply and demand imbalance predicts mortality in older nursing home residents: The PARTAGE study.

Autor: Salvi P; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy., Grillo A; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy., Gautier S; CHRU-Nancy, Pôle 'Maladies du Vieillissement, Gérontologie et Soins Palliatifs', Université de Lorraine, Nancy, France., Labat C; CHRU-Nancy, Pôle 'Maladies du Vieillissement, Gérontologie et Soins Palliatifs', Université de Lorraine, Nancy, France., Salvi L; Medicina II Cardiovascolare, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy., Valbusa F; Department of Internal Medicine, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar, Italy., Baldi C; Medicina Clinica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy., Rovina M; Medicina Clinica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy., Simon G; Medicina Clinica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy., Gao L; Department of Cardiology, Peking University First Hospital, Beijing, China., Tan I; Macquarie Medical School, Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, Australia.; The George Institute for Global Health, Sydney, Australia., Fabris B; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.; Medicina Clinica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy., Carretta R; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.; Medicina Clinica, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy., Avolio AP; Macquarie Medical School, Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, Australia., Parati G; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Benetos A; CHRU-Nancy, Pôle 'Maladies du Vieillissement, Gérontologie et Soins Palliatifs', Université de Lorraine, Nancy, France.; INSERM, DCAC u1116, Université de Lorraine, Nancy, France.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Apr; Vol. 72 (4), pp. 1048-1059. Date of Electronic Publication: 2024 Jan 13.
DOI: 10.1111/jgs.18752
Abstrakt: Background: A mismatch between myocardial oxygen supply and demand is the most common cause of ischemic myocardial injury in older persons. The subendocardial viability ratio (SEVR) can usefully estimate the degree of myocardial perfusion relative to left-ventricular workload. The aim of the present study was to evaluate the ability of SEVR to predict long-term mortality in the older population. Additionally, we aimed to identify the SEVR cutoff value best predicting total mortality.
Methods: This is a multicenter, longitudinal study involving a large population of individuals older than 80 years living in nursing homes. Patients with cancer, severe dementia, and very low level of autonomy were excluded from the study. Participants were monitored for 10 years. Adverse outcomes were recorded every 3 months from inclusion to the end of the study. SEVR reflects the balance between subendocardial oxygen supply and demand, and was estimated non-invasively by analyzing the carotid pressure waveform recorded by applanation arterial tonometry.
Results: A total of 828 people were enrolled (mean age: 87.7 ± 4.7 years, 78% female). 735 patients died within 10 years and 24 were lost to follow-up. SEVR was inversely associated with mortality at univariate Cox-regression model (risk ratio, 0.683 per unit increase in SEVR; 95% confidence interval (CI) [0.502-0.930], p = 0.015) and in a model including age, sex, body mass index, Activity of Daily Living index and Mini-Mental State Examination score (risk ratio, 0.647; 95% CI [0.472-0.930]). The lowest tertile of SEVR was associated with higher 10-years total mortality than the middle (p < 0.001) and the highest (p < 0.004) tertile. A SEVR cutoff value of 83% was identified as the best predictor of total mortality.
Conclusions: SEVR may be considered as a marker of "cardiovascular frailty." An accurate non-invasive estimation of SEVR could be a useful and independent parameter to assess survival probability in very old adults.
Trial Registration: NCT00901355, registered on ClinicalTrials.gov website.
(© 2024 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)
Databáze: MEDLINE
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