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Maffeis C, Inciardi RM, Khan MS, Tafciu E, Bergamini C, Benfari G, Setti M, Ribichini FL, Cicoira M, Butler J, Rossi A. Determinants of exercise intolerance symptoms considered non-specific for heart failure in patients with stage A and B: role of the left atrium in the transition phase to overt heart failure. Int J Cardiovasc Imaging 2021; 38:103-112. [PMID: 34460024 PMCID: PMC8818638 DOI: 10.1007/s10554-021-02375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/04/2021] [Indexed: 11/08/2022]
Abstract
To assess to what extent left atrial (LA) structure and function are associated with non-specific heart failure symptoms, so that patients were classified as HF stage A and B. Mechanisms underlying the transition to overt HF in patients with stage A and B HF are unclear. Consecutive outpatients undergoing echocardiography and clinical evaluation and classified as HF stage A and B with preserved left ventricular ejection fraction (LVEF) were included. The association between LA measures [volume (LAVi), peak longitudinal-(PALS), contraction-(PACS) and conduit-strain] and non-specific HF symptoms was assessed using adjusted logistic regression analyses. The incremental value of atrial myopathy in symptoms prediction on top of clinical or echocardiographic confounders was assessed through ROC curves analyses. The cohort comprehended 185 patients (63 ± 16 years, 47% women) of whom 133 (72%) were asymptomatic, and 52 (28%) reported non-specific HF symptoms. After adjustment for clinical and echocardiographic confounders for HF symptoms, LAVi, PALS and PACS were associated with symptoms (p < 0.05). Among echocardiographic variables, only LA parameters were significantly associated with symptoms on top of clinical confounders (for LAVi OR [95% CI] 1.56 [1.21–2.00], p < 0.0001; for PALS 1.45 (1.10–1.91), p = 0.0009; for PACS 2.10 [1.33–3.30], p = 0.002). After adjustment for age, hypertension and COPD or E/E′, LV mass-i and mitral ERO, atrial myopathy added predictive value for symptoms presence compared to the clinical variables or echocardiographic parameters described (AUC increase 0.80 to 0.88, p = 0.004, and 0.79 to 0.84, p = 0.06, respectively). In patients with HF stages A–B and preserved LVEF, measures of LA structure and function were associated with non-specific HF symptoms. A comprehensive LA remodeling evaluation may help clinicians in the appropriate identification of overt HF.
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Affiliation(s)
- Caterina Maffeis
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Riccardo M Inciardi
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | | | - Elvin Tafciu
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Corinna Bergamini
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Martina Setti
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Mariantonietta Cicoira
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy.
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Ramalho SHR, Santos M, Claggett B, Matsushita K, Kitzman DW, Loehr L, Solomon SD, Skali H, Shah AM. Association of Undifferentiated Dyspnea in Late Life With Cardiovascular and Noncardiovascular Dysfunction: A Cross-sectional Analysis From the ARIC Study. JAMA Netw Open 2019; 2:e195321. [PMID: 31199443 PMCID: PMC6575149 DOI: 10.1001/jamanetworkopen.2019.5321] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/23/2019] [Indexed: 12/12/2022] Open
Abstract
Importance Undifferentiated dyspnea is common in late life, but the relative contribution of subclinical cardiac dysfunction is unknown. Impairments in cardiac structure and function may be characteristics of undifferentiated dyspnea in elderly people, providing potential insights into occult heart failure (HF). Objective To quantify the association of undifferentiated dyspnea with cardiac dysfunction after accounting for other potential contributors. Design, Setting, and Participants This cross-sectional study used data from Atherosclerosis Risk in Communities study participants 65 years and older who attended the fifth study visit (from 2011 to 2013) and had not been diagnosed with HF, chronic obstructive pulmonary disease, morbid obesity, or severe kidney disease. Analyses were conducted from October 2017 to June 2018. Exposures Dyspnea measured using the modified Medical Research Council scale, with a score less than 2 classified as none to mild and a score of 2 or more classified as moderate to severe. Main Outcomes and Measures Using multivariable logistic regression, the association of undifferentiated dyspnea was defined using cardiac structure, systolic and diastolic function, pulmonary pressure (echocardiography), pulmonary function (spirometry), glomerular filtration rate, hemoglobin, body mass index, depression, and physical performance. The population-attributable risk was calculated for each dysfunction metric. Results Among 4342 participants (mean [SD] age, 75.9 [5.0] years; 2533 [58.3%] women), 1173 (27.0%) had undifferentiated dyspnea. Moderate to severe dyspnea was present in 574 participants (13.2%) and was associated with left ventricular (LV) hypertrophy (odds ratio [OR], 1.53; 95% CI, 1.25-1.87; P < .001) and LV diastolic (OR, 1.46; 95% CI, 1.20-1.78; P < .001) and systolic (OR, 1.28; 95% CI, 1.05-1.56; P = .02) dysfunction. Moderate to severe dyspnea was also associated with obstructive (OR, 1.59; 95% CI, 1.28-1.99; P < .001) and restrictive (OR, 2.56; 95% CI, 1.99-3.27; P < .001) findings on spirometry, renal impairment (OR, 1.32; 95% CI, 1.08-1.61; P = .01), anemia (OR, 1.72; 95% CI, 1.39-2.12; P < .001), lower (OR, 2.77; 95% CI, 2.18-3.51; P < .001) and upper (OR, 1.82; 95% CI, 1.49-2.23; P < .001) extremity weakness, depression (OR, 3.01; 95% CI, 2.24-4.25; P < .001), and obesity (OR, 2.35; 95% CI, 1.95-2.83; P < .001). After accounting for these, moderate to severe dyspnea was associated with LV hypertrophy (OR, 1.30; 95% CI, 1.01-1.67; P = .04) and was not associated with systolic or diastolic function. In contrast, in the fully adjusted model, other organ system measures were associated with dyspnea, except for glomerular filtration rate and grip strength. The population-attributable risk of dyspnea associated with obesity alone was 22.6% compared with 5.8% for LV hypertrophy. Conclusions and Relevance Undifferentiated dyspnea is multifactorial in older adults, and this study showed an association with obesity. When accounting for other relevant organ systems, cardiovascular function poorly discriminated those with vs those without dyspnea. Therefore, dyspnea should not be assumed to represent occult HF in this population.
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Affiliation(s)
- Sergio H. R. Ramalho
- Health Sciences and Technologies Post-Graduation Program, University of Brasília, Brasília, Brazil
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Mario Santos
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Laura Loehr
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Scott D. Solomon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Hicham Skali
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Amil M. Shah
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Hegendörfer E, Vaes B, Matheï C, Van Pottelbergh G, Degryse JM. Correlates of dyspnoea and its association with adverse outcomes in a cohort of adults aged 80 and over. Age Ageing 2017. [PMID: 28633384 DOI: 10.1093/ageing/afx095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background adults aged 80 and over, a fast growing age-group, with increased co-morbidity and frailty have not been the focus of previous research on dyspnoea. We investigate the correlates of dyspnoea and its association with adverse outcomes in a cohort of adults aged 80 and over. Methods about 565 community-dwelling adults aged 80 and over of the BELFRAIL prospective cohort had assessment of Medical Research Council dyspnoea scale (MRC), forced expiratory volume in 1 s (FEV1), N-terminal pro-brain natriuretic peptide (NT-proBNP), physical performance tests, grip strength, 15 items geriatric depression scale, activities of daily living (ADL), body mass index (BMI) and demographics data. Kaplan-Meier survival curves, Cox and logistic multivariable regression, classification and regression tree (CART) analysis assessed association of dyspnoea (MRC 3-5) with time-to-cardiovascular and all-cause death (5 years), time to first hospitalisation (3 years), new/worsened ADL disability (2 years), and its correlates. Results participants with dyspnoea MRC 3-5 (29.9%) had increased hazard ratios for cardiovascular mortality 2.85 (95% confidence interval 1.93-4.20), all-cause mortality 2.04 (1.58-2.64), first hospitalisation 1.72 (1.35-2.19); and increased odds ratio for new/worsened disability 2.49 (1.54-4.04), independent of age, sex and smoking status. Only FEV1, physical performance, BMI and NT-proBNP (in order of importance) were selected in the tree-based classification model for dyspnoea. Conclusions in a cohort of adults aged 80 and over, dyspnoea was common and an independent predictor of adverse outcomes, with cardio-respiratory and physical performance impairments as key independent correlates. Its routine and comprehensive evaluation in primary care could be very valuable in caring for this age-group.
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Affiliation(s)
- Eralda Hegendörfer
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Catharina Matheï
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
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Miner B, Tinetti ME, Van Ness PH, Han L, Leo-Summers L, Newman AB, Lee PJ, Vaz Fragoso CA. Dyspnea in Community-Dwelling Older Persons: A Multifactorial Geriatric Health Condition. J Am Geriatr Soc 2016; 64:2042-2050. [PMID: 27549914 DOI: 10.1111/jgs.14290] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To evaluate the associations between a broad array of cardiorespiratory and noncardiorespiratory impairments and dyspnea in older persons. DESIGN Cross-sectional. SETTING Cardiovascular Health Study. PARTICIPANTS Community-dwelling persons (N = 4,413; mean age 72.6, 57.1% female, 4.5% African American, 27.2% <high school education, 54.7% ever-smokers). MEASUREMENTS Dyspnea severity (moderate to severe defined as American Thoracic Society Grade ≥2) and several impairments, including those established using spirometry (forced expiratory volume in 1 second (FEV1 )), maximal inspiratory pressure (respiratory muscle strength), echocardiography, ankle-brachial index, blood pressure, whole-body muscle mass (bioelectrical impedance), single chair stand (lower extremity function), grip strength, serum hemoglobin and creatinine, Center for Epidemiologic Studies Depression Scale (CES-D), Mini-Mental State Examination, medication use, and body mass index (BMI). RESULTS In a multivariable logistic regression model, impairments that had strong associations with moderate to severe dyspnea were FEV1 less than the lower limit of normal (adjusted odds ratio (aOR) = 2.88, 95% confidence interval (CI) = 2.37-3.49), left ventricular ejection fraction less than 45% (aOR = 2.12, 95% CI = 1.43, 3.16), unable to perform a single chair stand (aOR = 2.10, 95% CI = 1.61-2.73), depressive symptoms (CES-D score ≥16; aOR = 2.02, 95% CI = 1.26-3.23), and obesity (BMI ≥30; aOR = 2.07, 95% CI = 1.67-2.55). Impairments with modest but still statistically significant associations with moderate to severe dyspnea included respiratory muscle weakness, diastolic cardiac dysfunction, grip weakness, anxiety symptoms, and use of cardiovascular and psychoactive medications (aORs = 1.31-1.71). CONCLUSION In community-dwelling older persons, several cardiorespiratory and noncardiorespiratory impairments were significantly associated with moderate to severe dyspnea, akin to a multifactorial geriatric health condition.
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Affiliation(s)
- Brienne Miner
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
| | - Mary E Tinetti
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut
| | - Peter H Van Ness
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Ling Han
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut
| | - Linda Leo-Summers
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Anne B Newman
- Department of Epidemiology and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patty J Lee
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Carlos A Vaz Fragoso
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut
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5
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Vaz Fragoso CA, Araujo K, Leo-Summers L, Van Ness PH. Lower Extremity Proximal Muscle Function and Dyspnea in Older Persons. J Am Geriatr Soc 2015. [PMID: 26200804 DOI: 10.1111/jgs.13529] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the association between performance on a single chair stand and moderate to severe exertional dyspnea. DESIGN Cross-sectional. SETTING Cardiovascular Health Study. PARTICIPANTS Community-dwelling individuals aged 65 and older (N = 4,413; mean age 72.6; female, n = 2,518 (57.1%); nonwhite, n = 199 (4.5%); obese, n = 788 (17.9%); history of smoking, n = 2,410 (54.6%)). MEASUREMENTS Performance on single chair stand (poor (unable to rise without arm use) vs normal (able to rise without arm use)), moderate to severe exertional dyspnea (American Thoracic Society grade ≥2), age, sex, ethnicity, obesity, smoking, frailty status (Fried-defined nonfrail, prefrail, frail), high cardiopulmonary risk (composite of cardiopulmonary diseases and diabetes mellitus), spirometric impairment, arthritis, depression, stroke, and kidney disease. RESULTS Poor performance on the single chair stand was established in 369 (8.4%) and moderate to severe exertional dyspnea in 773 (17.5%). Prefrail status was established in 2,210 (50.1%), frail status in 360 (8.2%), arthritis in 2,241 (51.4%), high cardiopulmonary risk in 2,469 (55.9%), spirometric impairment in 1,076 (24.4%), kidney disease in 111 (2.5%), depression in 107 (2.4%), and stroke in 93 (2.1%). In multivariable regression models, poor performance on the single chair stand was associated with moderate to severe exertional dyspnea (unadjusted odds ratio (OR) = 3.48, 95% confidence interval (CI) = 2.78-4.36; adjusted OR = 1.85, 95% CI = 1.41-2.41). CONCLUSION Poor performance on a single chair stand was associated with an adjusted 85% greater likelihood of moderate to severe exertional dyspnea than normal performance. These results suggest that reduced proximal muscle function of the lower extremities is associated with moderate to severe exertional dyspnea, even after adjusting for multiple confounders.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Department of Internal Medicine, School of Medicine, Yale University, West Haven, Connecticut.,Clinical Epidemiology Research Center, Veterans Affairs Connecticut, West Haven, Connecticut
| | - Katy Araujo
- Department of Internal Medicine, School of Medicine, Yale University, West Haven, Connecticut
| | - Linda Leo-Summers
- Department of Internal Medicine, School of Medicine, Yale University, West Haven, Connecticut
| | - Peter H Van Ness
- Department of Internal Medicine, School of Medicine, Yale University, West Haven, Connecticut
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6
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Oelsner EC, Lima JAC, Kawut SM, Burkart KM, Enright PL, Ahmed FS, Barr RG. Noninvasive tests for the diagnostic evaluation of dyspnea among outpatients: the Multi-Ethnic Study of Atherosclerosis lung study. Am J Med 2015; 128:171-180.e5. [PMID: 25447621 PMCID: PMC4346168 DOI: 10.1016/j.amjmed.2014.09.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dyspnea on exertion is a common and debilitating symptom, yet evidence for the relative value of cardiac and pulmonary tests for the evaluation of chronic dyspnea among adults without known cardiac or pulmonary disease is limited. METHODS The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled participants aged 45 to 84 years who were free of clinical cardiovascular disease from 6 communities; participants with clinical pulmonary disease were excluded from this report. Dyspnea on exertion was assessed via structured interview. Tests included electrocardiograms, cardiac computed tomography (CT) for coronary artery calcium, cardiac magnetic resonance imaging, spirometry, percent emphysema (percent of lung regions <-950 HU) on CT, inflammatory biomarkers, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Logistic regression was used to identify independent correlates of dyspnea after adjustment for age, sex, body mass index, physical activity, anxiety, and leg pain. RESULTS Among 1969 participants without known cardiopulmonary disease, 9% had dyspnea. The forced expiratory volume in 1 second (FEV1) (P < .001), NT-proBNP (P = .004), and percent emphysema on CT (P = .004) provided independent information on the probability of self-reported dyspnea. Associations with the FEV1 were stronger among smokers and participants with other recent respiratory symptoms or seasonal allergies; associations with NT-proBNP were present only among participants with coexisting symptoms of lower-extremity edema. Only the FEV1 provided a significant improvement in the receiver operating curve. CONCLUSIONS Among adults without known cardiac or pulmonary disease reporting dyspnea on exertion, spirometry, NT-proBNP, and CT imaging for pulmonary parenchymal disease were the most informative tests.
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Affiliation(s)
- Elizabeth C Oelsner
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY; Department of Epidemiology, Mailman School of Public Health of Columbia University, New York, NY.
| | - Joao A C Lima
- Department of Medicine, Johns Hopkins University, Baltimore, Md
| | - Steven M Kawut
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Kristin M Burkart
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
| | - Paul L Enright
- College of Public Health, University of Arizona, Tucson, Ariz
| | - Firas S Ahmed
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY; Department of Radiology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY; Department of Epidemiology, Mailman School of Public Health of Columbia University, New York, NY
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7
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Fan X, Meng Z. The mutual association between depressive symptoms and dyspnea in Chinese patients with chronic heart failure. Eur J Cardiovasc Nurs 2014; 14:310-6. [PMID: 24634388 DOI: 10.1177/1474515114528071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 02/24/2014] [Indexed: 11/16/2022]
Affiliation(s)
| | - Zhu Meng
- Shandong University, PR China
- Shandong Provincial Hospital, PR China
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8
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Ebihara S, Niu K, Ebihara T, Kuriyama S, Hozawa A, Ohmori-Matsuda K, Nakaya N, Nagatomi R, Arai H, Kohzuki M, Tsuji I. Impact of blunted perception of dyspnea on medical care use and expenditure, and mortality in elderly people. Front Physiol 2012; 3:238. [PMID: 22783203 PMCID: PMC3389490 DOI: 10.3389/fphys.2012.00238] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 06/12/2012] [Indexed: 11/30/2022] Open
Abstract
Dyspnea is an alarming symptom responsible for millions of patient visits each year. Poor perception of dyspnea might be reasonably attributed to an inappropriately low level of fear and inadequate earlier medical treatment for both patients and physicians, resulting in subsequent intensive care. This study was conducted to evaluate medical care use and cost, and mortality according to the perception of dyspnea in community-dwelling elderly people. We analyzed baseline data from a community-based Comprehensive Geriatric Assessment in 2002. The perception of dyspnea in 479 Japanese community-dwelling elderly people with normal lung function was measured in August 2002. The sensation of dyspnea during breathing with a linear inspiratory resistance of 10, 20, and 30 cmH(2)O/L/s was rated using the Borg scale. According to the perception of dyspnea, we divided the elderly into tertiles and compared all hospitalizations, out-patient visits, costs, and death through computerized linkage with National Health Insurance beneficiaries claims history files between August 2002 and March 2008. In-patient hospitalization days and medical care costs significantly increased with the blunted perception of dyspnea, resulting in an increase in total medical-costs with blunted perception of dyspnea. With low perception group as reference, the hazard ratios of all-cause mortality were 0.65 (95% CI 0.23-1.89) for intermediate perception group and 0.31 (0.10-0.97) for high perception group, indicating the mortality rate also significantly increased with the blunted perception of dyspnea after multivariates adjustment (p = 0.04). The blunted perception of dyspnea is related to hospitalization, large medical costs, and all-cause mortality in community-dwelling elderly people. These findings provide a rational for preventing serious illness with careful monitoring of objective conditions in the elderly.
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Affiliation(s)
- Satoru Ebihara
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of MedicineSendai, Japan
| | - Kaijun Niu
- Department of Epidemiology, School of Public Health, Tianjin Medical UniversityTianjin, China
| | - Takae Ebihara
- Department of Geriatrics and Gerontology, Institute of Development, Aging and Cancer, Tohoku UniversitySendai, Japan
| | - Shinichi Kuriyama
- Department of Public Health and Forensic Medicine, Tohoku University Graduate School of MedicineSendai, Japan
| | - Atsushi Hozawa
- Department of Public Health and Forensic Medicine, Tohoku University Graduate School of MedicineSendai, Japan
| | - Kaori Ohmori-Matsuda
- Department of Public Health and Forensic Medicine, Tohoku University Graduate School of MedicineSendai, Japan
| | - Naoki Nakaya
- Department of Public Health and Forensic Medicine, Tohoku University Graduate School of MedicineSendai, Japan
| | - Ryoichi Nagatomi
- Department of Science in Sports and Exercise, Tohoku University Graduate School of MedicineSendai, Japan
| | - Hiroyuki Arai
- Department of Geriatrics and Gerontology, Institute of Development, Aging and Cancer, Tohoku UniversitySendai, Japan
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of MedicineSendai, Japan
| | - Ichiro Tsuji
- Department of Public Health and Forensic Medicine, Tohoku University Graduate School of MedicineSendai, Japan
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9
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Marwick TH. Heart failure with preserved ejection fraction: neither deformation nor timing are preserved. Eur Heart J Cardiovasc Imaging 2012; 13:539-40. [DOI: 10.1093/ehjci/jes058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Ferguson GT. Maintenance pharmacotherapy of mild and moderate COPD: What is the Evidence? Respir Med 2011; 105:1268-74. [DOI: 10.1016/j.rmed.2011.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 01/28/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
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11
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Kaila K, Haykowsky MJ, Thompson RB, Paterson DI. Heart failure with preserved ejection fraction in the elderly: scope of the problem. Heart Fail Rev 2011; 17:555-62. [DOI: 10.1007/s10741-011-9273-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Giubbini R, Milan E, Bertagna F, Mut F, Metra M, Rodella C, Dondi M. Nuclear cardiology and heart failure. Eur J Nucl Med Mol Imaging 2011; 36:2068-80. [PMID: 19672592 DOI: 10.1007/s00259-009-1246-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 07/26/2009] [Indexed: 01/07/2023]
Abstract
The prevalence of heart failure in the adult population is increasing. It varies between 1% and 2%, although it mainly affects elderly people (6-10% of people over the age of 65 years will develop heart failure). The syndrome of heart failure arises as a consequence of an abnormality in cardiac structure, function, rhythm, or conduction. Coronary artery disease is the leading cause of heart failure and it accounts for this disorder in 60-70% of all patients affected. Nuclear techniques provide unique information on left ventricular function and perfusion by gated-single photon emission tomography (SPECT). Myocardial viability can be assessed by both SPECT and PET imaging. Finally, autonomic dysfunction has been shown to increase the risk of death in patients with heart disease and this may be applicable to all patients with cardiac disease regardless of aetiology. MIBG scanning has a very promising prognostic value in patients with heart failure.
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Affiliation(s)
- Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
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Jaubert MP, Armero S, Bonello L, Nicoud A, Sbragia P, Paganelli F, Arques S. Predictors of B-type natriuretic peptide and left atrial volume index in patients with preserved left ventricular systolic function: An echocardiographic-catheterization study. Arch Cardiovasc Dis 2010; 103:3-9. [DOI: 10.1016/j.acvd.2009.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 10/12/2009] [Accepted: 10/12/2009] [Indexed: 11/16/2022]
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Crawford SL, Avis NE, Gold E, Johnston J, Kelsey J, Santoro N, Sowers M, Sternfeld B. Sensitivity and specificity of recalled vasomotor symptoms in a multiethnic cohort. Am J Epidemiol 2008; 168:1452-9. [PMID: 18953064 PMCID: PMC2727191 DOI: 10.1093/aje/kwn279] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 08/11/2008] [Indexed: 11/15/2022] Open
Abstract
Many epidemiologic studies include symptom checklists assessing recall of symptoms over a specified time period. Little research exists regarding the congruence of short-term symptom recall with daily self-reporting. The authors assessed the sensitivity and specificity of retrospective reporting of vasomotor symptoms using data from 567 participants in the Study of Women's Health Across the Nation (1997-2002). Daily assessments were considered the "gold standard" for comparison with retrospective vasomotor symptom reporting. Logistic regression was used to identify predictors of sensitivity and specificity for retrospective reporting of any vasomotor symptoms versus none in the past 2 weeks. Sensitivity and specificity were relatively constant over a 3-year period. Sensitivity ranged from 78% to 84% and specificity from 85% to 89%. Sensitivity was lower among women with fewer symptomatic days in the daily assessments and higher among women reporting vasomotor symptoms in the daily assessment on the day of retrospective reporting. Specificity was negatively associated with general symptom awareness and past smoking and was positively associated with routine physical activity and Japanese ethnicity. Because many investigators rely on symptom recall, it is important to evaluate reporting accuracy, which was relatively high for vasomotor symptoms in this study. The approach presented here would be useful for examining other symptoms or behaviors.
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Affiliation(s)
- Sybil L Crawford
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Shaw Building Room 228, Worcester, MA 01655, USA.
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Pedersen F, Mehlsen J, Raymond I, Atar D, Skjoldborg US, Hildebrandt PR. Evaluation of dyspnoea in a sample of elderly subjects recruited from general practice. Int J Clin Pract 2007; 61:1481-91. [PMID: 17686092 DOI: 10.1111/j.1742-1241.2007.01428.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The objectives of this study were to investigate the cause of dyspnoea in a sample of elderly individuals and to assess the diagnostic yield of a three-step examination algorithm for the evaluation of dyspnoea paired with a cost analysis. A total of 152 subjects were examined. A predefined diagnostic approach in three steps was carried out to find the cause of dyspnoea. Step 1 included lung spirometry and ECG; step 2 included lung diffusion capacity, echocardiography, haemoglobin and thyroid function; and step 3 included cardiac magnetic resonance imaging, chest radiography and exercise test. Of 129 subjects with dyspnoea, 68 (53%) had signs of lung disease, 27 (21%) had heart disease, a total of 43 (33%) were obese, 20 (16%) were obese without other causes of dyspnoea and five (4%) had general physical deconditioning. Twelve per cent had none of the above-mentioned potential causes of dyspnoea. Steps 1, 1 + 2 and 1 + 2 + 3 revealed a cause of dyspnoea in 39%, 63%, and 73% of subjects respectively. The cost per diagnosed case at steps 2 and 3 was twice and 3.5 times the cost per diagnosed case at step 1. In this sample of elderly subjects, a potential cause of dyspnoea was identified in most cases, the most frequent being lung disease followed by heart disease and obesity. These data shed light on the diagnostic yield that can be expected from a relatively simple diagnostic approach, including the most frequent recommended initial screening tests. As expected, the incremental nature of this algorithm translated into incremental costs per diagnosis achieved.
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Affiliation(s)
- F Pedersen
- Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Copenhagen, Denmark.
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Arques S, Roux E, Luccioni R. Current clinical applications of spectral tissue Doppler echocardiography (E/E' ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved left ventricular systolic function. Cardiovasc Ultrasound 2007; 5:16. [PMID: 17386087 PMCID: PMC1847510 DOI: 10.1186/1476-7120-5-16] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 03/26/2007] [Indexed: 11/10/2022] Open
Abstract
Congestive heart failure with preserved left ventricular systolic function has emerged as a growing epidemic medical syndrome in developed countries, which is characterized by high morbidity and mortality rates. Rapid and accurate diagnosis of this condition is essential for optimizing the therapeutic management. The diagnosis of congestive heart failure is challenging in patients presenting without obvious left ventricular systolic dysfunction and additional diagnostic information is most commonly required in this setting. Comprehensive Doppler echocardiography is the single most useful diagnostic test recommended by the ESC and ACC/AHA guidelines for assessing left ventricular ejection fraction and cardiac abnormalities in patients with suspected congestive heart failure, and non-invasively determined basal or exercise-induced pulmonary capillary hypertension is likely to become a hallmark of congestive heart failure in symptomatic patients with preserved left ventricular systolic function. The present review will focus on the current clinical applications of spectral tissue Doppler echocardiography used as a reliable noninvasive surrogate for left ventricular diastolic pressures at rest as well as during exercise in the diagnosis of heart failure with preserved left ventricular systolic function. Chronic congestive heart failure, a disease of exercise, and acute heart failure syndromes are characterized by specific pathophysiologic and diagnostic issues, and these two clinical presentations will be discussed separately.
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Affiliation(s)
| | - Emmanuel Roux
- Department of Cardiology, Aubagne Hospital, Aubagne, France
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Arques S, Roux E, Sbragia P, Pieri B, Gelisse R, Ambrosi P, Luccioni R. Accuracy of Tissue Doppler Echocardiography in the Diagnosis of New-Onset Congestive Heart Failure in Patients with Levels of B-Type Natriuretic Peptide in the Midrange and Normal Left Ventricular Ejection Fraction. Echocardiography 2006; 23:627-34. [PMID: 16970713 DOI: 10.1111/j.1540-8175.2006.00281.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Based on the hypothesis that it reflects left ventricular (LV) diastolic pressures, B-type natriuretic peptide (BNP) is largely utilized as first-line diagnostic complement in the emergency diagnosis of congestive heart failure (HF). The incremental diagnostic value of tissue Doppler echocardiography, a reliable noninvasive estimate of LV filling pressures, has been reported in patients with preserved LV ejection fraction and discrepancy between BNP levels and the clinical judgment, however, its clinical validity in such patients in the presence of BNP concentrations in the midrange, which may reflect intermediate, nondiagnostic levels of LV filling pressures, is unknown. METHODS 34 patients without history of HF, presenting with acute dyspnea at rest, BNP levels of 100-400 pg/ml and normal LV ejection fraction were prospectively enrolled (17 with congestive HF and 17 with noncardiac cause). Tissue Doppler echocardiography was performed within 3 hours after admission. RESULTS Unlike BNP (P = 0.78), Boston criteria (P = 0.0129), radiographic pulmonary edema (P = 0.0036) and average E/Ea ratio (P = 0.0032) were predictive of congestive HF by logistic regression analysis. In this clinical setting, radiographic pulmonary edema had a positive predictive value of 80% in the diagnosis of congestive HF. In patients without evidence of radiographic pulmonary edema, average E/Ea > 10 was a powerful predictor of congestive HF (area under the ROC curve of 0.886, P < 0.001, sensitivity 100% and specificity 78.6%). CONCLUSION By better reflecting LV filling pressures, bedside tissue Doppler echocardiography accurately differentiates congestive HF from noncardiac cause in dyspneic patients with intermediate, nondiagnostic BNP levels and normal LV ejection fraction.
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Affiliation(s)
- Stephane Arques
- Department of Cardiology, Aubagne Hospital, Marseille, France.
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Arora R. Dyspnea in the elderly. Am J Med 2005; 118:1301-2; author reply 1302. [PMID: 16271928 DOI: 10.1016/j.amjmed.2005.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Accepted: 02/04/2005] [Indexed: 11/25/2022]
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Fimognari FL, Pastorelli R, Scarlata S, Incalzi RA. Restrictive ventilatory dysfunction and dyspnea in elderly subjects. Am J Med 2005; 118:1300-1; author reply 1301. [PMID: 16271926 DOI: 10.1016/j.amjmed.2005.04.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Accepted: 04/07/2005] [Indexed: 11/30/2022]
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Vedantham V, Fleischmann KE. Dyspnea and diastolic function: weighing the evidence. Am J Med 2005; 118:32-4. [PMID: 15639207 DOI: 10.1016/j.amjmed.2004.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Accepted: 08/02/2004] [Indexed: 10/25/2022]
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