P768Cardiopulmonary exercise testing for assessing frailty status in stable elderly patients with heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Hirashiki ◽  
K Kawashima ◽  
K Nomoto ◽  
M Kokubo ◽  
A Shimizu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
Exercise Testing ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Frailty Status ◽  
Peak Vo2 ◽  
Plot Analysis ◽  
Patients With Heart Failure

Abstract Introduction Frailty is a syndrome associated with aging that produces subclinical dysfunction across multiple organ systems and leads to increased risk of mortality. The Kihon Checklist (KCL) was developed by the Japanese Ministry of Health, Labor and Welfare to identify older persons in need of care; it is a reliable tool for predicting general frailty in older adults. There is little information about the relationship between frailty status and exercise capacity. Purpose To investigate whether cardiopulmonary exercise testing (CPX) parameters are associated with frailty in stable elderly patients with heart failure (HF). Methods Ninety-two stable elderly patients with HF were evaluated by using CPX and the total KCL (t-KCL). A t-KCL score of 0–3 was classified as robust, 4–7 as pre-frail, and ≥8 as frail. Diagnostic performance (DP) -plot analysis was used to assess the utility of CPX parameters to distinguish between the presence and absence of frailty. Results Mean age, left ventricular ejection fraction, plasma brain natriuretic peptide, peak work rate (WR), peak VO2, and t-KCL score were 81.7 years, 57.8%, 182 pg/mL, 49.6 W, 13.2 mL/kg/min, and 10.7, respectively. t-KCL score was significantly correlated with peak VO2 (r=−0.53, p<0.001) and peak WR (r=−0.63, p<0.001). In the patients with frailty (n=63), peak WR was significantly lower than that in patients without frailty (n=29; 40.8 and 71.0 W, respectively, p<0.001). Multivariate analysis revealed that peak WR was the only significant independent predictor of frailty (β=−0.111, p<0.001). In the DP-plot analysis, a cut-off value for peak WR of 51.9 W was the best predictor of frailty (accuracy; 0.706, Figure). Cut-off value for peak WR Conclusions Frailty status was significantly associated with peak WR in stable elderly patients with HF. CPX may be useful for assessing frailty status in stable elderly patients with HF.

Leg flow-mediated arterial dilation in elderly patients with heart failure and normal left ventricular ejection fraction

2007 ◽  
Vol 292 (3) ◽  
pp. H1427-H1434 ◽  
Author(s):  
W. Gregory Hundley ◽  
Ersin Bayram ◽  
Craig A. Hamilton ◽  
Eric A. Hamilton ◽  
Timothy M. Morgan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Normal Left Ventricular ◽  
Patients With Heart Failure

Background: flow-mediated arterial dilation (FMAD), an indicator of endothelial function, is reduced in patients with heart failure and reduced left ventricular ejection fraction (HFREF). Many elderly patients with heart failure exhibit a normal left ventricular ejection fraction (HFNEF). It is unknown whether FMAD is severely reduced in the elderly with HFNEF. Methods and Results: 30 participants >60 yr of age, 11 healthy, 9 with HFNEF, and 10 with HFREF, underwent a cardiovascular magnetic resonance (CMR) assessment of FMAD in the superficial femoral artery followed within 48 h by symptom-limited exercise with expired gas analysis. Elderly patients with HFREF and HFNEF had severely reduced peak oxygen consumption (V̇o2 peak; 12 ± 2 and 13 ± 1 ml·kg−1·min−1, respectively) vs. their healthy age-matched contemporaries (20 ± 3 ml·kg−1·min−1). FMAD was 3.8 ± 1.3% (0.85 ± 0.22 mm2) in patients with HFREF; it was 12.1 ± 3.6% (3.1 ± 1.2 mm2) and 13.7 ± 5.9% (3.9 ± 1.7 mm2), respectively, in patients with HFNEF and age-matched healthy older individuals. After adjustment for age and gender, the association of FMAD with V̇o2 was high in healthy and HFREF subjects ( P = 0.05 and 0.02, respectively) but less so in HFNEF participants ( P = 0.58). Conclusions: elderly patients with HFNEF do not exhibit marked reduction in leg FMAD. These data suggest that mechanisms other than impaired femoral arterial endothelial function contribute to the severe exercise intolerance experienced by these individuals.

Heart Failure with Recovered Ejection Fraction in a Cohort of Elderly Patients with Chronic Heart Failure

Cardiology ◽  
2016 ◽  
Vol 135 (3) ◽  
pp. 196-201 ◽  
Author(s):  
Joan Carles Trullàs ◽  
Luís Manzano ◽  
Francesc Formiga ◽  
Oscar Aramburu-Bodas ◽  
María Angustias Quesada-Simón ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Hazard Ratios ◽  
Patients With Heart Failure ◽  
Pharmacologic Management

Objective: The aim of this study was to determine whether patients with heart failure (HF) who recover left ventricular ejection fraction (LVEF), termed here as ‘Rec-HF', have a distinct clinical profile and prognosis compared with patients with HF and reduced LVEF (HF-REF) or HF and preserved LVEF (HF-PEF). Methods: We evaluated and classified patients from the Spanish Heart Failure Registry into three categories based on enrollment/follow-up echocardiograms: HF-PEF (LVEF ≥50%), HF-REF (LVEF persistently <50%) and Rec-HF (LVEF on enrollment <50% but normalized during follow-up). Results: A total of 1,202 patients were included, 1,094 with HF-PEF, 81 with HF-REF and 27 with Rec-HF. The three groups included patients of advanced age (mean age 75 years) with comorbidities. Rec-HF patients were younger, with a better functional status, lower prevalence of diabetes mellitus, dementia and cerebrovascular disease, and higher prevalence of COPD. The etiology of HF was more frequently ischemic and alcoholic and less frequently hypertensive. After a median follow-up of 367 days, the unadjusted hazard ratios for death in the Rec-HF versus HF-PEF and HF-REF groups were 0.11 (95% CI 0.02-080; p = 0.029) and 0.31 (95% CI 0.04-2.5; p = 0.274). Results were statistically nonsignificant in multivariate-adjusted models. Conclusion: Rec-HF is also present in elderly patients with HF but it is necessary to further investigate the natural history and optimal pharmacologic management of this ‘new HF syndrome'.

scholarly journals Role of confirmed and potential predictors of an unfavorable outcome in heart failure in everyday clinical practice

2021 ◽  
Author(s):  
Anna Chuda ◽  
Maciej Banach ◽  
Marek Maciejewski ◽  
Agata Bielecka-Dabrowa
Keyword(s):  
Heart Failure ◽  
Exercise Testing ◽  
Clinical Decision Making ◽  
Cardiopulmonary Exercise Testing ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Unfavorable Outcome ◽  
Left Ventricular Ejection ◽  
Monitoring Method ◽  
Ventricular Ejection Fraction

AbstractHeart failure (HF) is the only cardiovascular disease with an ever increasing incidence. HF, through reduced functional capacity, frequent exacerbations of disease, and repeated hospitalizations, results in poorer quality of life, decreased work productivity, and significantly increased costs of the public health system. The main challenge in the treatment of HF is the availability of reliable prognostic models that would allow patients and doctors to develop realistic expectations about the prognosis and to choose the appropriate therapy and monitoring method. At this moment, there is a lack of universal parameters or scales on the basis of which we could easily capture the moment of deterioration of HF patients’ condition. Hence, it is crucial to identify such factors which at the same time will be widely available, cheap, and easy to use. We can find many studies showing different predictors of unfavorable outcome in HF patients: thorough assessment with echocardiography imaging, exercise testing (e.g., 6-min walk test, cardiopulmonary exercise testing), and biomarkers (e.g., N-terminal pro-brain type natriuretic peptide, high-sensitivity troponin T, galectin-3, high-sensitivity C-reactive protein). Some of them are very promising, but more research is needed to create a specific panel on the basis of which we will be able to assess HF patients. At this moment despite identification of many markers of adverse outcomes, clinical decision-making in HF is still predominantly based on a few basic parameters, such as the presence of HF symptoms (NYHA class), left ventricular ejection fraction, and QRS complex duration and morphology.

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