Reduced estimated glomerular filtration rate and proteinuria are associated with increased cardiovascular events rate in octogenarian population / 中华心血管病杂志

<p><b>OBJECTIVE</b>To determine the relationship between estimated glomerular filtration rate (eGFR) and proteinuria with cardiovascular events in subjects aged 80 years or older.</p><p><b>METHODS</b>Data for this retrospective prognostic study were drawn from the patient database for routine checkup in Beijing hospital between January 2001 to December 2001. Baseline eGFR and proteinuria were evaluated in 340 subjects [mean age: (85.6 ± 4.0) years]. eGFR was calculated using the modified abbreviated MDRD equations based on the Chinese chronic kidney disease patients. The subjects were divided into normal renal function group and reduced renal function group (eGFR <60 ml·min(-1)·1.73 m(-2)). The subjects were divided into subjects without proteinuria and subjects with proteinuria group. Cardiovascular events included cardiovascular death, nonfatal myocardial infarction, nonfatal stroke.</p><p><b>RESULTS</b>The proportion of reduced renal function was 36.8% (125/340). The proportion of proteinuria was 10.3% (35/340). The proportion of reduced renal function or proteinuria was 41.8% (142/340). Follow-up time was 79 months (40-114 months). Cardiovascular events rate was significantly higher in reduced renal function group than in normal renal function group [37.6% (47/125) vs. 26.2% (55/210), P < 0.05 ] and in proteinuria group than in without proteinuria group [50.0% (17/34) vs. 28.2% (85/301), P < 0.01 ]. Cox multivariate analysis revealed that both eGFR (HR = 0.978, 95%CI:0.961-0.994, P < 0.05 ) and proteinuria (HR = 2.049, 95%CI:1.132-3.709, P < 0.05) were independent risk factors for cardiovascular events after adjusting for age, gender, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, uric acid, hypertension, coronary heart disease, diabetes mellitus.</p><p><b>CONCLUSIONS</b>Reduced eGFR and presence of proteinuria are independent risk factors for cardiovascular event in subjects aged 80 years or older. eGFR and proteinuria can thus be used for cardiovascular event risk stratification in subjects aged 80 years or older.</p>

Clinical characteristics and prognosis of heart failure with normal left ventricular ejection fraction in elderly patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The term heart failure with normal ejection fraction (HFNEF) is often used to describe the syndrome of heart failure with normal ejection fraction. Based on the previous studies, HFNEF has a significant morbidity and mortality and is associated with a similar prognosis to heart failure with reduced ejection fraction (HFREF). The present study aimed to investigate the clinical characteristics and prognosis of HFNEF in elderly patients.</p><p><b>METHODS</b>Consecutive elderly patients (≥ 60 years old) hospitalized for the first episode of heart failure (HF) in Beijing Hospital from January 2003 to December 2009 were retrospectively recruited. Three hundred and ten patients with HF were eligible for our study. As recently recommended, a cut-off value of 50% was used to distinguish HFNEF (LVEF ≥ 50%) from HFREF (LVEF < 50%). Data were retrospectively obtained from hospital records and databases. Follow-up data were obtained by telephone and from hospital records. For every eligible patient, the clinical characteristics and prognosis were collected and compared between the HFNEF and HFREF groups.</p><p><b>RESULTS</b>Patients with HFNEF accounted for 54.5% of all cases of elderly patients with HF. Compared with HFREF, the elderly patients with HFNEF had a higher proportion of females (62.1% vs. 32.6%, P < 0.001), higher body mass index (BMI) ((24.9 ± 4.7) vs. (23.5 ± 4.0) kg/m(2), P = 0.011), higher systolic blood pressure at admission ((141.5 ± 22.6) vs. (134.3 ± 18.6) mmHg, P = 0.002), but lower hemoglobin levels ((118.3 ± 22.7) vs. (125.8 ± 23.8) g/L, P = 0.005). The incidence of coronary heart disease (43.2% vs. 65.2%, P < 0.001) and myocardial infarction (16.6% vs. 46.1%, P < 0.001) were significantly lower in elderly patients with HFNEF than in those with HFREF (P < 0.001). With a mean follow-up of 33.5 (0.5 - 93) months, 120 patients (38.7%) died, including 94 (30.3%) cardiac deaths. The HFNEF group had fewer deaths than the HFREF group at the end of the first follow-up (46/169 (27.2%) vs. 58/141 (41.1%)) and at the end of the second follow-up (56/169 (33.1%) vs. 64/141 (45.4%)). Kaplan-Meier survival analysis showed a significantly higher survival rate in elderly patients with HFNEF than those with HFREF (P = 0.021 for total mortality and P < 0.001 for cardiac mortality). Multiple Logistic regression analysis showed that LVEF < 50% was an independent risk factor for death in elderly patients with HF.</p><p><b>CONCLUSIONS</b>More than half of elderly patients with HF have a normal LVEF. The prognosis of the elderly patients with HFNEF is poor, though slightly better than the elderly patients with HFREF.</p>

Value of the electrocardiographic Cornell criteria for detecting left ventricular hypertrophy in elderly men / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the value of electrocardiographic (ECG) Cornell criteria for detecting left ventricular hypertrophy (LVH) in elderly Chinese men.</p><p><b>METHODS</b>Since 1990, 244 autopsies were performed in our hospital in elderly men, LVH was determined in these autopsy hearts and correlated to ECG LVH signs recorded within 3 months before death according to Cornell (SV3+RaVL) and Sokolow-Lyon criteria (SV1+RV5 or RV6). The reference value of Cornell criteria was obtained based on values from autopsied healthy hearts, the sensitivity and specificity of Cornell and Sokolow-Lyon criteria for detecting left ventricular hypertrophy in these elderly men were calculated.</p><p><b>RESULTS</b>There were significantly correlations between QRS amplitudes of Cornell and Sokolow-Lyon criteria and autopsy left ventricular wall thickness in these hearts. The reference value of Cornell criteria (SV3+RaVL) was 2.9 mV. The sensitivity of Sokolow-Lyon and Cornell criteria for detecting LVH was 25.4% and 34.3% (P<0.05 vs Sokolow-Lyon criteria), respectively.</p><p><b>CONCLUSION</b>Voltage (SV3+RaVL)>or=2.9 mV might be a suitable diagnostic value for detecting left ventricular hypertrophy in Chinese elderly men.</p>

Correlation between atrial fibrillation and coronary artery disease in the elderly / 中华老年医学杂志

Objective To determine the association between atrial fibrillation(AF)and coronary artery disease(CAD)in elderly patients.Methods Based on autopsy data from 1990 to 2005,69 male patients with over 70 years old and AF history(32 with chronic AF,37 with paroxysmal AF)and diagnosed as CAD clinically were selected as AF group.Other 60 age-matched male patients without AF history were selected as the control group.The pathological changes of the coronary arteries between the groups were compared.Results The morbidity of CAD and myocardial infarction were 55.1% and 42.0% in AF group and 53.3% and 35% in the control(P＞0.05).The pathological changes of the coronary arteries between the two groups were similar(P＞0.05).The AF group had a heavier heart weight[(440.5?81.9)g vs(398.7?82.2)g,P＜0.01]and a thicker left ventricle [(1.42?0.34)cm vs(1.27?0.32)cm,P＜0.05]than did the control.The paroxysmal AF group had more branches of arteries(17 vs 5,P＜0.05)with pathological lesionⅣthan did the control. Conclusions There is a high morbidity of CAD in elderly patients,but it is not in relation to the occurrence of AF.