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Prognostic significance of changes in left ventricular systolic function in elderly patients with congestive heart
R B Willenheimer1, L R Erhardt, C M Cline
1Department of Cardiology, Malmö University Hospital, Lund University, Sweden.
Insights
In elderly heart failure patients, a single measurement of atrioventricular plane displacement (AVPD) effectively predicts mortality and hospitalizations. Serial AVPD changes did not significantly impact prognosis, highlighting the value of a one-time assessment.
Area of Science:
- Cardiology
- Geriatrics
- Echocardiography
Background:
- Prognostic significance of evolving left ventricular systolic function in elderly heart failure patients remains unclear.
- Atrioventricular plane displacement (AVPD) offers a reliable method for assessing left ventricular function, even with suboptimal echocardiographic imaging common in older adults.
Purpose of the Study:
- To prospectively evaluate the relationship between 1-year changes in left ventricular systolic function, assessed by AVPD, and subsequent 2-year mortality and morbidity in elderly heart failure patients.
Main Methods:
- AVPD was measured at baseline and 1 year in 123 elderly heart failure patients (mean age 76.0 years).
- A significant change in AVPD was defined as 1 mm or more, correlating to a 0.05 change in ejection fraction.
- Mortality and heart failure-related morbidity were tracked for 2 years post-1-year assessment.
Main Results:
- While 1-year AVPD changes (decrease, increase, or no change) did not significantly predict outcomes, a single AVPD measurement at 1 year was prognostic.
- Patients with a 1-year AVPD of ≤8.2 mm (ejection fraction ≤0.40) had significantly higher 2-year mortality (43.8% vs. 23.3%, P=0.031).
- This subgroup also experienced significantly more hospitalizations and hospital days due to heart failure.
Conclusions:
- Left ventricular systolic function in elderly heart failure patients can be reliably assessed using AVPD, even in cases of poor echocardiographic image quality.
- A single AVPD assessment, rather than serial measurements, is valuable for predicting prognosis in this population.
Background And Design:
The prognostic significance of changes in left ventricular systolic function over time is unknown in elderly patients with heart failure. We prospectively examined the relation between 1-year changes in left ventricular systolic function by echocardiographic determination of atrioventricular plane displacement (AVPD), and subsequent 2-year mortality and morbidity in elderly patients with heart failure. AVPD determination allows for left ventricular function to be adequately assessed even when image quality is poor, as is common in the elderly.
Methods:
AVPD was measured at baseline and 1 year in 123 patients with heart failure (age 76.0 +/- 5.4 years). An AVPD change of 1 mm or more (corresponding to an ejection fraction change of 0.05) was considered significant.
Results:
AVPD decreased in 26 patients (21%), increased in 46 (37%), and was unchanged in 51 (42%). During a 2-year follow-up (from the 1-year examination) mortality, total hospitalizations, and hospitalizations for heart failure (35% of all hospitalizations) did not differ significantly between the three groups. Patients (n = 80) with AVPD of 8.2 mm or less (corresponding to left ventricular ejection fraction of 0.40 or less) at the 1-year examination demonstrated a higher mortality than patients with AVPD greater than 8.2 mm (43.8 versus 23.3%; P = 0.031), and also had more hospitalizations and days in hospital due to heart failure (1.0 +/- 1.5 versus 0.4 +/- 0.8, P = 0.020 and 10.4 +/- 15.6 versus 4.6 +/- 10.6, P = 0.033, respectively).
Conclusions:
Left ventricular function was readily assessed in all patients by determination of AVPD. Our results indicate that single but not serial assessment of left ventricular systolic function by determination of AVPD is of value in assessing the prognosis in elderly patients with heart failure.