title: Tinnitus in elderly patients and prognosis of mild-to-moderate congestive heart failure: a cross-sectional study with a long-term extension of the clinical follow-up.
abstract: BACKGROUND
  The complex mechanism responsible for tinnitus, a symptom highly prevalent in elderly patients, could involve an impaired control of the microcirculation of the inner ear, particularly in patients with poor blood pressure control and impaired left ventricular (LV) function.
  
  
  METHODS
  In order to define the relationship between the presence of tinnitus and the severity and clinical prognosis of mild-to-moderate chronic heart failure (CHF) in a large population of elderly patients (N = 958), a cross-sectional study was conducted with a long-term extension of the clinical follow-up. Blood pressure, echocardiographic parameters, brain natriuretic peptide (BNP), hospitalization, and mortality for CHF were measured. Multivariate logistic regression analysis was used to assess the association between the presence of tinnitus and some of the prognostic determinants of heart failure.
  
  
  RESULTS
  The presence of tinnitus was ascertained in 233 patients (24.3%; mean age 74.9 ± 6 years) and was associated with reduced systolic and diastolic blood pressure (123.1 ± 16/67.8 ± 9 vs 125.9 ± 15/69.7 ± 9; P = .027/P = .006), reduced LV ejection fraction (LVEF%; 43.6 ± 15 vs 47.9 ± 14%, P = .001), and increased BNP plasma levels (413.1 ± 480 vs 286.2 ± 357, P = .013) in comparison to patients without symptoms. The distribution of CHF functional class was shifted toward a greater severity of the disease in patients with tinnitus. Combined one-year mortality and hospitalization for CHF (events/year) was 1.43 ± 0.2 in patients with tinnitus and 0.83 ± 0.1 in patients without tinnitus, with an adjusted hazard ratio (HR) of 0.61 (95% confidence interval (CI): 0.37 to 0.93, P <.002).
  
  
  CONCLUSIONS
  Our preliminary data indirectly support the hypothesis that tinnitus is associated with a worse CHF control in elderly patients and can have some important clinical implications for the early identification of patients who deserve a more aggressive management of CHF.
authors.affiliation: Department of Internal Medicine, Aging and Kidney Diseases, Internal Medicine Unit, Bologna, Italy. claudio.borghi@unibo.it
authors.forename: Claudio
authors.initials: C
authors.lastname: Borghi
authors.forename: Eugenio R
authors.initials: ER
authors.lastname: Cosentino
authors.forename: Elisa R
authors.initials: ER
authors.lastname: Rinaldi
authors.forename: Cristina
authors.initials: C
authors.lastname: Brandolini
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rimondi
authors.forename: Maddalena
authors.initials: M
authors.lastname: Veronesi
authors.forename: Arrigo Fg
authors.initials: AF
authors.lastname: Cicero
authors.forename: Ada
authors.initials: A
authors.lastname: Dormi
authors.forename: Antonio
authors.initials: A
authors.lastname: Pirodda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D016019:Survival Analysis; D014012:Tinnitus / Q000175:diagnosis*
chemical_list: D020097:Natriuretic Peptide, Brain