Pub Date : 2022-09-28DOI: 10.11909/j.issn.1671-5411.2022.09.003
Zhi Shang, Yang Liu, Yuyao Yuan, Xinyu Wang, Haiyi Yu, W. Gao
OBJECTIVES To analyze the differential expression of lipid spectrum between ST-segment elevated myocardial infarction (STEMI) and patients with emergency chest pain and excluded coronary artery disease (CAD), and establish the predictive model which could predict STEMI in the early stage. METHODS We conducted a single-center, nested case-control study using the emergency chest pain cohort of Peking University Third Hospital. Untargeted lipidomics were conducted while LASSO regression as well as XGBoost combined with greedy algorithm were used to select lipid molecules. RESULTS Fifty-two STEMI patients along with 52 controls were enrolled. A total of 1925 lipid molecules were detected. There were 93 lipid molecules in the positive ion mode which were differentially expressed between the STEMI and the control group, while in the negative ion mode, there were 73 differentially expressed lipid molecules. In the positive ion mode, the differentially expressed lipid subclasses were mainly diacylglycerol (DG), lysophophatidylcholine (LPC), acylcarnitine (CAR), lysophosphatidyl ethanolamine (LPE), and phosphatidylcholine (PC), while in the negative ion mode, significantly expressed lipid subclasses were mainly free fatty acid (FA), LPE, PC, phosphatidylethanolamine (PE), and phosphatidylinositol (PI). LASSO regression selected 22 lipids while XGBoost combined with greedy algorithm selected 10 lipids. PC (15: 0/18: 2), PI (19: 4), and LPI (20: 3) were the overlapping lipid molecules selected by the two feature screening methods. Logistic model established using the three lipids had excellent performance in discrimination and calibration both in the derivation set (AUC: 0.972) and an internal validation set (AUC: 0.967). In 19 STEMI patients with normal cardiac troponin, 18 patients were correctly diagnosed using lipid model. CONCLUSIONS The differentially expressed lipids were mainly DG, CAR, LPC, LPE, PC, PI, PE, and FA. Using lipid molecules selected by XGBoost combined with greedy algorithm and LASSO regression to establish model could accurately predict STEMI even in the more earlier stage.
{"title":"Early identification of STEMI patients with emergency chest pain using lipidomics combined with machine learning.","authors":"Zhi Shang, Yang Liu, Yuyao Yuan, Xinyu Wang, Haiyi Yu, W. Gao","doi":"10.11909/j.issn.1671-5411.2022.09.003","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.09.003","url":null,"abstract":"OBJECTIVES\u0000To analyze the differential expression of lipid spectrum between ST-segment elevated myocardial infarction (STEMI) and patients with emergency chest pain and excluded coronary artery disease (CAD), and establish the predictive model which could predict STEMI in the early stage.\u0000\u0000\u0000METHODS\u0000We conducted a single-center, nested case-control study using the emergency chest pain cohort of Peking University Third Hospital. Untargeted lipidomics were conducted while LASSO regression as well as XGBoost combined with greedy algorithm were used to select lipid molecules.\u0000\u0000\u0000RESULTS\u0000Fifty-two STEMI patients along with 52 controls were enrolled. A total of 1925 lipid molecules were detected. There were 93 lipid molecules in the positive ion mode which were differentially expressed between the STEMI and the control group, while in the negative ion mode, there were 73 differentially expressed lipid molecules. In the positive ion mode, the differentially expressed lipid subclasses were mainly diacylglycerol (DG), lysophophatidylcholine (LPC), acylcarnitine (CAR), lysophosphatidyl ethanolamine (LPE), and phosphatidylcholine (PC), while in the negative ion mode, significantly expressed lipid subclasses were mainly free fatty acid (FA), LPE, PC, phosphatidylethanolamine (PE), and phosphatidylinositol (PI). LASSO regression selected 22 lipids while XGBoost combined with greedy algorithm selected 10 lipids. PC (15: 0/18: 2), PI (19: 4), and LPI (20: 3) were the overlapping lipid molecules selected by the two feature screening methods. Logistic model established using the three lipids had excellent performance in discrimination and calibration both in the derivation set (AUC: 0.972) and an internal validation set (AUC: 0.967). In 19 STEMI patients with normal cardiac troponin, 18 patients were correctly diagnosed using lipid model.\u0000\u0000\u0000CONCLUSIONS\u0000The differentially expressed lipids were mainly DG, CAR, LPC, LPE, PC, PI, PE, and FA. Using lipid molecules selected by XGBoost combined with greedy algorithm and LASSO regression to establish model could accurately predict STEMI even in the more earlier stage.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123897846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-28DOI: 10.11909/j.issn.1671-5411.2022.09.010
T. Braun, Anne Wiegard, Johanna Geritz, C. Hansen, Kim Eng Tan, Hanna Hildesheim, J. Kudelka, C. Maetzler, J. Welzel, R. Romijnders, W. Maetzler, P. Bergmann
BACKGROUND Individuals with heart failure (HF) frequently experience limitations in mobility, but specific aspects of these limitations are not well understood. This study investigated the association of HF severity, based on the New York Heart Association (NYHA) classes, with digital mobility outcomes (DMOs) and handgrip strength in older inpatients with HF. METHODS For this explorative analysis, hospital admission and discharge data from an ongoing, prospective cohort study were used. The sample included older participants with HF and a sub-sample of heart-healthy individuals. Participants were equipped with a wearable inertial measurement unit (IMU) system during mobility performance (balancing, sit-to-stand transfer, walking). We analyzed the association between 17 DMOs and HF severity with multiple linear regression models. RESULTS The total sample included 61 older participants (65-97 years of age, 55.7% female). Of all DMOs, only sway path in a semi-tandem stance position (m/s²) showed a relevant association with NYHA classes (admission: β = -0.28, P = 0.09; discharge: β = -0.39, P = 0.02). Handgrip strength showed a trend towards a significant association (admission: β = -0.15, P = 0.10; discharge: β = -0.15, P = 0.19). CONCLUSIONS This is to our best knowledge the first analysis on the association of HF severity and IMU-based DMOs. Sway path and handgrip strength may be the most promising parameters for monitoring mobility aspects in treatment of HF.
背景:心力衰竭(HF)患者经常经历活动受限，但这些受限的具体方面尚不清楚。本研究基于纽约心脏协会(NYHA)分级调查HF严重程度与老年住院HF患者数字活动能力(DMOs)和握力的关系。方法探索性分析使用了一项正在进行的前瞻性队列研究的住院和出院数据。样本包括患有心力衰竭的老年参与者和心脏健康个体的亚样本。参与者在活动表现(平衡、坐立转换、行走)过程中配备可穿戴惯性测量单元(IMU)系统。我们用多元线性回归模型分析了17例DMOs与HF严重程度之间的关系。结果共纳入61例老年人(65 ~ 97岁，女性55.7%)。在所有DMOs中，只有半串联体位的摇摆路径(m/s²)与NYHA类别相关(准入:β = -0.28, P = 0.09;放电:β = -0.39, P = 0.02)。握力呈显著相关趋势(准入值:β = -0.15, P = 0.10;放电:β = -0.15, P = 0.19)。结论:据我们所知，这是第一次分析HF严重程度与基于imu的DMOs之间的关系。摇摆路径和握力可能是监测心衰治疗中移动性方面最有希望的参数。
{"title":"Association between heart failure severity and mobility in geriatric patients: an in-clinic study with wearable sensors.","authors":"T. Braun, Anne Wiegard, Johanna Geritz, C. Hansen, Kim Eng Tan, Hanna Hildesheim, J. Kudelka, C. Maetzler, J. Welzel, R. Romijnders, W. Maetzler, P. Bergmann","doi":"10.11909/j.issn.1671-5411.2022.09.010","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.09.010","url":null,"abstract":"BACKGROUND\u0000Individuals with heart failure (HF) frequently experience limitations in mobility, but specific aspects of these limitations are not well understood. This study investigated the association of HF severity, based on the New York Heart Association (NYHA) classes, with digital mobility outcomes (DMOs) and handgrip strength in older inpatients with HF.\u0000\u0000\u0000METHODS\u0000For this explorative analysis, hospital admission and discharge data from an ongoing, prospective cohort study were used. The sample included older participants with HF and a sub-sample of heart-healthy individuals. Participants were equipped with a wearable inertial measurement unit (IMU) system during mobility performance (balancing, sit-to-stand transfer, walking). We analyzed the association between 17 DMOs and HF severity with multiple linear regression models.\u0000\u0000\u0000RESULTS\u0000The total sample included 61 older participants (65-97 years of age, 55.7% female). Of all DMOs, only sway path in a semi-tandem stance position (m/s²) showed a relevant association with NYHA classes (admission: β = -0.28, P = 0.09; discharge: β = -0.39, P = 0.02). Handgrip strength showed a trend towards a significant association (admission: β = -0.15, P = 0.10; discharge: β = -0.15, P = 0.19).\u0000\u0000\u0000CONCLUSIONS\u0000This is to our best knowledge the first analysis on the association of HF severity and IMU-based DMOs. Sway path and handgrip strength may be the most promising parameters for monitoring mobility aspects in treatment of HF.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"19 9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129997049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-28DOI: 10.11909/j.issn.1671-5411.2022.09.005
Si-Yu Yan, Weixian Yang, P. Lu, Xuan Guo, Cai-Xia Guo, Yan-Ni Su, Li-hong Ma
BACKGROUND Chinese herbal medicine is widely used as a complement or alternative treatment in coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI) in China. We compared the incidence of the major adverse cardiovascular event (MACE) of CAD patients with or without the complement use of Chinese herbal medicine after PCI. METHODS In this prospective, observational study that was conducted from September 2016 to August 2019 in Fuwai Hospital (China), we followed up consecutive patients who received PCI treatment for two years. MACE was defined as the composite all-cause mortality, revascularization, and myocardial infarction (MI) and was compared between those using (integrative medicine group) or those not using Chinese herbal medicine as an additional treatment to standard Western medicine, with unadjusted (Kaplan-Meier curves) and risk-adjusted (multivariable Cox regression) analyses. RESULTS A total of 5942 patients after PCI were enrolled in this study, and 5453 patients were included in the final analysis (4189 [76.8%] male; mean age: 61.9 ± 9.9% years). During the follow-ups, 2932 (53.8%) patients used only Western medicine while 2521(46.2%) patients had used Chinese herbal medicine as an additional treatment to standard Western medicine. Patients in the integrative medicine group (IM group) were older than the Western medicine group (WM group), had more females and less previous MI. The incidence of MACE was 15.3% (449/2932) in WM group and 11.54% (291/2521) in IM group. Cox regression analysis showed that cumulative incidence of MACE was 27% lower in patients of the IM group than those in WM group (hazard ratio = 0.73; 95% CI: 0.63-0.85; P < 0.0001). CONCLUSIONS For CAD patients after PCI treatment, complement use of Chinese herbal medicine is associated with a lower 2-year MACE incidence. Randomized prospective studies are warranted to provide higher levels of benefit evidence in these patients.
{"title":"Complement use of Chinese herbal medicine after percutaneous coronary intervention: a prospective observational study.","authors":"Si-Yu Yan, Weixian Yang, P. Lu, Xuan Guo, Cai-Xia Guo, Yan-Ni Su, Li-hong Ma","doi":"10.11909/j.issn.1671-5411.2022.09.005","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.09.005","url":null,"abstract":"BACKGROUND\u0000Chinese herbal medicine is widely used as a complement or alternative treatment in coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI) in China. We compared the incidence of the major adverse cardiovascular event (MACE) of CAD patients with or without the complement use of Chinese herbal medicine after PCI.\u0000\u0000\u0000METHODS\u0000In this prospective, observational study that was conducted from September 2016 to August 2019 in Fuwai Hospital (China), we followed up consecutive patients who received PCI treatment for two years. MACE was defined as the composite all-cause mortality, revascularization, and myocardial infarction (MI) and was compared between those using (integrative medicine group) or those not using Chinese herbal medicine as an additional treatment to standard Western medicine, with unadjusted (Kaplan-Meier curves) and risk-adjusted (multivariable Cox regression) analyses.\u0000\u0000\u0000RESULTS\u0000A total of 5942 patients after PCI were enrolled in this study, and 5453 patients were included in the final analysis (4189 [76.8%] male; mean age: 61.9 ± 9.9% years). During the follow-ups, 2932 (53.8%) patients used only Western medicine while 2521(46.2%) patients had used Chinese herbal medicine as an additional treatment to standard Western medicine. Patients in the integrative medicine group (IM group) were older than the Western medicine group (WM group), had more females and less previous MI. The incidence of MACE was 15.3% (449/2932) in WM group and 11.54% (291/2521) in IM group. Cox regression analysis showed that cumulative incidence of MACE was 27% lower in patients of the IM group than those in WM group (hazard ratio = 0.73; 95% CI: 0.63-0.85; P < 0.0001).\u0000\u0000\u0000CONCLUSIONS\u0000For CAD patients after PCI treatment, complement use of Chinese herbal medicine is associated with a lower 2-year MACE incidence. Randomized prospective studies are warranted to provide higher levels of benefit evidence in these patients.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127534394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-28DOI: 10.11909/j.issn.1671-5411.2022.09.009
Ioannis Drosos, R. Rosa, P. Seppelt, S. Cremer, S. Mas-Peiro, K. Hemmann, Jana Oppermann, Recha Blessing, M. Vasa-Nicotera, A. Zeiher, Z. Dimitriadis
Background Percutaneous left atrial appendage occlusion (LAAO) requires puncture of the interatrial septum. The immediate hemodynamic effects of iatrogenic atrial septal defects (iASD) after LAAO have not been examined so far. We aimed at evaluating these effects through invasive measurements of pressure and oxygen saturation. Moreover, we assessed the incidence of persistent iASD at three months. METHODS Forty-eight patients scheduled for percutaneous LAAO were prospectively included in the study. Pressure and oxygen saturation were measured (1) in the right atrium (RA) before transseptal puncture, (2) in the left atrium (LA) through the transseptal sheath after transseptal puncture, (3) in the LA after removal of introducer sheath, and (4) in the RA after removal of introducer sheath. Transesophageal echocardiography was performed at three months to detect iASD. RESULTS Pressure in the RA increased significantly after removing the introducer sheath (P = 0.034), whereas no difference was found in oxygen saturation in the RA (P = 0.623). Pressure measurement in the LA showed no significant difference after removing the introducer sheath (P = 0.718). Oxygen saturation in the LA also showed no significant difference (P = 0.129). Follow-up transesophageal echocardiogram at 3 months revealed a persistent iASD in 4 patients (8.5 %). CONCLUSIONS Our study suggests that iASD after percutaneous LAAO does not result in significant shunts directly after the procedure, although a significant increase of mean right atrial pressure can be observed. Persistent iASDs after percutaneous LAAO seem to be relatively rare at three months.
{"title":"Iatrogenic atrial septal defects after transseptal puncture for percutaneous left atrial appendage occlusion and their hemodynamic effects.","authors":"Ioannis Drosos, R. Rosa, P. Seppelt, S. Cremer, S. Mas-Peiro, K. Hemmann, Jana Oppermann, Recha Blessing, M. Vasa-Nicotera, A. Zeiher, Z. Dimitriadis","doi":"10.11909/j.issn.1671-5411.2022.09.009","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.09.009","url":null,"abstract":"Background\u0000Percutaneous left atrial appendage occlusion (LAAO) requires puncture of the interatrial septum. The immediate hemodynamic effects of iatrogenic atrial septal defects (iASD) after LAAO have not been examined so far. We aimed at evaluating these effects through invasive measurements of pressure and oxygen saturation. Moreover, we assessed the incidence of persistent iASD at three months.\u0000\u0000\u0000METHODS\u0000Forty-eight patients scheduled for percutaneous LAAO were prospectively included in the study. Pressure and oxygen saturation were measured (1) in the right atrium (RA) before transseptal puncture, (2) in the left atrium (LA) through the transseptal sheath after transseptal puncture, (3) in the LA after removal of introducer sheath, and (4) in the RA after removal of introducer sheath. Transesophageal echocardiography was performed at three months to detect iASD.\u0000\u0000\u0000RESULTS\u0000Pressure in the RA increased significantly after removing the introducer sheath (P = 0.034), whereas no difference was found in oxygen saturation in the RA (P = 0.623). Pressure measurement in the LA showed no significant difference after removing the introducer sheath (P = 0.718). Oxygen saturation in the LA also showed no significant difference (P = 0.129). Follow-up transesophageal echocardiogram at 3 months revealed a persistent iASD in 4 patients (8.5 %).\u0000\u0000\u0000CONCLUSIONS\u0000Our study suggests that iASD after percutaneous LAAO does not result in significant shunts directly after the procedure, although a significant increase of mean right atrial pressure can be observed. Persistent iASDs after percutaneous LAAO seem to be relatively rare at three months.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"19 9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129643365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVE Lung function and grip strength (GS) are associated with cardiovascular disease (CVD), but whether these risk factors interact to affect CVD is unknown. This study aimed to explore the interactions between lung function and GS with major CVD (defined as fatal/non-fatal myocardial infarction, stroke, and heart failure) incidence. METHODS We conducted a prospective cohort study on the Chinese population in Jiangsu Province. Cox proportional hazards models were used to explore the associations between GS, lung function, and major CVD incidence. RESULTS A total of 5967 participants were included in our study; among them, 182 participants developed major CVD. Participants with low forced vital capacity (FVC) had a higher risk of major CVD (hazard ratio (HR) = 1.45; 95% confidence interval (CI): 1.05-2.01; P < 0.05) compared with normal FVC. The risk of major CVD incidence (HR = 0.54; 95% CI: 0.35-0.83; P < 0.01) was significantly lower in participants with high GS than in individuals with low GS. The interaction between FVC and GS for major CVD incidence (P = 0.006) was statistically significant. Compared with normal FVC participants with high GS, low FVC participants with low GS had the highest risk of major CVD incidence (HR = 2.50; 95% CI: 1.43-4.36; P < 0.01). CONCLUSION Among people with low FVC, the risk of major CVD is lower with high GS. Participants with low FVC and low GS have the highest risk of major CVD. Therefore, more attention should be paid to the incidence of major CVD in individuals with low FVC, especially those who have lower GS.
{"title":"The interaction effect of grip strength and lung function (especially FVC) on cardiovascular diseases: a prospective cohort study in Jiangsu Province, China.","authors":"Jiali Liu, Jiaqi Wang, Dan Wang, Yu Qin, Yongqing Zhang, Q. Xiang","doi":"10.11909/j.issn.1671-5411.2022.09.007","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.09.007","url":null,"abstract":"OBJECTIVE\u0000Lung function and grip strength (GS) are associated with cardiovascular disease (CVD), but whether these risk factors interact to affect CVD is unknown. This study aimed to explore the interactions between lung function and GS with major CVD (defined as fatal/non-fatal myocardial infarction, stroke, and heart failure) incidence.\u0000\u0000\u0000METHODS\u0000We conducted a prospective cohort study on the Chinese population in Jiangsu Province. Cox proportional hazards models were used to explore the associations between GS, lung function, and major CVD incidence.\u0000\u0000\u0000RESULTS\u0000A total of 5967 participants were included in our study; among them, 182 participants developed major CVD. Participants with low forced vital capacity (FVC) had a higher risk of major CVD (hazard ratio (HR) = 1.45; 95% confidence interval (CI): 1.05-2.01; P < 0.05) compared with normal FVC. The risk of major CVD incidence (HR = 0.54; 95% CI: 0.35-0.83; P < 0.01) was significantly lower in participants with high GS than in individuals with low GS. The interaction between FVC and GS for major CVD incidence (P = 0.006) was statistically significant. Compared with normal FVC participants with high GS, low FVC participants with low GS had the highest risk of major CVD incidence (HR = 2.50; 95% CI: 1.43-4.36; P < 0.01).\u0000\u0000\u0000CONCLUSION\u0000Among people with low FVC, the risk of major CVD is lower with high GS. Participants with low FVC and low GS have the highest risk of major CVD. Therefore, more attention should be paid to the incidence of major CVD in individuals with low FVC, especially those who have lower GS.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122409488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-28DOI: 10.11909/j.issn.1671-5411.2022.09.001
Sara Lk Clemmensen, K. Kragholm, B. Tayal, C. Torp‐Pedersen, S. Kold, P. Søgaard, S. Riahi
BACKGROUND It has previously been described that fall-associated injuries including fractures are commonly observed among patients with bradyarrhythmia. However, knowledge on the risk of pacemaker implantation after admission due to femur fracture from large population-based epidemiologic data is lacking. Therefore, we investigated the risk of pacemaker implantation following femur fracture in patients with and without a history of previous syncope. METHODS All patients with femur fracture between 2005-2017 were identified using the Danish Nationwide Patient Registry. Among these, patients already having a pacemaker were excluded. Primary outcome was one-year risk of pacemaker implantation and secondary outcome was one-year all-cause mortality. Multivariable logistic regression was used to obtain absolute and relative risks of the study endpoint in relation to patients with versus without history of syncope and standardized to the age, sex, selected comorbidity and pharmacotherapy distribution of all patients. RESULTS Of 93,093 patients with femur fracture, 5508 (5.9%) had a history of syncope within five years. Patients with prior syncope were slightly older (84 vs. 83 years), more often male (33.6% vs. 29.4%), and had more often comorbidities relative to those without history of syncope. All-cause mortality was significantly higher among those with previous history of syncope compared to those without previous syncope (29.9% vs. 28.6%, P = 0.021). The relative mortality risk was 1.05 (95% CI: 1.01-1.09, P = 0.021). A total of 695 (0.8%) patients underwent pacemaker implantation within 5 years following femur fracture, and a significantly higher proportion of patients with syncope had a pacemaker implanted within one year (1.6% vs. 0.7%, P < 0.001; relative risk, 2.01 [95% CI: 1.55-2.46]). CONCLUSIONS In patients with femur fracture, a history of syncope was significantly associated with a higher one-year risk of pacemaker implantation.
背景:先前有报道称，包括骨折在内的跌倒相关损伤在慢速心律失常患者中很常见。然而，从基于大量人群的流行病学数据中缺乏关于入院后因股骨骨折植入起搏器的风险的知识。因此，我们调查了有或没有晕厥病史的患者股骨骨折后植入起搏器的风险。方法2005-2017年期间所有股骨骨折患者均通过丹麦全国患者登记处进行识别。其中，已经安装起搏器的患者被排除在外。主要结局是一年的起搏器植入风险，次要结局是一年的全因死亡率。采用多变量logistic回归获得研究终点与有无晕厥史患者的绝对和相对风险，并将所有患者的年龄、性别、选择的合并症和药物治疗分布标准化。结果93093例股骨骨折患者中，5508例(5.9%)5年内有晕厥病史。有晕厥病史的患者年龄稍大(84岁对83岁)，多为男性(33.6%对29.4%)，并且与无晕厥病史的患者相比，有更多的合并症。有晕厥史者的全因死亡率明显高于无晕厥史者(29.9%比28.6%，P = 0.021)。相对死亡风险为1.05 (95% CI: 1.01-1.09, P = 0.021)。共有695例(0.8%)患者在股骨骨折后的5年内植入了起搏器，晕厥患者在1年内植入起搏器的比例明显更高(1.6% vs. 0.7%， P < 0.001;相对危险度为2.01 [95% CI: 1.55-2.46])。结论在股骨骨折患者中，有晕厥史的患者一年内植入起搏器的风险较高。
{"title":"Risk of pacemaker implantation after femur fracture in patients with and without a history syncope: a Danish nationwide registry-based follow-up study.","authors":"Sara Lk Clemmensen, K. Kragholm, B. Tayal, C. Torp‐Pedersen, S. Kold, P. Søgaard, S. Riahi","doi":"10.11909/j.issn.1671-5411.2022.09.001","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.09.001","url":null,"abstract":"BACKGROUND\u0000It has previously been described that fall-associated injuries including fractures are commonly observed among patients with bradyarrhythmia. However, knowledge on the risk of pacemaker implantation after admission due to femur fracture from large population-based epidemiologic data is lacking. Therefore, we investigated the risk of pacemaker implantation following femur fracture in patients with and without a history of previous syncope.\u0000\u0000\u0000METHODS\u0000All patients with femur fracture between 2005-2017 were identified using the Danish Nationwide Patient Registry. Among these, patients already having a pacemaker were excluded. Primary outcome was one-year risk of pacemaker implantation and secondary outcome was one-year all-cause mortality. Multivariable logistic regression was used to obtain absolute and relative risks of the study endpoint in relation to patients with versus without history of syncope and standardized to the age, sex, selected comorbidity and pharmacotherapy distribution of all patients.\u0000\u0000\u0000RESULTS\u0000Of 93,093 patients with femur fracture, 5508 (5.9%) had a history of syncope within five years. Patients with prior syncope were slightly older (84 vs. 83 years), more often male (33.6% vs. 29.4%), and had more often comorbidities relative to those without history of syncope. All-cause mortality was significantly higher among those with previous history of syncope compared to those without previous syncope (29.9% vs. 28.6%, P = 0.021). The relative mortality risk was 1.05 (95% CI: 1.01-1.09, P = 0.021). A total of 695 (0.8%) patients underwent pacemaker implantation within 5 years following femur fracture, and a significantly higher proportion of patients with syncope had a pacemaker implanted within one year (1.6% vs. 0.7%, P < 0.001; relative risk, 2.01 [95% CI: 1.55-2.46]).\u0000\u0000\u0000CONCLUSIONS\u0000In patients with femur fracture, a history of syncope was significantly associated with a higher one-year risk of pacemaker implantation.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132833761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-28DOI: 10.11909/j.issn.1671-5411.2022.09.008
B. Ostrowska, L. Lind, E. Sciaraffia, C. Blomström-Lundqvist
BACKGROUND Early identification of patients at risk of congestive heart failure (HF) may alter their poor prognosis. The aim was therefore to test whether simple electrocardiographic variables, the P-wave and PR-interval, could predict incident HF. METHODS The PIVUS (Prospective Investigation of the Vasculature in Uppsala Seniors) study (1016 individuals all aged 70 years, 50% women) was used to identify predictors of HF. Subjects with prevalent HF, QRS duration ≥ 130 ms, atrial tachyarrhythmias, implanted pacemaker/defibrillator, second- and third-degree atrioventricular block or delta waves at baseline were excluded. Cox proportional hazard analysis was used to relate the PR interval, P-wave duration (Pdur) and amplitude (Pamp), measured in lead V1, to incident HF. Adjustment was performed for gender, RR-interval, beta-blocking agents, systolic blood pressure, body mass index and smoking. RESULTS Out of 836 subjects at risk, 107 subjects were diagnosed with HF during a follow-up of 15 years. In the multivariate analysis, there was a strong U-shaped correlation between Pdur in lead V1 and incident HF (P = 0.0001) which was significant for a Pdur < 60 ms [HR = 2.75; 95% CI: 1.87-4.06, at Pdur 40 ms] but not for prolonged Pdur. There was no significant relationship between incident HF and the PR-interval or the Pamp. A Pdur < 60 ms improved discrimination by 3.7% when added to the traditional risk factors including sex, RR-interval, beta-blocking agents, systolic blood pressure, BMI and smoking (P = 0.048). CONCLUSIONS A short Pdur, an easily measured parameter on the ECG, may potentially be a useful marker of future HF, enabling its early detection and prevention, thus improving outcomes.
{"title":"A short P-wave duration is associated with incident heart failure in the elderly: a 15 years follow-up cohort study.","authors":"B. Ostrowska, L. Lind, E. Sciaraffia, C. Blomström-Lundqvist","doi":"10.11909/j.issn.1671-5411.2022.09.008","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.09.008","url":null,"abstract":"BACKGROUND\u0000Early identification of patients at risk of congestive heart failure (HF) may alter their poor prognosis. The aim was therefore to test whether simple electrocardiographic variables, the P-wave and PR-interval, could predict incident HF.\u0000\u0000\u0000METHODS\u0000The PIVUS (Prospective Investigation of the Vasculature in Uppsala Seniors) study (1016 individuals all aged 70 years, 50% women) was used to identify predictors of HF. Subjects with prevalent HF, QRS duration ≥ 130 ms, atrial tachyarrhythmias, implanted pacemaker/defibrillator, second- and third-degree atrioventricular block or delta waves at baseline were excluded. Cox proportional hazard analysis was used to relate the PR interval, P-wave duration (Pdur) and amplitude (Pamp), measured in lead V1, to incident HF. Adjustment was performed for gender, RR-interval, beta-blocking agents, systolic blood pressure, body mass index and smoking.\u0000\u0000\u0000RESULTS\u0000Out of 836 subjects at risk, 107 subjects were diagnosed with HF during a follow-up of 15 years. In the multivariate analysis, there was a strong U-shaped correlation between Pdur in lead V1 and incident HF (P = 0.0001) which was significant for a Pdur < 60 ms [HR = 2.75; 95% CI: 1.87-4.06, at Pdur 40 ms] but not for prolonged Pdur. There was no significant relationship between incident HF and the PR-interval or the Pamp. A Pdur < 60 ms improved discrimination by 3.7% when added to the traditional risk factors including sex, RR-interval, beta-blocking agents, systolic blood pressure, BMI and smoking (P = 0.048).\u0000\u0000\u0000CONCLUSIONS\u0000A short Pdur, an easily measured parameter on the ECG, may potentially be a useful marker of future HF, enabling its early detection and prevention, thus improving outcomes.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"11 8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126630100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVE To investigate the effects of Tongmai Yangxin Pill (TMYXP) combined with metoprolol tartrate or metoprolol alone for the treatment of premature ventricular complex (PVC) in patients with symptomatic frequent PVC. METHODS A total of 584 patients with symptomatic frequent PVC were randomly assigned (in a 1:1 ratio) into two groups: study group [n = 292, TMYXP (40 pills twice/day, orally) combined with metoprolol tartrate (25 mg twice/day, orally)] and control group [n = 292, metoprolol tartrate (25 mg twice/day, orally) plus placebo pill (40 pills twice/day, orally)]. The total treatment period was eight weeks. RESULTS After eight weeks of treatment, the total effective rate of reduction of PVC in the study group and the control group were 76.4% and 51.4%, respectively (P < 0.001). TMYXP combined with metoprolol tartrate demonstrated a significantly greater reduction of the frequency of PVCs compared with the metoprolol tartrate alone (−4537 times/24 h vs. −3013 times/24 h, P < 0.001). The study group also showed a better result compared with the control group with respect to PVC related symptoms. In terms of New York Heart Association classification improvement, the total effective rates were 21.9% in the study group and 12.4% in the control group ( P < 0.05). Both the study group and the control group exhibited improvements in echocardiographic indexes. Left ventricular ejection fraction was significantly improved in the study group compared with the control group ( P < 0.05). There was no significant difference in the incidence of adverse events between the two groups. CONCLUSIONS Compared with metoprolol tartrate alone, TMYXP combined with metoprolol tartrate could more effectively reduce the frequency of PVC and alleviated PVC related symptoms, and improve cardiac function in patients with symptomatic PVC.
目的探讨通脉养心丸(TMYXP)联合酒石酸美托洛尔或单独美托洛尔治疗有症状的频繁室性早搏(PVC)的疗效。方法将584例有症状的频繁PVC患者随机分为两组(按1:1比例):研究组[n = 292, TMYXP(40粒，2次/天，口服)联合酒石酸美托洛尔(25 mg, 2次/天，口服)]和对照组[n = 292，酒石酸美托洛尔(25 mg, 2次/天，口服)+安慰剂丸(40粒，2次/天，口服)]。总治疗期为8周。结果治疗8周后，研究组和对照组的总有效率分别为76.4%和51.4% (P < 0.001)。与单独使用酒石酸美托洛尔相比，TMYXP联合使用酒石酸美托洛尔可显著降低室性早搏频率(- 4537次/24 h vs - 3013次/24 h, P < 0.001)。与对照组相比，研究组在与PVC相关的症状方面也显示出更好的结果。在纽约心脏协会分级改善方面，研究组总有效率为21.9%，对照组总有效率为12.4% (P < 0.05)。研究组和对照组超声心动图指标均有改善。研究组左室射血分数明显高于对照组(P < 0.05)。两组患者不良事件发生率无显著差异。结论与单用酒石酸美托洛尔相比，TMYXP联合酒石酸美托洛尔能更有效地降低PVC发生频率，缓解PVC相关症状，改善症状性PVC患者心功能。
{"title":"Tongmai Yangxin Pill combined with metoprolol or metoprolol alone for the treatment of symptomatic premature ventricular complex: a multicenter, randomized, parallel-controlled clinical study","authors":"Li-Jun Liu, Guohua Zhu, Hong Luo, Xi-peng Sun, Jing Li, Qifeng Hua","doi":"10.11909/j.issn.1671-5411.2022.04.008","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.04.008","url":null,"abstract":"OBJECTIVE To investigate the effects of Tongmai Yangxin Pill (TMYXP) combined with metoprolol tartrate or metoprolol alone for the treatment of premature ventricular complex (PVC) in patients with symptomatic frequent PVC. METHODS A total of 584 patients with symptomatic frequent PVC were randomly assigned (in a 1:1 ratio) into two groups: study group [n = 292, TMYXP (40 pills twice/day, orally) combined with metoprolol tartrate (25 mg twice/day, orally)] and control group [n = 292, metoprolol tartrate (25 mg twice/day, orally) plus placebo pill (40 pills twice/day, orally)]. The total treatment period was eight weeks. RESULTS After eight weeks of treatment, the total effective rate of reduction of PVC in the study group and the control group were 76.4% and 51.4%, respectively (P < 0.001). TMYXP combined with metoprolol tartrate demonstrated a significantly greater reduction of the frequency of PVCs compared with the metoprolol tartrate alone (−4537 times/24 h vs. −3013 times/24 h, P < 0.001). The study group also showed a better result compared with the control group with respect to PVC related symptoms. In terms of New York Heart Association classification improvement, the total effective rates were 21.9% in the study group and 12.4% in the control group ( P < 0.05). Both the study group and the control group exhibited improvements in echocardiographic indexes. Left ventricular ejection fraction was significantly improved in the study group compared with the control group ( P < 0.05). There was no significant difference in the incidence of adverse events between the two groups. CONCLUSIONS Compared with metoprolol tartrate alone, TMYXP combined with metoprolol tartrate could more effectively reduce the frequency of PVC and alleviated PVC related symptoms, and improve cardiac function in patients with symptomatic PVC.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130471427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-28DOI: 10.11909/j.issn.1671-5411.2022.04.003
Jose Rivas Rios, Yi-xin Zhang, M. Oye, Civan Altunkaynak, Jinous Saremian, E. Missov
L iposarcoma is one of the most common soft tissue sarcomas, representing 50% of all retroperitoneal sarcomas. A large retroperitoneal sarcoma can exert mass effect on intraabdominal organs and the thoracic cavity producing symptoms similar to those seen in acute decompensated heart failure (HF), such as abdominal swelling, dyspnea on exertion, and orthopnea. However, the presentation with new-onset HF masking a massive retroperitoneal liposarcoma is exceedingly rare. Here, we present an interesting case of an elderly patient with new-onset decompensated HF in the setting of multi-vessel coronary artery disease who responded well to intravenous diuretic therapy without complete symptom resolution. Further workup showed a massive retroperitoneal sarcoma as the contributing etiology. Given his poor cardiac function, he was not initially a surgical candidate. However, after being placed on appropriate goal-directed medical therapy, he experienced recovery in his ejection fraction (EF) and is now a surgical candidate. A 78-year-old male with a history of hypertension, hyperlipidemia, and tobacco abuse came to the emergency room with complaints of progressive shortness of breath, orthopnea, and abdominal distention. On initial evaluation, the patient was normotensive, tachycardiac, and volume overloaded. The laboratory results showed elevated N-terminal pro-B-type natriuretic peptide level with a benign comprehensive metabolic panel. Chest X-ray revealed cardiomegaly with pulmonary vascular congestion. Transthoracic echocardiogram showed a severely reduced EF of 10%–15%, left ventricular eccentric hypertrophy and global hypokinesis. He responded well to intravenous diuretics, but had persistent orthopnea and minimal improvement of abdominal distension. He underwent computed tomography of the abdomen and pelvis which showed an extremely bulky, multi-lobulated retroperitoneal mass measuring 29 cm × 33 cm × 35 cm with mass effect on multiple intra-abdominal organs (Figure 1). Computed tomography guided core needle biopsy of the mass confirmed well-differentiated liposarcoma (WDLPS) with atypical spindle cells and adipocytes (Figure 2). Fluorescence in situ hybridization analysis revealed murine double minute 2 (MDM2) amplification. No evidence of metastatic disease was found on additional workup. The patient was not initially a candidate for surgical resection due to his low EF, however, after three months of goal-directed medical therapy, he had recovery in EF from 10%− 15% to 40%. Outpatient ischemic evaluation revealed multivessel disease and he underwent coronary artery bypass surgery. He is planned for tumor resection. Sarcomas are a heterogeneous group of over 80 different tumors arising from mesenchymal or connective tissue. In 2018, soft tissue sarcomas represented approximately 0.8% of all cancers in the United States. Pure WDLS accounts for approximately Journal of Geriatric Cardiology
{"title":"New-onset heart failure masking a massive retroperitoneal liposarcoma","authors":"Jose Rivas Rios, Yi-xin Zhang, M. Oye, Civan Altunkaynak, Jinous Saremian, E. Missov","doi":"10.11909/j.issn.1671-5411.2022.04.003","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.04.003","url":null,"abstract":"L iposarcoma is one of the most common soft tissue sarcomas, representing 50% of all retroperitoneal sarcomas. A large retroperitoneal sarcoma can exert mass effect on intraabdominal organs and the thoracic cavity producing symptoms similar to those seen in acute decompensated heart failure (HF), such as abdominal swelling, dyspnea on exertion, and orthopnea. However, the presentation with new-onset HF masking a massive retroperitoneal liposarcoma is exceedingly rare. Here, we present an interesting case of an elderly patient with new-onset decompensated HF in the setting of multi-vessel coronary artery disease who responded well to intravenous diuretic therapy without complete symptom resolution. Further workup showed a massive retroperitoneal sarcoma as the contributing etiology. Given his poor cardiac function, he was not initially a surgical candidate. However, after being placed on appropriate goal-directed medical therapy, he experienced recovery in his ejection fraction (EF) and is now a surgical candidate. A 78-year-old male with a history of hypertension, hyperlipidemia, and tobacco abuse came to the emergency room with complaints of progressive shortness of breath, orthopnea, and abdominal distention. On initial evaluation, the patient was normotensive, tachycardiac, and volume overloaded. The laboratory results showed elevated N-terminal pro-B-type natriuretic peptide level with a benign comprehensive metabolic panel. Chest X-ray revealed cardiomegaly with pulmonary vascular congestion. Transthoracic echocardiogram showed a severely reduced EF of 10%–15%, left ventricular eccentric hypertrophy and global hypokinesis. He responded well to intravenous diuretics, but had persistent orthopnea and minimal improvement of abdominal distension. He underwent computed tomography of the abdomen and pelvis which showed an extremely bulky, multi-lobulated retroperitoneal mass measuring 29 cm × 33 cm × 35 cm with mass effect on multiple intra-abdominal organs (Figure 1). Computed tomography guided core needle biopsy of the mass confirmed well-differentiated liposarcoma (WDLPS) with atypical spindle cells and adipocytes (Figure 2). Fluorescence in situ hybridization analysis revealed murine double minute 2 (MDM2) amplification. No evidence of metastatic disease was found on additional workup. The patient was not initially a candidate for surgical resection due to his low EF, however, after three months of goal-directed medical therapy, he had recovery in EF from 10%− 15% to 40%. Outpatient ischemic evaluation revealed multivessel disease and he underwent coronary artery bypass surgery. He is planned for tumor resection. Sarcomas are a heterogeneous group of over 80 different tumors arising from mesenchymal or connective tissue. In 2018, soft tissue sarcomas represented approximately 0.8% of all cancers in the United States. Pure WDLS accounts for approximately Journal of Geriatric Cardiology","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121601861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-28DOI: 10.11909/j.issn.1671-5411.2022.04.009
A. De Giorgi, R. Cappadona, Caterina Savrié, B. Boari, R. Tiseo, Giulia Marta Viglione, C. Molino, E. Misurati, M. Pasin, R. Manfredini, F. Fabbian
BACKGROUND Masked diastolic hypotension is a new blood pressure (BP) pattern detected by ambulatory blood pressure monitoring (ABPM) in elderly hypertensives. The aim of this study was to relate ABPM and comorbidity in a cohort of fit elderly subjects attending an outpatient hypertension clinic. METHODS Comorbidity was assessed by Charlson comorbidity index (CCI) and CHA2DS2VASc score. All subjects evaluated with ABPM were aged ≥ 65 years. CCI and CHA2DS2VASc score were calculated. Diastolic hypotension was defined as mean ambulatory diastolic BP < 65 mmHg and logistic regression analysis was carried out in order to detect and independent relationship between comorbidity burden and night-time diastolic BP < 65 mmHg. RESULTS We studied 174 hypertensive elderly patients aged 72.1 ± 5.2 years, men were 93 (53.4%). Mean CCI was 0.91 ± 1.14 and mean CHA2DS2VASc score of 2.68 ± 1.22. Subjects with night-time mean diastolic values < 65 mmHg were higher in females [54.7% vs. 45.3%, P = 0.048; odds ratio (OR) = 1.914, 95% CI: 1.047−3.500]. Logistic regression analysis showed that only CHA2DS2VASc score was independently associated with night-time mean diastolic values < 65 mmHg (OR = 1.518, 95% CI: 1.161−1.985; P = 0.002), but CCI was not. CONCLUSIONS ABPM and comorbidity evaluation appear associated in elderly fit subjects with masked hypotension. Comorbid women appear to have higher risk for low ambulatory BP.
{"title":"Ambulatory diastolic blood pressure: a marker of comorbidity in elderly fit hypertensive individuals?","authors":"A. De Giorgi, R. Cappadona, Caterina Savrié, B. Boari, R. Tiseo, Giulia Marta Viglione, C. Molino, E. Misurati, M. Pasin, R. Manfredini, F. Fabbian","doi":"10.11909/j.issn.1671-5411.2022.04.009","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2022.04.009","url":null,"abstract":"BACKGROUND Masked diastolic hypotension is a new blood pressure (BP) pattern detected by ambulatory blood pressure monitoring (ABPM) in elderly hypertensives. The aim of this study was to relate ABPM and comorbidity in a cohort of fit elderly subjects attending an outpatient hypertension clinic. METHODS Comorbidity was assessed by Charlson comorbidity index (CCI) and CHA2DS2VASc score. All subjects evaluated with ABPM were aged ≥ 65 years. CCI and CHA2DS2VASc score were calculated. Diastolic hypotension was defined as mean ambulatory diastolic BP < 65 mmHg and logistic regression analysis was carried out in order to detect and independent relationship between comorbidity burden and night-time diastolic BP < 65 mmHg. RESULTS We studied 174 hypertensive elderly patients aged 72.1 ± 5.2 years, men were 93 (53.4%). Mean CCI was 0.91 ± 1.14 and mean CHA2DS2VASc score of 2.68 ± 1.22. Subjects with night-time mean diastolic values < 65 mmHg were higher in females [54.7% vs. 45.3%, P = 0.048; odds ratio (OR) = 1.914, 95% CI: 1.047−3.500]. Logistic regression analysis showed that only CHA2DS2VASc score was independently associated with night-time mean diastolic values < 65 mmHg (OR = 1.518, 95% CI: 1.161−1.985; P = 0.002), but CCI was not. CONCLUSIONS ABPM and comorbidity evaluation appear associated in elderly fit subjects with masked hypotension. Comorbid women appear to have higher risk for low ambulatory BP.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114558172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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