scholarly journals Left ventricular mechanical function and aortic elastic properties in newborns with aortic coarctation. Prognostic significance of obtained data

2018 ◽  
Vol 22 (3) ◽  
pp. 10
Author(s):  
Y. S. Sinelnikov ◽  
E. N. Orekhova ◽  
T. V. Matanovskaya
Keyword(s):  
Left Ventricle ◽  
Conflict Of Interest ◽  
Cardiovascular Events ◽  
Heart Defects ◽  
Prognostic Significance ◽  
Coarctation Of The Aorta ◽  
Left Ventricular ◽  
Dynamic Monitoring ◽  
Ultrasound Evaluation ◽  
Increased Risk

<p>Coarctation of the aorta is one of the most common congenital heart defects. Despite excellent early results of correcting isolated coarctation of the aorta in the neonatal period, in the long-term postoperative period such patients have an increased risk of cardiovascular events. Today there are numerous studies demonstrating the signs of complex cardiovascular remodeling in patients after surgical correction of coarctation of the aorta. Pathological ventricular-arterial interaction is considered to determine the structural and functional changes in the left ventricle and the biomechanical properties of the aorta, which continue after correction of the coarctation segment of the aorta. In this respect, ultrasound evaluation of the left ventricle mechanics and aorta becomes a valuable diagnostic tool for dynamic monitoring of structural and functional remodeling of the left ventricle and severity of arteriopathy. Such evaluation will allow timely to detect increasing risk of cardiovascular events and to correct therapeutic measures.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong></strong></p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interest.<br /><strong></strong></p><p><strong>Authors’ contribution</strong></p><p><strong></strong>Conception and study design: E.N. Orekhova, T.V. Matanovskaya</p><p>Drafting the article: E.N. Orekhova</p><p>Critical revision of the article: Y.S. Sinelnikov</p><p>Final approval of the version to be published: Y.S. Sinelnikov, E.N. Orekhova, T.V. Matanovskaya<br /><strong></strong></p><p><strong>ORCID ID</strong></p><p>Y.S. Sinelnikov, <a href="https://orcid.org/0000-0002-6819-2980">https://orcid.org/0000-0002-6819-2980</a><br />E.N. Orekhova, <a href="https://orcid.org/0000-0002-7097-8771">https://orcid.org/0000-0002-7097-8771</a><br />T.V. Matanovskaya, <a href="https://orcid.org/0000-0002-2277-8935">https://orcid.org/0000-0002-2277-8935</a></p>

Cardiovascular events in patients with type 2 diabetes

2002 ◽  
Vol 2 (1_suppl) ◽  
pp. S4-S8
Author(s):  
Erland Erdmann
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Risk Factor ◽  
Adverse Effects ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Increased Risk

Diabetes is a common risk factor for cardiovascular disease. Coronary heart disease and left ventricular dysfunction are more common in diabetic patients than in non-diabetic patients, and diabetic patients benefit less from revascularisation procedures. This increased risk can only partly be explained by the adverse effects of diabetes on established risk factors; hence, a substantial part of the excess risk must be attributable to direct effects of hyperglycaemia and diabetes. In type 2 diabetes, hyperinsulinaemia, insulin resistance and hyperglycaemia have a number of potential adverse effects, including effects on endothelial function and coagulation. Risk factor modification has been shown to reduce the occurrence of cardiovascular events in patients with diabetes; indeed, diabetic patients appear to benefit more in absolute terms than non-diabetic patients. There is thus a strong case for intensive treatment of risk factors, including insulin resistance and hyperglycaemia, in patients with type 2 diabetes.

scholarly journals Replacement Myocardial Fibrosis in Patients with Mitral Valve Prolapse: Relation to Mitral Regurgitation, Ventricular Remodeling and Arrhythmia

Circulation ◽  
2021 ◽  
Author(s):  
Anne-Laure Constant Dit Beaufils ◽  
Olivier Huttin ◽  
Antoine Jobbe-Duval ◽  
Thomas Senage ◽  
Laura Filippetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ventricular Arrhythmia ◽  
Myocardial Fibrosis ◽  
Mitral Valve Prolapse ◽  
Cardiovascular Events ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Arterial Embolism

Background: Mitral valve prolapse (MVP) is a frequent disease that can be complicated by mitral regurgitation (MR), heart failure, arterial embolism, rhythm disorders and death. Left ventricular (LV) replacement myocardial fibrosis, a marker of maladaptive remodeling, has been described in patients with MVP, but the implications of this finding remain scarcely explored. We aimed at assessing the prevalence, pathophysiological and prognostic significance of LV replacement myocardial fibrosis through late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) in patients with MVP. Methods: Four hundred patients (53±15 years, 55% male) with MVP (trace to severe MR by echocardiography) from 2 centers, who underwent a comprehensive echocardiography and LGE CMR, were included. Correlates of replacement myocardial fibrosis (LGE+), influence of MR degree, and ventricular arrhythmia were assessed. The primary outcome was a composite of cardiovascular events (cardiac death, heart failure, new-onset atrial fibrillation, arterial embolism, and life-threatening ventricular arrhythmia). Results: Replacement myocardial fibrosis (LGE+) was observed in 110 patients (28%; 91 myocardial wall including 71 basal inferolateral wall, 29 papillary muscle). LGE+ prevalence was 13% in trace-mild MR, 28% in moderate and 37% in severe MR, and was associated with specific features of mitral valve apparatus, more dilated LV and more frequent ventricular arrhythmias (45 vs 26%, P<0.0001). In trace-mild MR, despite the absence of significant volume overload, abnormal LV dilatation was observed in 16% of patients and ventricular arrhythmia in 25%. Correlates of LGE+ in multivariable analysis were LV mass (OR 1.01, 95% CI [1.002-1.017], P=0.009) and moderate-severe MR (OR: 2.28, 95% CI [1.21-4.31], P=0.011). LGE+ was associated with worse 4-year cardiovascular event-free survival (49.6±11.7 in LGE+ vs 73.3±6.5% in LGE-, P<0.0001). In a stepwise multivariable Cox model, MR volume and LGE+ (HR: 2.6 [1.4-4.9], P=0.002) were associated with poor outcome. Conclusions: LV replacement myocardial fibrosis is frequent in patients with MVP, is associated with mitral valve apparatus alteration, more dilated LV, MR grade, ventricular arrhythmia, and is independently associated with cardiovascular events. These findings suggest a MVP-related myocardial disease. Finally, CMR provides additional information to echocardiography in MVP.

Abstract 14036: An Algorithm to Guide Prognosis Based on the Combination of Peak VO 2 and V E -VCO 2 slope in Patients with HFrEF: The Henry Ford HospITal CardioPulmonary EXercise Testing (FIT-CPX) Project

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Clinton A Brawner ◽  
Ali Shafiq ◽  
Heather A Aldred ◽  
Raakesh Hassan ◽  
Stephanie Vasko ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Cardiopulmonary Exercise Testing ◽  
Composite Endpoint ◽  
Left Ventricular ◽  
Cardiac Transplant ◽  
Cardiopulmonary Exercise ◽  
Increased Risk ◽  
Event Rates

Many studies have reported the prognostic significance of peak oxygen consumption (VO 2 ) and V E -VCO 2 slope in patients with heart failure (HF). However, there are limited data stratifying risk based on a combination of these measures and how to best use them. Purpose: Describe 1 and 3-y event rates for the composite endpoint of mortality, left ventricular assist device (LVAD), or cardiac transplant (CT) based on the combined evaluation of peak VO 2 and V E -VCO 2 slope in patients with HF with reduced ejection fraction (≤ 40%; HFrEF). Methods: Patients (n= 1,116; 33% female; age= 54 ± 13 y) with a cardiopulmonary exercise test between 1997 and 2010 and confirmed HFrEF were identified. Endpoint data was obtained through 2011. Patients were grouped based on peak VO 2 (< 12, 12 to18, and > 18 mL/kg/min) and (V E -VCO 2 slope ≥ 34 or < 34). Cumulative events were identified from life tables. Cox regression with adjustment for age, gender, ejection fraction, and beta-blocker therapy was used to calculate the hazard ratio for V E -VCO 2 slope ≥ 34 within each peak VO 2 group. Results: The 1 and 3-y event rates are shown in the Table. Among patients with a peak VO 2 < 12, 1 and 3-y events were 23% and 44%, respectively. Within this group, V E -VCO 2 slope ≥ 34 represented more than twice the risk at both 1 y (HR 2.42, 95% CI 1.09, 5.38) and 3 y (HR 2.32, 95% CI 1.33, 4.05). Among patients with a peak VO 2 12 to 18, 1 and 3-y events were 14% and 30%, respectively. Within this group, a V E -VCO 2 slope ≥ 34 was associated with increased risk at both 1 y (HR 1.80, 95% CI 1.13, 2.87) and 3 y (HR 1.80, 95% CI 1.30, 2.50). Among patients with peak VO 2 > 18, 1 and 3-y events were 2% and 10%, respectively, and V E -VCO 2 slope was not statistically associated with increased risk. Conclusion: Among patients with a peak VO 2 ≤ 18, V E -VCO 2 slope ≥ 34 further refines the risk for a composite endpoint of mortality, LVAD, or CT at both 1 and 3 y.

Abstract 14541: Incidence, Risk Factors, and Outcomes of Heart Failure in Patients With Graves’ Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jwan A Naser ◽  
Sorin Pislaru ◽  
Marius N Stan ◽  
Grace Lin
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Cardiovascular Events ◽  
De Novo ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Graves Disease ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Overt Hyperthyroidism

Background: Graves’ disease (GD) can both aggravate pre-existing cardiac disease and cause de novo heart failure (HF). Due to the rarity of thyrotoxic HF, population-based studies are lacking, and data from smaller studies are widely variable. Methods: We reviewed the medical records of 1371 consecutive patients with GD evaluated at our clinic between 2009 and 2019. HF was defined according to Framingham criteria. GD-related HFrEF was defined by left ventricular ejection fraction of <50%, while HFpEF was defined according to the Heart Failure Association of the European Society of Cardiology. Outcomes of major cardiovascular events, all-cause mortality, and cardiac hospitalizations were analyzed with adjustments for age, gender, and history of coronary artery disease (CAD). 1:1 matching with controls (age, gender, and CAD) was additionally done. Results: HF occurred in 74 patients (31 HFrEF; 43 HFpEF). Incidence of GD-related HF, HFrEF, and HFpEF was 5.4%, 2.3%, and 3.1%, respectively. In HFrEF, atrial fibrillation (AF) (RR 10.05, p <0.001) and thyrotropin receptor antibodies (TRAb) level (RR 1.05 per unit, p=0.005) were independent predisposing factors. In HFpEF, independent risk factors were COPD (RR 5.78, p < 0.001), older age (RR 1.48 per 10 years, p = 0.003), overt hyperthyroidism (RR 5.37, p = 0.021), higher BMI (1.06 per unit, p = 0.003), and HTN (RR 3.03, p = 0.011). Rates of cardiac hospitalizations were higher in HFrEF (41.9% vs 3.2%, p <0.001) and HFpEF (44.2% vs 4.7%, p < 0.001) compared to controls. Furthermore, while both increased risk of strokes (HFrEF: RR 4.12, p = 0.027; HFpEF: RR 4.64, p = 0.009), only HFrEF increased risk of all-cause mortality (RR 3.78, p = 0.045). Conclusion: De novo HF occurs in 5.4% of patients with GD and increases the rate of cardiovascular events. HF occurs more frequently in GD patients with AF, higher TRAb, higher BMI, and overt hyperthyroidism, suggesting that these may be targets for treatment to prevent cardiovascular complications, especially in older multimorbid patients.

scholarly journals Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy

2020 ◽  
Vol 9 (6) ◽  
pp. 1997 ◽  
Author(s):  
Bianca Olivia Cojan-Minzat ◽  
Alexandru Zlibut ◽  
Ioana Danuta Muresan ◽  
Carmen Cionca ◽  
Dalma Horvat ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Left Ventricular Geometry ◽  
Major Adverse Cardiovascular Events ◽  
Increased Risk ◽  
Replacement Fibrosis ◽  
Nonischemic Dilated Cardiomyopathy ◽  
Cox Analysis ◽  
A Prospective Study

To investigate the relationship between left ventricular (LV) long-axis strain (LAS) and LV sphericity index (LVSI) and outcomes in patients with nonischemic dilated cardiomyopathy (NIDCM) and myocardial replacement fibrosis confirmed by late gadolinium enhancement (LGE) using cardiac magnetic resonance imaging (cMRI), we conducted a prospective study on 178 patients (48 ± 14.4 years; 25.2% women) with first NIDCM diagnosis. The evaluation protocol included ECG monitoring, echocardiography and cMRI. LAS and LVSI were cMRI-determined. Major adverse cardiovascular events (MACEs) were defined as a composite outcome including heart failure (HF), ventricular arrhythmias (VAs) and sudden cardiac death (SCD). After a median follow-up of 17 months, patients with LGE+ had increased risk of MACEs. Kaplan-Meier curves showed significantly higher rate of MACEs in patients with LGE+ (p < 0.001), increased LVSI (p < 0.01) and decreased LAS (p < 0.001). In Cox analysis, LAS (HR = 1.32, 95%CI (1.54–9.14), p = 0.001), LVSI [HR = 1.17, 95%CI (1.45–7.19), p < 0.01] and LGE+ (HR = 1.77, 95%CI (2.79–12.51), p < 0.0001) were independent predictors for MACEs. In a 4-point risk scoring system based on LV ejection fraction (LVEF) < 30%, LGE+, LAS > −7.8% and LVSI > 0.48%, patients with 3 and 4 points had a significantly higher risk for MACEs. LAS and LVSI are independent predictors of MACEs and provide incremental value beyond LVEF and LGE+ in patients with NIDCM and myocardial fibrosis.

scholarly journals Amiodarone-Induced Thyrotoxicosis Is a Predictor of Adverse Cardiovascular Outcome

2009 ◽  
Vol 94 (1) ◽  
pp. 109-114 ◽  
Author(s):  
Kai-Hang Yiu ◽  
Man-Hong Jim ◽  
Chung-Wah Siu ◽  
Chi-Ho Lee ◽  
Michele Yuen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cardiovascular Events ◽  
Ventricular Arrhythmias ◽  
Clinical Characteristics ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Amiodarone Therapy ◽  
Ventricular Ejection Fraction ◽  
Increased Risk

Abstract Background: Amiodarone-induced thyrotoxicosis (AIT) is a clinical condition that is notoriously difficult to manage; the relative risk of adverse cardiovascular events in these patients compared with euthyroid patients is largely unknown. Objective: We compared the clinical characteristics and major adverse cardiovascular events (MACE) in AIT and euthyroid patients. Method: Patients at a tertiary referral center who had been prescribed amiodarone for at least 3 months were retrospectively analyzed. Baseline clinical characteristics, laboratory parameters, and outcome events were evaluated. MACE was defined as cardiovascular mortality, myocardial infarction, stroke and heart failure, or ventricular arrhythmias that required hospitalization. Results: A total of 354 patients (61.8 ± 14.1 yr; 64.7% male) with a mean follow-up of 48.6 ± 26.7 months were studied. AIT, euthyroid status, and amiodarone-induced hypothyroidism were identified in 57 (16.1%), 224 (63.3%), and 73 (20.6%) patients, respectively. No differences in baseline clinical characteristics were observed between AIT and euthyroid patients. Nonetheless AIT patients demonstrated a higher MACE rate (31.6 vs. 10.7%, P &lt; 0.01), mostly driven by a higher rate of ventricular arrhythmias that required admission (7.0 vs. 1.3%, P = 0.03). Cox-regression multivariate analysis revealed that AIT (hazard ratio 2.68; confidence interval 1.53–4.68; P &lt; 0.01) and left ventricular ejection fraction less than 45% (hazard ratio 2.52; confidence interval 1.43–4.42; P &lt; 0.01) were independent predictors of MACE. Conclusion: In patients prescribed long-term amiodarone therapy, occurrence of AIT is associated with a 2.7-fold increased risk of MACE. Regular and close biochemical surveillance is thus advisable to identify and treat this high-risk group of patients.

Abstract 12842: Both Hyponatremia and Elevated Plasma Renin Activity Are Independent and Additive Cardiovascular Risk Factors in Patients With Angiographically Proven Coronary Artery Disease (CAD): The Intermountain Heart Collaborative Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tami L Bair ◽  
Jeffrey L Anderson ◽  
Heidi T May ◽  
Benjamin D Horne ◽  
Joseph B Muhlestein
Keyword(s):  
Plasma Renin Activity ◽  
Cardiovascular Events ◽  
Collaborative Study ◽  
Plasma Renin ◽  
Left Ventricular ◽  
Renin Activity ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Low Sodium ◽  
Increased Risk

Background: Several studies have documented an increased risk of future major adverse cardiovascular events (MACE) among CAD patients with elevated baseline plasma renin activity (PRA). One of the proposed mechanisms of elevated PRA is sodium depletion - hyponatremia. However, the relationship between PRA and hyponatremia is not well defined. Methods: A total of 1,781 pts with angiographic CAD (>50% stenosis) enrolled in the Intermountain Heart Collaborative Study were evaluated. Pts were excluded if they had a history of myocardial infarction (MI), heart failure (HF), left ventricular ejection fraction (EF) <45% or were discharged on beta blocker therapy. Baseline sodium levels were stratified between low (<135 mm/L) and normal (≥135 mm/L), and PRA between elevated (>2.3 ng/ml/h) and low (≤2.3 ng/ml/h) risk categories. The independent associations between these categories and MACE (death, MI, HF hospitalization, stroke and new onset renal failure) at five years were determined by multivariable Cox hazard regression analysis. Results: The mean pt age was 65.5 years; most pts were men (73.2%) and hypertensive (70.4%). Overall, PRA was elevated in 940 (52.8%) of the pts and sodium was low in 42 (2.4%) of the pts. The prevalence of elevated PRA was greater among pts with low sodium (66.7% versus 52.4% [p=0.07]). Five-year incidence of MACE was higher among pts with low sodium (61.9% versus 40.7%, p=0.006) and also among those with elevated PRA (43.7% versus 38.3%, p=0.02). After adjustment for baseline characteristics, among pts with low sodium, elevated PRA did not predict an increase in MACE (adjusted hazard ratio (HR)=0.72, p=0.53). However, among those with normal sodium, elevated PRA trended toward an association with MACE (HR=1.14, p=0.08). Conclusion: Among stable pts with angiographically documented CAD, both hyponatremia and elevated PRA are independently associated with future adverse cardiovascular events, although much of the adverse effect of elevated PRA may be explained by the concomitant presence of hyponatremia. The underlying physiology of these findings and its potential implications to future medical management of these pts deserves further study.

Abstract 3636: Ekg Left Ventricular Hypertrophy And Cardiovascular Events In Patients With Type 1 And Type 2 Diabetes Mellitus

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Massimo Salvetti ◽  
Maria Lorenza Muiesan ◽  
Barbara Stanga ◽  
Antonio Cimino ◽  
Umberto Valentini ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Total Cholesterol ◽  
Odds Ratio ◽  
Cardiovascular Events ◽  
Prognostic Significance ◽  
Type 2 Dm ◽  
Increased Risk

Background: A large number of studies have demonstrated that LVH detected with standard electrocardiography is an independent predictor of future cardiovascular complications in various subsets of patients. Despite the fact that ECG represents the first cardiovascular test performed in diabetics, few data are available on the prognostic significance of EKG LVH in these patients. Aim of this study was to evaluate the relationship between EKG LVH and the risk of future cardiovascular events in a wide group of patients with diabetes mellitus (DM). Methods A total of 1131 prospectively identified patients with type 1 (n=613, age 36 ± 13 years, 40 % women, BP 127 ± 16/79 ± 8 mmHg, total cholesterol 196 ± 43 mg/dl, HbA1C 7.81 ± 1.67%) and with type 2 DM (n=618, age 53 ± 11 years, 34 % women, BP 137 ± 18/82 ± 8 mmHg, total cholesterol 208 ± 41 mg/dl, HbA1C 7.97 ± 1.72%) were studied. At baseline all subjects underwent baseline clinical examination with blood pressure measurement according to current guidelines, standard laboratory examinations and a 12 leads electrocardiogram. LVH was defined as the presence of a “Sokolow-Lyon” voltage >38 mm and/or a “Cornell voltage QRS duration product” >2440 mm* msec. Treatment was not standardized. Results LVH prevalence was 8.3 % in type 2 DM and 6.4 % in type 1 DM. Patients were followed for 63 ± 27 months (range 1–126). A first non fatal cardiovascular event occurred in 62 patients. Kaplan-Meyer analysis revealed a higher risk of cardiovascular events in patients with LVH both with type 1 and type 2 DM (Log Rank Mantel Cox p<0.01). In Cox analysis, controlling for age, gender, BMI, history of cardiovascular disease, systolic blood pressure, heart rate, total plasma cholesterol, HbA1c, albuminuria and antihypertensive treatment, the presence of LVH was associated with an increased risk of cardiovascular events in all patients (odds ratio 2.96, 95% CI 1.39 to 6.32, p<0.01) and separately in DM type 1 (odds ratio 5.71, 95% CI 1.29 to 25.17, p=0.02) and in type 2 DM (odds ratio 2.92, 95% CI 1.02 to 8.35, p=0.05). Conclusions: Our data demonstrate that in patients with DM the detection of LVH by EKG is associated to an increased risk of cardiovascular events, independently of other risk factors and represent the first demonstration of the prognostic significance of EKG-LVH in patients with type 1 diabetes

The ageing heart

ESC CardioMed ◽  
2018 ◽  
pp. 150-154
Author(s):  
Magnus Bäck ◽  
Laure Joly ◽  
Nicolas Sadoul ◽  
Athanase Benetos
Keyword(s):  
Heart Disease ◽  
Cardiovascular Events ◽  
The Elderly ◽  
Left Ventricular ◽  
Cumulative Exposure ◽  
Diastolic Filling ◽  
Ischaemic Damage ◽  
Age Related ◽  
Increased Risk ◽  
Conductive System

The ageing heart is faced with age-related structural alterations of the coronary circulation, myocardium, valves, conductive system, and aorta, as well as the cumulative exposure to various cardiovascular risk factors over a lifetime. Coronary ageing in terms of atherosclerosis and coronary calcifications and the resulting ischaemic heart disease, imply specific diagnostic and therapeutic challenges in the elderly. In addition to a higher risk of ischaemic damage, the myocardial ageing per se is associated with left ventricular hypertrophy and increased stiffening, resulting in typical diastolic filling patterns with ageing. The myocardium may be further affected by the consequences of valvular ageing and an increased prevalence of either stenotic or regurgitant valvular heart disease. The conductance system also experiences age-related changes resulting in conduction abnormalities and arrhythmias. It should be emphasized that age-dependent arterial stiffening and hypertension may account for a heart–vessel coupling to further deteriorate the ageing heart. Ultimately all those factors participate in an age-related increased risk of cardiovascular events and heart failure. Finally, it is important to also consider extra-cardiac co-morbidities, frailty, and the cognitive and functional status of the older patient when evaluating the ageing heart.

Sign in / Sign up

Export Citation Format

Share Document