Echocardiographic predictors of late mortality in elderly patients with acute coronary syndromes.
BACKGROUND
Echocardiographic ventricular function predicts prognosis and guides management in patients with acute coronary syndromes. In elderly patients, interpretation of echocardiographic measurements may be difficult, especially regarding assessment of diastolic left ventricular function.


OBJECTIVE
To examine the usefulness of echocardiographic systolic and echocardiographic diastolic LV function measurements as predictors of long-term outcome in elderly patients with ACS.


METHODS
We studied 142 consecutive elderly patients (> or = 70 years old, mean age 80 +/- 6 years) with ACS who had an echocardiogram at the index hospitalization and were in sinus rhythm. LV ejection fraction and diastolic mitral inflow pattern were examined as predictors of survival and repeat hospitalization over a period of 18-24 months.


RESULTS
During the 2 year mean follow-up period 35/142 patients died (25%). Survival was lower in patients with EF < 40% (n = 42) as compared to EF > or = 40% (n = 100) (2 year survival rate 61% vs. 81%, P = 0.038). Patients with severe diastolic dysfunction (a restrictive LV filling pattern, n = 7) had a lower survival rate than those without (43 vs. 76%, P = 0.009). The most powerful independent predictor of mortality was a restrictive filling pattern (hazard ratio 4.6, 95% confidence interval 1.6-13.5), followed by a clinical diagnosis of heart failure on admission and older age. Rate of survival free of repeat hospitalization was low (33% at 18 months) but repeat hospitalization was not predicted either by EF or by a restrictive filling pattern.


CONCLUSIONS
As in the young, echocardiographic measurements of systolic and diastolic LV function predicted long-term survival in elderly patients with ACS. A restrictive filling pattern was the strongest independent predictor of mortality.
Shiran
Avinoam
A
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.
Adawi
Salim
S
Dobrecky-Mery
Idit
I
Halon
David A
DA
Lewis
Basil S
BS
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D018619:Echocardiography, Doppler, Pulsed; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology