Journal of Geriatric Cardiology最新文献

Objectives: To compare respiratory parameters of peripheral blood mononuclear cell mitochondria and iron metabolism indicators in patients with different NYHA functional classes of ischemic heart failure (HF).

Methods: This single center, prospective, non-blinded study enrolled 20 patients with diagnosed chronic HF of ischemic genesis with reduced and mildly reduced left ventricle ejection fraction. The maximum oxygen consumption at the peak of the exercise test (VO₂ peak), iron metabolism parameters and respiratory activity of peripheral blood mononuclear cell mitochondria were assessed.

Results: Among the patients, a half of individuals were diagnosed with iron deficiency. Subgroups of patients with different HF severity did not significant differ in VO₂ peak (P = 0.209), serum iron (P = 0.468) and ferritin (P = 0.235) levels. But there was a trend in increasing in these parameters with increasing NYHA HF functional class. Respiratory control coefficient (RC) in NAD-dependent and FAD-dependent mitochondrial oxidation were lower in patients with NYHA HF III functional class compared to individuals with NYHA HF I functional class (P = 0.028 and P = 0.040, respectively). Serum iron (P = 0.026), ferritin (P = 0.045) levels, transferrin saturation (P = 0.006) were negatively correlated with RC in NAD-dependent mitochondrial oxidation.

Conclusions: In aggravation of ischemic HF NYHA FC, there is a decrease in RC of PBMC mitochondria during the oxidation of NAD-dependent and FAD-dependent substrates. In the whole sample, patients with laboratory-confirmed iron deficiency accounted a half of the total number. Iron metabolism parameters had a paradoxical inverse relationship with the level of RC in PBMC mitochondria of patients with HF.

Background: Patients aged 85 years or older admitted for heart failure (HF) have increased enormously due to improved survival in this disease. However, few studies assess the characteristics, treatments, and prognosis of very elderly patients admitted for acute HF.

Methods: This study is a retrospective analysis of the EPICTER registry, that included patients admitted for acute HF in 74 Spanish hospitals. For this analysis, a total of 1887 patients were included and divided into 2 groups: 85 years or older (very elderly, 680 patients) and those under 85 years.

Results: Compared to patients < 85 years, very elderly patients were more frequently women, had more hypertension and disease cerebrovascular disease, and less presence of chronic obstructive pulmonary disease (COPD), diabetes, and acute myocardial infarction. There were no differences in symptoms, except for delirium, significantly more common in very elderly patients. Management of these patients was more conservative and died more than the younger ones (41% vs. 25%, P < 0.001). The predictor variables of mortality in very elderly patients were the presence of COPD and peripheral arterial disease, delirium, and estimated survival of less than 6 months assessed by the physician in charge of the patient care.

Conclusion: Very elderly patients admitted for HF differ from younger ones in comorbidities, management, and symptoms, and have higher mortality. The presence of delirium, peripheral arterial disease, and COPD worsen the prognosis in these patients and can help to adapt the therapeutic effort and place emphasis on adequate symptom control.

Background: Cardiac resynchronization therapy (CRT) has been a major therapeutic advancement for patients with heart failure and electrical dyssynchrony. While CRT improves symptoms, reduces hospitalizations, and enhances survival, the role of implantable cardioverter-defibrillators (ICDs) alongside CRT in patients with non-ischemic cardiomyopathy (NICM) remains controversial. To evaluate and compare the outcomes of CRT with ICD (CRT-D) versus CRT with pacemaker-only (CRT-P) in individuals diagnosed with NICM, with a specific focus on the elderly.

Methods: A comprehensive search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted in January 2024. Studies comparing CRT-D and CRT-P in patients with NICM were included, with subgroup analyses focusing on patients aged 75 years and older.

Results: Twelve studies, including two randomized clinical trials, with a total of 62,145 patients and 16,754 pooled death events (9,171 in CRT-D and 7,583 in CRT-P), were analyzed. CRT-D was associated with a significantly lower risk of all-cause mortality compared to CRT-P (pooled OR = 0.72; 95% CI: 0.61-0.85; P < 0.01), with significant heterogeneity (I ² = 83%). RCT subgroup analysis, was not statistically significant (pooled OR = 0.82; 95% CI: 0.64-1.06; P = 0.41; I ² = 0%). In patients older than 75 years, no significant difference in mortality risk was observed (pooled OR 0.96; 95% CI: 0.81-1.15; I ²=39%).

Conclusion: Our meta-analysis suggests that the addition of ICD therapy to CRT in patients with NICM significantly reduces all-cause mortality. However, this benefit does not extend to cardiovascular mortality, likely due to the primary role of ICDs in preventing sudden cardiac death rather than other causes such as progressive heart failure. The survival advantage of CRT-D is most pronounced in younger patients, with those over 75 years of age deriving less benefit. This highlights the importance of careful patient selection, considering age and comorbidities, when deciding on ICD implantation in NICM patients.

[This corrects the article DOI: 10.11909/j.issn.1671-5411.2017.08.005.].

Background: Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem. The aim of the study was to assess the incidence of delirium and determine the risk factors for delirium in patients ≥ 60 years of age hospitalized due to acute myocardial infarction (AMI).

Methods: The study included 405 consecutive patients (mean age: 73.1 ± 8.5, males: 61%) hospitalized due to AMI divided and characterized according to the in-hospital delirium presence.

Results: Of 405 patients, 57 (14%, mean age: 80.9 ± 7.3, males: 58%) experienced delirium. Patients with delirium were older (80.9 ± 7.3 vs. 71.82 ± 8.1 years), all of them presented multimorbidity, they more frequently used polypharmacy (96.5 vs. 30.2%) and their hospitalization was longer (8.0 ± 1.4 vs. 4.6 ± 1.0 days) as compared to the patients without delirium. Patients with delirium more frequently experience periprocedural complications as well as the in-hospital reversible problems: fever (40.4 vs. 0.9%), infections (78.9 vs. 3.7%), pulmonary oedema (73.7 vs. 0.6%), hypoxemia (91.1 vs. 98.3%), urinary catheter (96.5 vs. 17.2%), dehydration (89.5 vs. 6.6%), and insomnia (71.9 vs. 0.3%) compared to patients without delirium (P < 0.001 for all). Valvular heart disease (OR = 4.78; 95%CI: 1.10-2.70; P < 0.001, pulmonary oedema (OR = 66.79; 95%CI: 12.04-370.34, P < 0.001), and dehydration (OR = 37.26; 95%CI: 10.50-132.27, P < 0.001) were risk factors for delirium occurrence.

Conclusions: The in-hospital course of AMI is complicated by delirium occurrence in 14% of patients ≥ 60 years old. Recognizing and modification of potential, reversible risk factors associated with AMI can reduce the risk of delirium.

Background: Non-invasive computed tomography angiography (CTA)-based fractional flow reserve (CT-FFR) could become a gatekeeper to invasive coronary angiography. Deep learning (DL)-based CT-FFR has shown promise when compared to invasive FFR. To evaluate the performance of a DL-based CT-FFR technique, DeepVessel FFR (DVFFR).

Methods: This retrospective study was designed for iScheMia Assessment based on a Retrospective, single-center Trial of CT-FFR (SMART). Patients suspected of stable coronary artery disease (CAD) and undergoing both CTA and invasive FFR examinations were consecutively selected from the Beijing Anzhen Hospital between January 1, 2016 to December 30, 2018. FFR obtained during invasive coronary angiography was used as the reference standard. DVFFR was calculated blindly using a DL-based CT-FFR approach that utilized the complete tree structure of the coronary arteries.

Results: Three hundred and thirty nine patients (60.5 ±10.0 years and 209 men) and 414 vessels with direct invasive FFR were included in the analysis. At per-vessel level, sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of DVFFR were 94.7%, 88.6%, 90.8%, 82.7%, and 96.7%, respectively. The area under the receiver operating characteristics curve (AUC) was 0.95 for DVFFR and 0.56 for CTA-based assessment with a significant difference (P < 0.0001). At patient level, sensitivity, specificity, accuracy, PPV and NPV of DVFFR were 93.8%, 88.0%, 90.3%, 83.0%, and 95.8%, respectively. The computation for DVFFR was fast with the average time of 22.5 ± 1.9 s.

Conclusions: The results demonstrate that DVFFR was able to evaluate lesion hemodynamic significance accurately and effectively with improved diagnostic performance over CTA alone. Coronary artery disease (CAD) is a critical disease in which coronary artery luminal narrowing may result in myocardial ischemia. Early and effective assessment of myocardial ischemia is essential for optimal treatment planning so as to improve the quality of life and reduce medical costs.