title: Echocardiographic indices associated with frailty in adults ≥65 years.
abstract: Frailty is prevalent in patients with cardiovascular disease, but few studies have evaluated relations between frailty and echocardiographically determined cardiac indexes. To assess the prevalence of frailty and its association with echocardiographic characteristics, we prospectively measured frailty in 257 patients ≥65 years who underwent echocardiography (transthoracic echocardiography [TTE]) from June 2012 to February 2013. Deficits of weight loss, exhaustion, physical activity, gait speed, and handgrip strength were used to categorize patients as frail (≥3 features), intermediately frail (1 or 2 features), or nonfrail (0 features). Pearson correlation was used to examine bivariate associations between TTE variables and frailty. Kaplan-Meier methods were used to estimate overall survival based on frailty status. A multivariable model was used to examine TTE indexes associated with frailty while accounting for age and baseline cardiac co-morbidities. Of the 257 patients studied, 40 (15.6%) were nonfrail, 167 (65.0%) intermediately frail, and 50 (19.4%) frail. Left atrial volume (r = 0.14; p = 0.03), stroke volume (r = -0.19; p <0.01), E/A ratio (r = 0.26; p <0.001), and pulmonary artery systolic pressure (r = 0.33; p <0.001) correlated with fraility. After age and baseline cardiac comorbidities were accounted for, larger left atrial volumes, lower stroke volumes, and higher pulmonary artery systolic pressures remained independently associated with frailty. Frail patients had worse survival compared with nonfrail and intermediately frail patients (p = 0.016 by log-rank). In conclusion, 1/5 of older patients who underwent clinically indicated TTE were frail, with worse survival and a unique fingerprint of TTE findings distinguishing them from nonfrail patients.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wisconsin; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: gharacholou.shahyar@mayo.edu.
authors.forename: S Michael
authors.initials: SM
authors.lastname: Gharacholou
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Teruko
authors.initials: T
authors.lastname: Tashiro
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Cha
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Scott
authors.affiliation: Division of Primary Care Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Takahashi
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015897:Comorbidity; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors