title: Diastolic dysfunction and abnormal exercise ventilation predict adverse outcome in elderly patients with chronic systolic heart failure.
abstract: BACKGROUND
  Heart failure is increasing in the elderly and represents a socioeconomic burden requiring the correct management for which risk stratification is mandatory. Among younger patients, echocardiogram and cardiopulmonary exercise test are useful in prognostic stratification. Few studies have analyzed the utility of these tests in elderly patients.
  
  
  METHODS
  We report on 90 patients over 70 years old, on whom cardiopulmonary tests and echocardiograms were performed between 1998 and 2006 (67 M, 23 F; 75 ± 3 years; ejection fraction (EF) 30 ± 6%; NYHA 2.1 ± 0.8; 60% ischemic; therapy according to international guidelines). Echocardiographic variables were (1) left ventricular ejection fraction (EF); (2) severity of diastolic dysfunction on multiparametric examination of Doppler and TDI parameters; (3) severity of functional mitral regurgitation. Cardiopulmonary variables were (1) peak VO(2); (2) peak O(2) pulse; (3) peak respiratory quotient (RQ); (4) VE/VCO(2) slope. Endpoint considered was mortality of any cause at three-years follow-up.
  
  
  RESULTS
  Mortality was 21%. At univariate analysis, survivors (n = 71) and deceased (n = 19) were similar for age, NYHA class, peakVO(2) and RQ; they differed for EF, severity of mitral regurgitation, severity of diastolic dysfunction, O(2) pulse and VE/VCO(2) slope. At multivariate analysis, only VE/VCO(2) slope and severe diastolic dysfunction (restrictive filling pattern) discriminated between the two groups. In particular, the association of restrictive filling pattern and VE/VCO(2) slope ≥ 45 predicted 3-year mortality with sensitivity of 84% and specificity of 88%.
  
  
  CONCLUSIONS
  Echocardiographic and cardiopulmonary data can identify high-risk elderly patients with systolic heart failure, who may need aggressive clinical management.
authors: Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, piazzale Brescia 20, Milan, Italy. Malfi@auxologico.it
authors: Gabriella
authors: G
authors: Malfatto
authors: Giovanna
authors: G
authors: Branzi
authors: Alessia
authors: A
authors: Giglio
authors: Francesca
authors: F
authors: Ciambellotti
authors: Alessandra
authors: A
authors: Villani
authors: Gianfranco
authors: G
authors: Parati
authors: Mario
authors: M
authors: Facchini
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003971:Diastole; D015150:Echocardiography, Doppler; D015444:Exercise; D005080:Exercise Test; D005260:Female; D054143:Heart Failure, Systolic / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology; D015999:Multivariate Analysis; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012123:Pulmonary Ventilation; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left