Association of Undifferentiated Dyspnea in Late Life With Cardiovascular and Noncardiovascular Dysfunction
| Autor: | Ramalho, Sergio H. R., Santos, Mario, Claggett, Brian, Matsushita, Kunihiro, Kitzman, Dalane W., Loehr, Laura, Solomon, Scott D., Skali, Hicham, Shah, Amil M. |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: | |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| Popis: | This cross-sectional study of data from the Atherosclerosis Risk in Communities (ARIC) study quantifies the association of undifferentiated dyspnea with cardiac dysfunction in older adults. Key Points Question To what extent is undifferentiated dyspnea in late life associated with cardiac dysfunction after accounting for other potentially contributing dysfunctional organ systems? Findings In this cross-sectional study of 4342 participants 65 years and older, undifferentiated dyspnea was associated with worse cardiac function but also with impairments in noncardiac organ function. After accounting for impairments in noncardiac organ function, dyspnea was not associated with left ventricular systolic or diastolic function but was associated with obesity, depression, pulmonary dysfunction, and extremity weakness. Meaning The findings suggest that cardiovascular function poorly discriminates older persons with undifferentiated dyspnea from those without; therefore, dyspnea should not be assumed to represent occult heart failure in the elderly population. Importance Undifferentiated dyspnea is common in late life, but the relative contribution of subclinical cardiac dysfunction is unknown. Impairments in cardiac structure and function may be characteristics of undifferentiated dyspnea in elderly people, providing potential insights into occult heart failure (HF). Objective To quantify the association of undifferentiated dyspnea with cardiac dysfunction after accounting for other potential contributors. Design, Setting, and Participants This cross-sectional study used data from Atherosclerosis Risk in Communities study participants 65 years and older who attended the fifth study visit (from 2011 to 2013) and had not been diagnosed with HF, chronic obstructive pulmonary disease, morbid obesity, or severe kidney disease. Analyses were conducted from October 2017 to June 2018. Exposures Dyspnea measured using the modified Medical Research Council scale, with a score less than 2 classified as none to mild and a score of 2 or more classified as moderate to severe. Main Outcomes and Measures Using multivariable logistic regression, the association of undifferentiated dyspnea was defined using cardiac structure, systolic and diastolic function, pulmonary pressure (echocardiography), pulmonary function (spirometry), glomerular filtration rate, hemoglobin, body mass index, depression, and physical performance. The population-attributable risk was calculated for each dysfunction metric. Results Among 4342 participants (mean [SD] age, 75.9 [5.0] years; 2533 [58.3%] women), 1173 (27.0%) had undifferentiated dyspnea. Moderate to severe dyspnea was present in 574 participants (13.2%) and was associated with left ventricular (LV) hypertrophy (odds ratio [OR], 1.53; 95% CI, 1.25-1.87; P |
| Databáze: | OpenAIRE |
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