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Vitale C, Spoletini I, Rosano GM. The Dual Burden of Frailty and Heart Failure. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:107-116. [PMID: 39081645 PMCID: PMC11284334 DOI: 10.36628/ijhf.2023.0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 03/18/2024] [Accepted: 04/08/2024] [Indexed: 08/02/2024]
Abstract
Frailty is highly prevalent among patients with heart failure (HF) and independently predicts adverse outcomes. However, optimal frailty definitions, assessments, and management in HF remain unclear. Frailty is common in HF, affecting up to 80% of patients depending on population characteristics. Even pre-frailty doubles mortality risk versus robust patients. Frailty worsens HF prognosis through systemic inflammation, neurohormonal changes, sarcopenia, and micronutrient deficiency. Simple screening tools like gait speed and grip strength predict outcomes but lack HF-specificity. Comprehensive geriatric assessment is ideal but not always feasible. Exercise, nutrition, poly-pharmacy management, and multidisciplinary care models can help stablize frailty components and improve patient-centred outcomes. Frailty frequently coexists with and exacerbates HF. Routine frailty screening should guide supportive interventions to optimize physical, cognitive, and psychosocial health. Further research on HF-specific frailty assessment tools and interventions is warranted to reduce this dual burden.
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Affiliation(s)
- Cristiana Vitale
- Clinical Academic Group, St. George’s University Hospital, London, United Kingdom
| | | | - Giuseppe M.C. Rosano
- Department of Human Sciences and Promotion of Quality of Life, Chair of Pharmacology, San Raffaele University of Rome, Rome, Italy
- Department of Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
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2
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Qian Z, Huang Y, Zhang Y, Yang N, Fang Z, Zhang C, Zhang L. Metabolic clues to aging: exploring the role of circulating metabolites in frailty, sarcopenia and vascular aging related traits and diseases. Front Genet 2024; 15:1353908. [PMID: 38415056 PMCID: PMC10897029 DOI: 10.3389/fgene.2024.1353908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
Background: Physical weakness and cardiovascular risk increase significantly with age, but the underlying biological mechanisms remain largely unknown. This study aims to reveal the causal effect of circulating metabolites on frailty, sarcopenia and vascular aging related traits and diseases through a two-sample Mendelian Randomization (MR) analysis. Methods: Exposures were 486 metabolites analyzed in a genome-wide association study (GWAS), while outcomes included frailty, sarcopenia, arterial stiffness, atherosclerosis, peripheral vascular disease (PAD) and aortic aneurysm. Primary causal estimates were calculated using the inverse-variance weighted (IVW) method. Methods including MR Egger, weighted median, Q-test, and leave-one-out analysis were used for the sensitive analysis. Results: A total of 125 suggestive causative associations between metabolites and outcomes were identified. Seven strong causal links were ultimately identified between six metabolites (kynurenine, pentadecanoate (15:0), 1-arachidonoylglycerophosphocholine, androsterone sulfate, glycine and mannose) and three diseases (sarcopenia, PAD and atherosclerosis). Besides, metabolic pathway analysis identified 13 significant metabolic pathways in 6 age-related diseases. Furthermore, the metabolite-gene interaction networks were constructed. Conclusion: Our research suggested new evidence of the relationship between identified metabolites and 6 age-related diseases, which may hold promise as valuable biomarkers.
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Affiliation(s)
- Zonghao Qian
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuzhen Huang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ni Yang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziwei Fang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cuntai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Le Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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van Zundert A, Gatt SP, van Zundert TC. Prevention and treatment of noncognitive complications. Saudi J Anaesth 2023; 17:557-565. [PMID: 37779568 PMCID: PMC10540984 DOI: 10.4103/sja.sja_329_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 10/03/2023] Open
Abstract
Patients aged 65 and older are the fastest growing segment in the population of many countries. Based on evolving demographics showing increasing life expectancies, it is expected that there will be a concurrent rise in the demand for a large variety of surgical and anesthesia services. Surgery offers definitive management of many age-related diseases and provides symptom-relieving (morbidity) and life-extending (mortality) benefits. However, elderly adult surgical patients, especially the frail ones, often require a different level of care than younger patients during the perioperative period. As many have chronic illnesses and acquired deconditioning and functional decline, older patients are prone to develop untoward outcomes such as postoperative complications and loss of independence. This manuscript focuses on the holistic quality person-centered care, supported by a wide stakeholder team of health-care workers, ensuring fidelity to comprehensive geriatric assessment and optimization services where possible, offering a systematic approach to early health risk assessment and risk modification in the perioperative period, with the ultimate goal of reducing postoperative complications and health-care costs. The "comprehensive geriatric assessment and optimization" cost-effective approach builds on robust evidence with older people more likely to be alive, a shorter length of hospital stay due to fewer postoperative medical complications, and improved rates of return to usual residence. Prehabilitation programs are delivered focusing on primary (through counseling) and secondary prevention (through screening) with an aim to improve fitness for surgery, by evaluating functional capacity, nutritional and psychological health, prompting interventions, targeting physical exercise, lifestyle and nutritional advice, and psychological support.
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Affiliation(s)
- André van Zundert
- The Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital and The University of Queensland, Brisbane, QLD, Australia
| | - Stephen P. Gatt
- Department of Anaesthesia, The University of New South Wales, Sydney, NSW, Australia and Udayana University, Indonesia
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Tomás JM, Oliver A, Torres Z, Parker J, Marques-Sule E, Sentandreu-Mañó T. A Biopsychosocial Model Predicting Myocardial Infarction. J Clin Med 2023; 12:5715. [PMID: 37685782 PMCID: PMC10489059 DOI: 10.3390/jcm12175715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Myocardial infarction is one of the main causes of death, and cardiovascular risk factors (CVRFs) are always considered when studying it. However, although it is known that other social and psychological variables, and especially frailty, can increase the risk of infarction, their simultaneous effect has not been extensively studied. This study is based on data from the SHARE project (latest wave, Wave 8), with a representative sample of 46,498 participants aged 50 or older (M = 70.40, SD = 9.33), of whom 57.4% were females. Statistical analyses included a full structural equation model that predicts 27% of infarction occurrence and evidences the significant effect of well-being, depression, and social connectedness on frailty. Frailty, in turn, explains 15.5% of the variability of CVRFs. This work supports the need to study these physical, social, and mental health factors together to intervene on frailty and, in turn, improve cardiovascular outcomes.
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Affiliation(s)
- José M. Tomás
- Department of Methodology for the Behavioral Sciences, University of Valencia, 46010 Valencia, Spain; (J.M.T.); (A.O.)
| | - Amparo Oliver
- Department of Methodology for the Behavioral Sciences, University of Valencia, 46010 Valencia, Spain; (J.M.T.); (A.O.)
| | - Zaira Torres
- Department of Methodology for the Behavioral Sciences, University of Valencia, 46010 Valencia, Spain; (J.M.T.); (A.O.)
| | - Janhavi Parker
- SMBT Institute of Medical Sciences and Research Centre, Nashik 422403, Maharashtra, India;
| | - Elena Marques-Sule
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (E.M.-S.); (T.S.-M.)
| | - Trinidad Sentandreu-Mañó
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (E.M.-S.); (T.S.-M.)
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Aguilar-Iglesias L, Merino-Merino A, Sanchez-Corral E, Garcia-Sanchez MJ, Santos-Sanchez I, Dominguez-Calvo J, Saez-Maleta R, Perez-Rivera JA. Fast systematic geriatric assessment in acute heart failure patients admitted in Cardiology. Heart Lung 2023; 60:133-138. [PMID: 36996756 DOI: 10.1016/j.hrtlng.2023.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Heart failure prevalence is increasing in elder adults. These patients usually present geriatric syndromes, especially frailty. The effect of frailty on heart failure is under discussion but there are few data about the clinical characterization of frail patients who are admitted for acute heart failure decompensation. OBJECTIVE The purpose of this study was to study the differences in clinical baseline variables and geriatric scales between frail and non-frail patients admitted to the Cardiology unit via the Emergency Department for acute heart failure. METHODS We enrolled all patients with acute heart failure who were admitted to the Cardiology unit from the Emergency Department of our hospital from July 2020 through May 2021. A multidimensional and comprehensive geriatric assessment was performed at the moment of admission. We studied differences in baseline variables and geriatric scales according to the frailty status determined by the FRAIL scale. RESULTS A total of 202 patients were included. In the whole population, 68 (33.7%) patients presented frailty defined by a FRAIL score ≥ 3. The frail patients were older (80±9 vs. 69±12 years; p<0.001), and had a worse quality of life (58.31±12.18 vs.39.26±13.71 points; p<0.001) according to the Minnesota scale, presented high comorbidity (47 (69.1%) vs. 67 (50.4%) patients; p = 0.011) defined as ≥3 points according to the Charlson scale and were more dependent (40 (58.8%) vs. 25 (18.8%) patients; p<0.001) according to the Barthel scale. The frail patients presented higher MAGGIC risk scores (24.09±4.99 vs. 18.89±6.26; p<0.001). Despite this adverse profile, the treatments prescribed during the admission and at the hospital discharge were similar. CONCLUSIONS The prevalence of geriatric syndromes, especially frailty, is very high in patients admitted for acute heart failure. Frail patients with acute heart failure had an adverse clinical profile with more prevalence of concomitant geriatric syndromes. Therefore, we consider that a geriatric assessment should be performed during the admission of acute heart failure patients to improve care and attention.
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Meenakshi-Siddharthan DV, Livia C, Peterson TE, Stalboerger P, Attia ZI, Clavell AL, Friedman PA, Kapa S, Noseworthy PA, Schafer MJ, Stulak JM, Behfar A, Boilson BA. Artificial Intelligence-Derived Electrocardiogram Assessment of Cardiac Age and Molecular Markers of Senescence in Heart Failure. Mayo Clin Proc 2023; 98:372-385. [PMID: 36868745 DOI: 10.1016/j.mayocp.2022.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/27/2022] [Accepted: 10/12/2022] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To ascertain whether heart failure (HF) itself is a senescent phenomenon independent of age, and how this is reflected at a molecular level in the circulating progenitor cell niche, and at a substrate level using a novel electrocardiogram (ECG)-based artificial intelligence platform. PATIENTS AND METHODS Between October 14, 2016, and October 29, 2020, CD34+ progenitor cells were analyzed by flow cytometry and isolated by magnetic-activated cell sorting from patients of similar age with New York Heart Association functional classes IV (n = 17) and I-II (n = 10) heart failure with reduced ejection fraction and healthy controls (n = 10). CD34+ cellular senescence was quantitated by human telomerase reverse transcriptase expression and telomerase expression by quantitative polymerase chain reaction, and senescence-associated secretory phenotype (SASP) protein expression assayed in plasma. An ECG-based artificial intelligence (AI) algorithm was used to determine cardiac age and difference from chronological age (AI ECG age gap). RESULTS CD34+ counts and telomerase expression were significantly reduced and AI ECG age gap and SASP expression increased in all HF groups compared with healthy controls. Expression of SASP protein was closely associated with telomerase activity and severity of HF phenotype and inflammation. Telomerase activity was more closely associated with CD34+ cell counts and AI ECG age gap. CONCLUSION We conclude from this pilot study that HF may promote a senescent phenotype independent of chronological age. We show for the first time that the AI ECG in HF shows a phenotype of cardiac aging beyond chronological age, and appears to be associated with cellular and molecular evidence of senescence.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Marissa J Schafer
- Department of Physiology and Biomedical Engineering; Robert and Arlene Kogod Center on Aging
| | | | - Atta Behfar
- Van Cleve Cardiac Regeneration Program; Department of Cardiovascular Diseases
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Abe T, Jujo K, Maeda D, Saito K, Ogasahara Y, Saito K, Saito H, Iwata K, Konishi M, Kitai T, Kasai T, Wada H, Momomura SI, Kagiyama N, Kamiya K, Yamashita M, Hamazaki N, Nozaki K, Maekawa E, Ako J, Matsue Y. The interaction between physical frailty and prognostic impact of heart failure medication in elderly patients. ESC Heart Fail 2023; 10:1698-1705. [PMID: 36824014 DOI: 10.1002/ehf2.14114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/25/2022] [Accepted: 08/04/2022] [Indexed: 02/25/2023] Open
Abstract
AIMS Frailty is highly prevalent and associated with poor prognoses in elderly patients with heart failure (HF). However, the potential effects of physical frailty on the benefits of HF medications in elderly patients with HF are unclear. We aimed to determine the influence of physical frailty on the prognosis of HF medications in elderly patients with HF with reduced and mildly reduced ejection fraction (HFr/mrEF). METHODS AND RESULTS From the combined HF database of the FRAGILE-HF and Kitasato cohorts, hospitalized HF patients with a left ventricular ejection fraction < 50% and age ≥ 65 years were analysed. Patients treated with or without renin-angiotensin-aldosterone system inhibitors (RAASi) and beta-blockers at discharge were compared. Physical frailty was defined by the presence of ≥3 items on the Japanese version of the Cardiovascular Health Study criteria. The primary endpoint was all-cause mortality rate. Among the 1021 enrolled patients, 604 patients (59%) received both RAASi and beta-blockers, and 604 patients (59%) were diagnosed as physically frail. Patients receiving both RAASi and beta-blockers showed a significantly lower 1 year mortality than those not receiving either, even after adjusting for covariates (hazard ratio: 0.50, 95% confidence interval: 0.34-0.75). This beneficial effect of both medications on 1 year mortality was comparable between patients with and without physical frailty (hazard ratio: 0.53 and 0.51, respectively; P for interaction = 0.77). CONCLUSIONS The presence of physical frailty did not interact with the beneficial prognostic impact of RAASi and beta-blocker combination therapy in elderly patients with HFr/mrEF.
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Affiliation(s)
- Takuro Abe
- Department of Cardiology, Nishiarai Heart Center Hospital, 1-12-8 Nishiarai-Honcho, Adachi-ku, Tokyo, 123-0845, Japan
| | - Kentaro Jujo
- Department of Cardiology, Nishiarai Heart Center Hospital, 1-12-8 Nishiarai-Honcho, Adachi-ku, Tokyo, 123-0845, Japan
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Katsumi Saito
- Department of Cardiology, Nishiarai Heart Center Hospital, 1-12-8 Nishiarai-Honcho, Adachi-ku, Tokyo, 123-0845, Japan
| | - Yuki Ogasahara
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kazuya Saito
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hiroshi Saito
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroshi Wada
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
| | | | - Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Alexa-Stratulat T, Pavel-Tanasa M, Cianga VA, Antoniu S. Immune senescence in non-small cell lung cancer management: therapeutic relevance, biomarkers, and mitigating approaches. Expert Rev Anticancer Ther 2022; 22:1197-1210. [PMID: 36270650 DOI: 10.1080/14737140.2022.2139242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Lung cancer and mainly non-small cell lung cancer (NSCLC) still remain a prevalent malignancy worldwide despite sustained screening approaches. Furthermore, a significant proportion of the cases are diagnosed at advanced stages when conservative therapy is often unsuccessful. Cell senescence is an endogenous antitumor weapon but when it is upregulated exerts opposite activities favoring tumor metastasizing and poor response to therapy. However, little is known about this dangerous relationship between cell senescence and NSCLC outcome or on potential approaches to mitigate its unfavorable consequences. AREAS COVERED We discuss cell senescence focusing on immune senescence, its cell and humoral effectors (namely immune senescence associated secretory phenotype-iSASP), its impact on NSCLC outcome, and its biomarkers. Senotherapeutics as mitigating approaches are also considered based on the availability of experimental data pertinent to NSCLC. EXPERT OPINION Characterization of NSCLC subsets in which immune senescence is a risk factor for poor prognosis and poor therapeutic response might be very helpful in supporting the addition of senotherapeutics to conventional cancer therapy. This approach has the potential to improve disease outcome but more studies in this area are necessary.
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Affiliation(s)
- Teodora Alexa-Stratulat
- Department of Medicine III-Oncology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Mariana Pavel-Tanasa
- Department of Immunology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Vlad-Andrei Cianga
- Department of Hematology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Sabina Antoniu
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
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Jia Y, Li D, Yu J, Liu Y, Li F, Li W, Zhang Q, Gao Y, Zhang W, Zeng Z, Zeng R, Liao X, Zhao Q, Wan Z. Subclinical cardiovascular disease and frailty risk: the atherosclerosis risk in communities study. BMC Geriatr 2022; 22:321. [PMID: 35413794 PMCID: PMC9006603 DOI: 10.1186/s12877-022-02974-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 03/21/2022] [Indexed: 02/08/2023] Open
Abstract
Background Cardiovascular disease (CVD) is associated with a greater frailty risk, but it remains unknown if pathways that contribute to CVD are associated with the frailty risk. Thus, we aimed to investigate whether elevations in high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for those without known CVD at baseline are associated with a higher frailty risk. Methods This study used data from the Atherosclerosis Risk in Communities study. Cardiac biomarkers were measured from stored plasma samples collected at Visit 2 (1991–1993). Frailty was recorded at Visit 5 (2011–2013). Cox regression models were used to determine the association of cardiac biomarkers with frailty risk. Results Overall, 360/5199 (6.9%) participants aged 55.1 ± 5.1 years developed frailty during a median follow-up of 21.7 years. The incidence of frailty was significantly higher in participants with hs-cTnT ≥14 ng/L (vs. < 14 ng/L: 17.9% vs. 6.7%) or NT-proBNP ≥300 pg/ml (vs. < 300 pg/ml: 19.7% vs. 6.8%) (all P < 0.001). Comparing higher vs. lower cut-off levels of either hs-cTnT (14 ng/l) or NT-proBNP (300 pg/ml) demonstrated a greater than two-fold higher frailty risk, with hazard ratios (HRs) of 2.13 (95% confidence interval (CI): 1.130–4.01, P = 0.020) and 2.61 (95% CI: 1.28–5.33, P = 0.008), respectively. Individuals with both elevated hs-cTnT and NT-proBNP had a higher frailty risk than those without it (HR: 4.15; 95% CI: 1.50–11.48, P = 0.006). Conclusions High hs-cTnT and NT-proBNP levels are strongly associated with incident frailty in the community-dwelling population without known CVD. Subclinical cardiac damage (hs-cTnT) and/or wall strain (NT-proBNP) may be the key pathway of CVD patients developing frailty. Detection of hs-cTnT and NT-proBNP may help for early screening of high-risk frailty and providing individualised intervention. Trial registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005131. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02974-z.
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Affiliation(s)
- Yu Jia
- Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China Hospital, Sichuan University West China School of Medicine, Chengdu, China.,West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Dongze Li
- Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China Hospital, Sichuan University West China School of Medicine, Chengdu, China
| | - Jing Yu
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China Hospital, Sichuan University West China School of Medicine, Chengdu, China.,West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Fanghui Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wentao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Zhang
- Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China Hospital, Sichuan University West China School of Medicine, Chengdu, China.,West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yongli Gao
- Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China Hospital, Sichuan University West China School of Medicine, Chengdu, China.,West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Zhang
- Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China Hospital, Sichuan University West China School of Medicine, Chengdu, China.,West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi Zeng
- Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China Hospital, Sichuan University West China School of Medicine, Chengdu, China
| | - Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- Department of General Practice, International Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Zhao
- Department of General Practice, International Medical Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Zhi Wan
- Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China Hospital, Sichuan University West China School of Medicine, Chengdu, China.
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Tournas G, Kourek C, Mantzaraki V, Georgiopoulos G, Pantos C, Toumanidis S, Briasoulis A, Paraskevaidis I. Assessment of Frailty and Related Outcomes in Older Patients with Heart Failure: a Cohort Study. Hellenic J Cardiol 2022; 67:42-47. [DOI: 10.1016/j.hjc.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 11/04/2022] Open
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Clinical Phenotypes of Cardiovascular and Heart Failure Diseases Can Be Reversed? The Holistic Principle of Systems Biology in Multifaceted Heart Diseases. CARDIOGENETICS 2022. [DOI: 10.3390/cardiogenetics12020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Recent advances in cardiology and biological sciences have improved quality of life in patients with complex cardiovascular diseases (CVDs) or heart failure (HF). Regardless of medical progress, complex cardiac diseases continue to have a prolonged clinical course with high morbidity and mortality. Interventional coronary techniques together with drug therapy improve quality and future prospects of life, but do not reverse the course of the atherosclerotic process that remains relentlessly progressive. The probability of CVDs and HF phenotypes to reverse can be supported by the advances made on the medical holistic principle of systems biology (SB) and on artificial intelligence (AI). Studies on clinical phenotypes reversal should be based on the research performed in large populations of patients following gathering and analyzing large amounts of relative data that embrace the concept of complexity. To decipher the complexity conundrum, a multiomics approach is needed with network analysis of the biological data. Only by understanding the complexity of chronic heart diseases and explaining the interrelationship between different interconnected biological networks can the probability for clinical phenotypes reversal be increased.
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12
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Flores-Álvarez FJ, Sillero-Herrera A, Cuesta-Gaviño J, Fernández-Sánchez ML, Vega-Sánchez J, López-Fe JL, Gamboa-Antiñolo FM, Utrilla-Ayala D, Aguirre-Palacio A, De Villar-Conde E, Vergara-López S. Frailty as a predictor of clinical problems and events that require elderly patients with heart failure to use health resources. Arch Gerontol Geriatr 2022; 101:104698. [PMID: 35390571 DOI: 10.1016/j.archger.2022.104698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/15/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The clinical management of elderly patients with heart failure (HF) is not firmly established. Decision-making should be individualized depending on the biological deterioration of each patient, from aggressive management to a palliative approach. Frailty can serve as the basis for this comprehensive individualized management. Our objective was to evaluate the importance of the main clinical problems, as well as the events that required the use of health resources, based the degree of frailty, in elderly patients with HF. METHODS AND RESULTS Retrospective observational cohort study. Frailty was defined according to the deficit accumulation construct. A total of 546 patients hospitalized for acute HF were included. The median age (Q1-Q3) was 82 (78-86) years. A total of 454 patients (83%) showed some degree of frailty: 221 (48.7%) mild, 207 (45.6%) moderate and 26 (5.7%) advanced. There was a significant tendency towards polypharmacy from no to severe frailty. Hospital events were recorded for 4 (1-6) patients with mild frailty, 4 (2-6) patients with moderate frailty and 2 ((1-4) patients with advanced frailty (p = 0.045). A total of 204 patients (37.4%) died during follow-up. The median time to death was 11.4 (4-16.8), 6.7 (3.3-11.6), 6.5 (3.4-12.2) and 4.1 (0.8-7.7) months for patients with no, mild, moderate, or advanced frailty, respectively (p = 0.006). CONCLUSIONS Frailty due to deficit accumulation is a good predictor of clinical problems and events that require the use of health resources; therefore, it can serve as a basis for the management of HF in the elderly.
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Affiliation(s)
- F J Flores-Álvarez
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - A Sillero-Herrera
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - J Cuesta-Gaviño
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | | | - J Vega-Sánchez
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - J L López-Fe
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - F M Gamboa-Antiñolo
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - D Utrilla-Ayala
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - A Aguirre-Palacio
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - E De Villar-Conde
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain)
| | - S Vergara-López
- Internal Medicine Service. Hospitals of Valme and El Tomillar. Seville (Spain).
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Exploring the Relationship between Frailty, Functional Status, Polypharmacy, and Quality of Life in Elderly and Middle-Aged Patients with Cardiovascular Diseases: A One-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042286. [PMID: 35206472 PMCID: PMC8871852 DOI: 10.3390/ijerph19042286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023]
Abstract
The association between frailty, disability in activities of daily living (ADL), polypharmacy, and quality of life (QoL) in middle-aged patients with cardiovascular disease (CVD) is little investigated. This study sought (a) to explore this association comparatively in elderly and middle-aged hospitalized patients with CVD and (b) to determine which domains of ADL and QoL might improve the frailty prediction. A one-year follow-up study including 90 elderly (≥65 years old) and 89 middle-aged patients (40-65 years old) was conducted. At baseline, frailty assessment was performed based on the Fried criteria; Barthel Index (BI) and Duke Activity Status Index (DASI) were used for ADL, and European Quality of Life-5 dimensions (EQ-5D) for QoL. At follow-up, data were collected via telephone. At baseline, 79 patients (51 elderly and 28 middle-aged) were frail. The CVD frail patients showed functional dependency and a poor QoL compared to the non-frail (p < 0.001) and within each subgroup at follow-up. Mobility was found to predict frailty in both elderly (OR = 2.34) (C.I. (1.03-5.29)) and middle-aged patients (OR = 2.58) (C.I. (1.15-5.78)). The ADL assessment and self-reported QoL may help to identify an aggravation or an advanced frailty condition in hospitalized elderly and middle-aged CVD patients.
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Chi J, Chen F, Zhang J, Niu X, Tao H, Ruan H, Jin L, Wang Y. Frailty is associated with 90-day unplanned readmissions and death in patients with heart failure: A longitudinal study in China. Heart Lung 2022; 53:25-31. [PMID: 35121488 DOI: 10.1016/j.hrtlng.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Frailty has been reported to be significantly associated with adverse health outcomes in people with heart failure (HF). OBJECTIVES To explore the potential effects of frailty on unplanned readmissions and death in people with HF patients aged 18 years or older. METHODS 342 HF patients aged 18 years or older from the heart centers of two different tertiary care hospitals located in northwest of China were enrolled between July and December 2020. Frailty was assessed by the Tilburg Frailty Indicator. The patients were followed for unplanned readmissions, and all-cause mortality at 30, 60, as well as 90 days after discharge. Multivariate cox regression models were used to analyze the effects of frailty on 90-day unplanned readmission and death in the patients with HF. RESULTS Frailty prevalence was 54.7% among 342 HF patients, with a mean age of 64.65 ± 11.90 years. It was found that compared to non-frailty HF patients, the frailty HF patients were older and displayed higher systolic blood pressure, longer duration of HF, more severe cognitive function, and more comorbidities (P < 0.05). On the contrary, the patients in the frail group had a higher incidence of unplanned readmission (73.1% vs. 26.9%, χ2 = 18.87, P < 0.01) and death (100% vs. 0%, χ2 = 6.94, P < 0.01) than those in the non-frail group. Multivariate cox regression analysis showed that frailty could serve as an independent risk factor for 90-day unplanned readmission (HR = 1.469, 95% CI 1.318-1.637, P < 0.01) and 90-day death (HR=2.270, 95% CI 1.091-4.726, P < 0.01) in the patients with HF. CONCLUSION Frailty can act as an independent predictor of unplanned readmission and death 90-day after discharge in HF patients aged 18 years or older.
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Affiliation(s)
- Junting Chi
- Department of Nursing, First People's Hospital of Yunnan, 157 Jinbi Road, Xishan District, Kunming, Yunnan 650032, PR China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan 650032, PR China; School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Fei Chen
- School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China; Evidence-Based Nursing Center, School of Nursing, Lanzhou University, NO. 28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Jing Zhang
- School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Xiaodan Niu
- School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Hongxia Tao
- School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Haihui Ruan
- School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Lifen Jin
- Department of Nursing, First People's Hospital of Yunnan, 157 Jinbi Road, Xishan District, Kunming, Yunnan 650032, PR China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan 650032, PR China.
| | - Yanhong Wang
- School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China.
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Rech DA, da Silveira LS, Martins EM, de Oliveira Roque ABA, Althoff A, Maiorana AJ, Vieira AM, Karsten M. Frailty influences the vascular responsiveness of elderly individuals with chronic heart failure. Microvasc Res 2022; 141:104316. [PMID: 35038445 DOI: 10.1016/j.mvr.2022.104316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Frailty is highly prevalent in heart failure (HF) patients. HF is associated with oxidative stress and chronic inflammation, which impair oxygen use by skeletal muscles. Little is known about the influence of frailty on vascular responsiveness and tissue oxygenation. OBJECTIVE Analyze the influence of frailty on vascular responsiveness and muscle oxygenation in elderly individuals with and without HF. METHODS Individuals aged ≥60 years, with or without HF, were evaluated for frailty (phenotype). Near-infrared spectroscopy (NIRS) was used to assess muscle oxygenation at rest (oxygen saturation - StO2 and deoxyhemoglobin) and during handgrip exercise (minimum StO2 and maximum deoxyhemoglobin), and oxygenation variables. STATISTICAL ANALYSIS Results were grouped according to the frailty phenotype: non-frail, pre-frail, and frail. Shapiro-Wilk test was used to assess normality. Data were compared using a two-way analysis of variance (ANOVA). Bonferroni post hoc test was applied to determine the influence of frailty or HF on NIRS variables. SPSS software was used in the analyses; p < 0.05 was considered significant. RESULTS 55 elderly participants (61.8% female; 70.4 ± 7.2 years old; 28 HF patients) participated in the study. 32.7% (n = 18) were classified as non-frail, 43.3% (n = 24) as pre-frail, and 23.6% (n = 13) as frail. The analysis of vascular responsiveness (n = 52) identified an influence (p < 0.05) of frailty on the reperfusion rate (slope 2 and ∆StO2 of nadir-peak) and desaturation during occlusion (area under the curve of StO2) in HF patients. There was no influence of frailty or HF on muscle oxygenation at rest and during exercise (n = 54; p > 0.05). CONCLUSION The coexistence of frailty and HF seems to impair vascular responsiveness, as frail elderly participants with HF presented lower reperfusion rates and higher desaturation levels during the arterial occlusion test. However, the presence of frailty or HF alone had no influence on muscle oxygenation at rest or during exercise.
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Affiliation(s)
- Daiana Aparecida Rech
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil
| | - Lucas Santos da Silveira
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil
| | - Edgar Manoel Martins
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil
| | | | - Amanda Althoff
- Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil
| | - Andrew John Maiorana
- Department of Allied Health, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia; School of Allied Health, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia.
| | - Ariany Marques Vieira
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Montreal Behavioural Medicine Centre, 5400 Boul Gouin O, Montréal, Québec, QC H4J 1C5, Canada
| | - Marlus Karsten
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre, RS 90050-170, Brazil.
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Strandberg LS, Roos A, Holzmann MJ. Stable high-sensitivity cardiac troponin T levels and the association with frailty and prognosis in patients with chest pain. AMERICAN JOURNAL OF MEDICINE OPEN 2021; 1-6:100001. [PMID: 39036625 PMCID: PMC11256254 DOI: 10.1016/j.ajmo.2021.100001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/18/2021] [Accepted: 08/22/2021] [Indexed: 07/23/2024]
Abstract
Background Chronic myocardial injury is defined by stable high-sensitivity cardiac troponin (hs-cTn) levels above the 99th percentile value, which may be a sign of a biologically aged heart. This study investigated the association between frailty and chronic myocardial injury. Methods In a cohort of patients with chest pain and stable hs-cTnT levels measured 2011-2014, we included all patients who were assessed by two scoring systems measuring frailty. Adjusted odds ratios (ORs) were calculated to estimate the risk of frailty at different hs-cTnT levels (referent: hs-cTnT ≤ 14 ng/l). Cox regression was used to estimate risks of death and cardiovascular events in relation to frailty status and hs-cTnT levels (referent: non-frail and hs-cTnT ≤ 14 ng/l). Results A total of 979 patients were included, of whom 269 (27%) had chronic myocardial injury. The risk of being frail was almost four times higher in patients with chronic myocardial injury, compared with patients in the reference group (hs-cTnT ≥ 30 ng/l: OR: 3.69, 95% CI: 2.02-6.76). During a follow-up of 4.3 years, 275 (28%) patients died. Mortality risks increased with increasing hs-cTnT levels and degree of frailty, being increased four-fold in frail patients with hs-cTnT levels ≥ 30 ng/l (HR: 4.07, 95% CI: 2.42-6.86). Conclusions Stable hs-cTnT levels are associated with the degree of frailty, and frailty measurements could help to identify patients with stable hs-cTnT levels who are at a high risk of death. The findings support the hypothesis that chronic myocardial injury could be a marker of a biologically aged heart.
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Affiliation(s)
| | - Andreas Roos
- Department of Medicine, Karolinska Institute, Solna, Stockholm, Sweden
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Martin J. Holzmann
- Department of Medicine, Karolinska Institute, Solna, Stockholm, Sweden
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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Bodolea C, Hiriscau EI, Buzdugan EC, Grosu AI, Stoicescu L, Vesa Ș, Cauli O. The Association between Peripheral Blood Cells and the Frailty Syndrome in Patients with Cardiovascular Diseases. Endocr Metab Immune Disord Drug Targets 2021; 20:1419-1433. [PMID: 32787768 PMCID: PMC8226153 DOI: 10.2174/1871530320666200813135905] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 12/24/2022]
Abstract
Background Frailty syndrome is characterized by multisystem dysregulation frequently found in older individuals or even in younger patients with chronic disabling diseases such as cardiovascular diseases. Objective To determine whether peripheral blood cell count, and its subpopulations, red blood cell and platelets, morphology and different ratios (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and red blood distribution width-to-platelet ratio) are associated with cardiac frail patients, and through this to improve the prediction of frailty status in patients with cardiovascular diseases. Methods An observational, retrospective, cohort study enrolling 179 patients with cardiovascular disease divided into two groups: non-frail group (100 pts) and frail group (79 pts), a cohort detached from the Frail.RO study. The frailty was evaluated based on the Fried criteria; haematological markers, sociodemographic data, and variables related to cardiovascular diseases and comorbidities were also recorded. Results Lower lymphocytes, platelet count, and neutrophil-to-lymphocyte ratio were significantly associated with a more severe frailty syndrome. Regarding red blood cells, haemoglobin concentration and red cell distribution width significantly correlated with the severity of the frailty syndrome. Receiver operating characteristic curve analysis for these markers associated with the frailty syndrome revealed an acceptable sensitivity of 66% and specificity of 65% to identify frail individuals. Malnutrition and hypercholesterolemia are relevant predictors for identifying frailty in hospitalized cardiovascular patients. Conclusion The evaluation of peripheral blood cell composition routinely measured in clinical practice can represent a valuable, but limited indicator, to diagnose frailty syndrome and eventually, the effects of interventions in frail patients with cardiovascular diseases.
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Affiliation(s)
- Constantin Bodolea
- ICU Department, ”Iuliu Hațieganu”, University of Medicine and Pharmacy, Cluj-Napoca, Romania,ICU Department, ”Iuliu Hațieganu” University Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Elisabeta I Hiriscau
- ICU Department, ”Iuliu Hațieganu” University Clinical Municipal Hospital, Cluj-Napoca, Romania,Nursing Department, ”Iuliu Hațieganu”, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Elena-Cristina Buzdugan
- Internal Medicine Department, ”Iuliu Hațieganu”University of Medicine and Pharmacy, Cluj-Napoca, Romania,Cardiology Unit, University Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Alin I Grosu
- Internal Medicine Department, ”Iuliu Hațieganu”University of Medicine and Pharmacy, Cluj-Napoca, Romania,Cardiology Unit, University Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Laurențiu Stoicescu
- Internal Medicine Department, ”Iuliu Hațieganu”University of Medicine and Pharmacy, Cluj-Napoca, Romania,Cardiology Unit, University Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Ștefan Vesa
- Department of Clinical Pharmacology,”Iuliu Hațieganu”University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Omar Cauli
- Department of Nursing, University of Valencia, Valencia, Spain
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Attaway A, Bellar A, Dieye F, Wajda D, Welch N, Dasarathy S. Clinical impact of compound sarcopenia in hospitalized older adult patients with heart failure. J Am Geriatr Soc 2021; 69:1815-1825. [PMID: 33735939 DOI: 10.1111/jgs.17108] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Skeletal muscle loss or sarcopenia is a frequent complication in heart failure (HF) and contributes to adverse clinical outcomes. We evaluated if age (primary) and chronic disease (secondary) related sarcopenia, that we refer to as compound sarcopenia, impacts clinical outcomes in hospitalized patients with HF. DESIGN Cross-sectional study using hospitalized patient data. SETTING Data from the Agency for Healthcare Research and Quality through the Healthcare Cost and Utilization Project (HCUP). PARTICIPANTS Hospitalized adult patients with a primary or secondary diagnosis of HF (n = 64,476) and a concurrent random 2% sample of general medical population (GMP; n = 322,217) stratified by age (<50 years of age [y], 51-65y, >65y) from the Nationwide Inpatient Sample (NIS) database (years 2010-2014). MEASUREMENTS In-hospital mortality, length of stay (LoS), cost of hospitalization per admission (CoH), comorbidities and discharge disposition, with and without muscle loss phenotype, were analyzed. Muscle loss phenotype was defined using a comprehensive code set from international classification of diseases-9 (ICD-9). RESULTS Muscle loss phenotype was observed in 8673 (13.5%) patients with HF compared to 5213 (1.6%) GMP across all age strata. In patients with HF, muscle loss phenotype was associated with higher mortality, LoS, and CoH. Patients with HF (>65y) and muscle loss phenotype had higher mortality (adjusted OR: 1.81; 95% CI 1.56-2.10), CoH (adjusted OR 1.48; 95% CI 1.44-1.1.52), and LoS (adjusted OR 1.40; 95% CI 1.37-1.43) compared to >65y GMP with muscle loss phenotype. CONCLUSION Muscle loss phenotype is more commonly associated with increasing age in hospitalized patients with HF. Clinical outcomes were significantly worse in patients with HF aged >65y compared to younger patients with HF and all age strata in GMP with and without a muscle loss phenotype.
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Affiliation(s)
- Amy Attaway
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Annette Bellar
- Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Faty Dieye
- Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | - Douglas Wajda
- Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Health and Human performance, Cleveland State University, Cleveland, Ohio, USA
| | - Nicole Welch
- Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA.,Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Srinivasan Dasarathy
- Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA.,Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
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Gonçalves VC, Cuenca-Bermejo L, Fernandez-Villalba E, Martin-Balbuena S, da Silva Fernandes MJ, Scorza CA, Herrero MT. Heart Matters: Cardiac Dysfunction and Other Autonomic Changes in Parkinson's Disease. Neuroscientist 2021; 28:530-542. [PMID: 33583239 DOI: 10.1177/1073858421990000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
It has been more than 200 years since James Parkinson made the first descriptions of the disease that bears his name. Since then, knowledge about Parkinson's disease has been improved, and its pathophysiology, diagnosis, and treatments are well described in the scientific and medical literature. However, there is no way to prevent the disease from its progressive nature yet and only its symptoms can be minimized. It is known that the process of neurodegeneration begins before the onset of motor signs and symptoms of the disease, when diagnosis is usually made. Therefore, recognizing manifested non-motor symptoms can make an early diagnosis possible and lead to a better understanding of the disease. Autonomic dysfunctions are important non-motor manifestations of Parkinson's disease and affect the majority of patients. Importantly, heart failure is the third leading cause of death in people suffering from Parkinson's disease. Several evidences have shown the correlation between Parkinson's disease and the preexistence of cardiovascular diseases. Therefore, cardiovascular monitoring and identification of its dysfunctions can have a prodromal role for Parkinson's disease. This review presents studies of the literature that can lead to a better understanding of Parkinson's disease with special attention to its relation to heart and cardiovascular parameters.
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Affiliation(s)
- Valeria C Gonçalves
- Clinical & Experimental Neuroscience (NiCE), Biomedical Research Institute of Murcia (IMIB- Arrixaca), Murcia, Spain.,Clinical & Experimental Neuroscience (NiCE), Institute for Ageing Research (IUIE), School of Medicine, Campus Mare Nostrum. University of Murcia, Murcia, Spain.,Disciplina de Neurociência, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Lorena Cuenca-Bermejo
- Clinical & Experimental Neuroscience (NiCE), Biomedical Research Institute of Murcia (IMIB- Arrixaca), Murcia, Spain.,Clinical & Experimental Neuroscience (NiCE), Institute for Ageing Research (IUIE), School of Medicine, Campus Mare Nostrum. University of Murcia, Murcia, Spain
| | - Emiliano Fernandez-Villalba
- Clinical & Experimental Neuroscience (NiCE), Biomedical Research Institute of Murcia (IMIB- Arrixaca), Murcia, Spain.,Clinical & Experimental Neuroscience (NiCE), Institute for Ageing Research (IUIE), School of Medicine, Campus Mare Nostrum. University of Murcia, Murcia, Spain
| | - Sebastian Martin-Balbuena
- Clinical & Experimental Neuroscience (NiCE), Biomedical Research Institute of Murcia (IMIB- Arrixaca), Murcia, Spain.,Clinical & Experimental Neuroscience (NiCE), Institute for Ageing Research (IUIE), School of Medicine, Campus Mare Nostrum. University of Murcia, Murcia, Spain
| | - Maria Jose da Silva Fernandes
- Disciplina de Neurociência, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Carla A Scorza
- Disciplina de Neurociência, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Maria-Trinidad Herrero
- Clinical & Experimental Neuroscience (NiCE), Biomedical Research Institute of Murcia (IMIB- Arrixaca), Murcia, Spain.,Clinical & Experimental Neuroscience (NiCE), Institute for Ageing Research (IUIE), School of Medicine, Campus Mare Nostrum. University of Murcia, Murcia, Spain
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Darden DB, Moore FA, Brakenridge SC, Navarro EB, Anton SD, Leeuwenburgh C, Moldawer LL, Mohr AM, Efron PA, Mankowski RT. The Effect of Aging Physiology on Critical Care. Crit Care Clin 2021; 37:135-150. [PMID: 33190766 PMCID: PMC8194285 DOI: 10.1016/j.ccc.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Older patients experience a decline in their physiologic reserves as well as chronic low-grade inflammation named "inflammaging." Both of these contribute significantly to aging-related factors that alter the acute, subacute, and chronic response of these patients to critical illness, such as sepsis. Unfortunately, this altered response to stressors can lead to chronic critical illness followed by dismal outcomes and death. The primary goal of this review is to briefly highlight age-specific changes in physiologic systems majorly affected in critical illness, especially because it pertains to sepsis and trauma, which can lead to chronic critical illness and describe implications in clinical management.
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Affiliation(s)
- Dijoia B Darden
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Frederick A Moore
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Scott C Brakenridge
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Eduardo B Navarro
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Stephen D Anton
- Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Road, Gainesville, FL 32611, USA
| | - Christiaan Leeuwenburgh
- Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Road, Gainesville, FL 32611, USA
| | - Lyle L Moldawer
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Alicia M Mohr
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Philip A Efron
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Robert T Mankowski
- Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Road, Gainesville, FL 32611, USA.
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Oliveira PRC, Rodrigues VES, Oliveira AKLD, Oliveira FGL, Rocha GA, Machado ALG. Fatores associados à fragilidade em idosos acompanhados na Atenção Primária à Saúde. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Verificar a associação entre os marcadores de fragilidade e as características sociodemográficas e clínicas em idosos na Atenção Primária à Saúde. Método Pesquisa transversal, realizada com 356 idosos cadastrados em unidades de saúde da família, no Nordeste do Brasil. Os instrumentos de coleta utilizados foram o Índice de Vulnerabilidade Clínico-Funcional e outro de perfil socioeconômico e de saúde. Analisaram-se os dados pela estatística inferencial, utilizando o teste do Qui-quadrado, com nível de significância 0,05. Resultados A média de idade foi de 72,85 anos (±8,965); 63,8% eram do sexo feminino, 39% apresentaram risco de fragilização e 22,5% demonstraram fragilidade. Houve associação entre fragilidade, sexo, faixa etária, estado civil, escolaridade, renda, presença de doença cardíaca e hipertensão. Conclusões e implicações para a prática Os marcadores de fragilidade nos idosos evidenciaram associação entre as características sociodemográficas e clínicas, indicando a necessidade de rastreio precoce no nível primário de atenção à saúde.
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Tsuji S, Shinmura K, Nagai K, Wada Y, Kusunoki H, Tamaki K, Ito M, Sano K, Amano M, Hasegawa Y, Kishimoto H, Maruo K, Iseki T, Tachibana T. Low back pain is closely associated with frailty but not with sarcopenia: Cross-sectional study of rural Japanese community-dwelling older adults. Geriatr Gerontol Int 2020; 21:54-59. [PMID: 33245209 DOI: 10.1111/ggi.14100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 12/20/2022]
Abstract
AIM We speculated that low back pain, which is the most common ailment in older adults, is associated with frailty and/or sarcopenia and contributes to the progression of either condition. Our objective was to evaluate the relationship between low back pain, sarcopenia and frailty in rural Japanese community-dwelling older adults. METHODS We recruited 730 participants aged ≥65 years who underwent a comprehensive health examination between November 2016 and December 2018. The Oswestry Disability Index (ODI) was used to assess low back pain quantitatively, and scores were compared for the frail groups determined by the Japanese version of Cardiovascular Health Study, and the sarcopenia groups as determined by the Asian Working Group for Sarcopenia 2019. RESULTS Among 730 participants, the prevalence of low back pain was 57.8%. There were significant differences in the ODI scores between the robust, prefrail and frail groups (P < 0.001). In contrast, there were no significant differences in the ODI scores among the robust, low appendicular skeletal muscle and sarcopenia groups. Logistic regression analysis showed that the prevalence of low back pain and the ODI scores were significantly associated with frailty after adjustment for age, sex and body mass index (odds ratio 3.41, 95% confidence interval 1.39-8.39, P = 0.008, and odds ratio 1.06, 95% confidence interval 1.04-1.09, P < 0.001, respectively). CONCLUSIONS To the best of our knowledge, this study is the first to show the close association between low back pain and frailty, and suggests that not only the decline in physical function but also neuropsychiatric factors, including chronic pain, constitute a vicious cycle of frailty in community-dwelling older adults. Geriatr Gerontol Int 2021; 21: 54-59.
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Affiliation(s)
- Shotaro Tsuji
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ken Shinmura
- Department of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Koutatsu Nagai
- School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Yosuke Wada
- Department of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroshi Kusunoki
- Department of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kayoko Tamaki
- Department of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masako Ito
- School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Kyoko Sano
- School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Manabu Amano
- School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan
| | - Yoko Hasegawa
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiromitsu Kishimoto
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Keishi Maruo
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tomoya Iseki
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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The aging transplant population and immunobiology: any therapeutic implication? Curr Opin Organ Transplant 2020; 25:255-260. [PMID: 32374576 PMCID: PMC9366898 DOI: 10.1097/mot.0000000000000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to describe the latest investigations into the immunobiology of aging and the potential impact on outcomes after mechanical circulatory support implantation and heart transplantation. This information is relevant given the growing numbers of older patients with heart failure undergoing evaluation for mechanical circulatory support device (MCSD) or heart transplantation. RECENT FINDINGS A host of aging-associated aspects of immune dysfunction have been described in the general population including T-cell senescence, exhaustion, and terminal dedifferentiation, as well as impaired function of innate immune cells. Another important consequence of T-cell senescence is inflammation, which is known to have a strong relationship with both heart failure and frailty in older patients. Recent data on the association between T-cell and monocyte phenotypes as well as evaluation of gene expression and adverse outcomes after MCSD suggests the potential value of immunologic assessment of MCSD and heart transplant candidates and recipients. Measurement of physical frailty represents another avenue for patient evaluation that may complement immunologic assessment. Determination of immune dysfunction and frailty prior to transplantation may have implications for choice of induction and dosing of maintenance immunosuppression. SUMMARY As the age of transplant and MCSD candidates and recipients continues to increase, it is important for providers to recognize the potential impact of aging-associated immune dysfunction and how it may influence candidate selection, postintervention monitoring, and adjustment of immunosuppression.
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Woitok BK, Ravioli S, Funk GC, Lindner G. Characteristics of very elderly patients in the emergency department - A retrospective analysis. Am J Emerg Med 2020; 46:200-203. [PMID: 33069543 DOI: 10.1016/j.ajem.2020.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Elderly people, defined by age 65 years and older, made up 18.45% of the Swiss Population in 2018 and their number is projected to rise continuously. Data investigating specific characteristics of this patient subgroup, especially in the emergency setting, is scarce. METHODS Demographic data of admission records from all patients aged 65 years or older admitted to our emergency department (ED) between January 1st 2015 and December 31st 2018 were investigated. Retrospective chart reviews of patients admitted in 2018 were conducted. Comorbidity burden was assessed by Charlson Comorbidity Index. Risk factors for death, longer hospitalization and placement in a nursing facility were identified by multivariate regression. RESULTS The prevalence of elderly patients (≥65 years) admitted to the ED between 2015 and 2018 was rising from 33% in 2015 to 37.8% in 2018. In 2018 709 patients were 90 years and older (3.6%). Age above 90 years and high comorbidity burden were identified as independent risk factors for death. Polypharmacy, hyponatremia and high comorbidity burden were independent risk factors for longer hospitalizations. Advanced age and high comorbidity burden were independent risk factors for placement in a nursing facility. CONCLUSION The number of elderly patients admitted to our ED is continuously rising. There was no difference in overall disease burden, number of medications and hospital length of stay between octogenarians and nonagenarians. We identified risk factors for mortality, long hospitalizations and need of placement in a nursing facility.
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Affiliation(s)
- Bertram K Woitok
- Dept. of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
| | - Svenja Ravioli
- Dept. of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - Georg-Christian Funk
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilheminenspital, Vienna, Austria
| | - Gregor Lindner
- Dept. of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn, Switzerland
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Natanzon SS, Maor E, Klempfner R, Goldenberg I, Shaviv E, Massalha E, Shlomo N, Goldanov Y, Mazin I. Norton score and clinical outcomes following acute decompensated heart failure hospitalization. J Cardiol 2020; 76:335-341. [DOI: 10.1016/j.jjcc.2020.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/22/2020] [Accepted: 05/03/2020] [Indexed: 12/11/2022]
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26
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Matsumura K, Teranaka W, Matsumoto H, Fujii K, Tsujimoto S, Otagaki M, Morishita S, Hashimoto K, Shibutani H, Yamamoto Y, Shiojima I. Loss of skeletal muscle mass predicts cardiac death in heart failure with a preserved ejection fraction but not heart failure with a reduced ejection fraction. ESC Heart Fail 2020; 7:4100-4107. [PMID: 32964678 PMCID: PMC7754999 DOI: 10.1002/ehf2.13021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/01/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
Aims Loss of skeletal muscle mass is an important determinant associated with poor long‐term prognosis in patients with acute decompensated heart failure (ADHF). However, limited evidence is available. This study investigated the prognostic value of the psoas muscle mass index (PMI) in patients with ADHF. Methods and results A total of 210 consecutive patients aged ≥60 years with ADHF were enrolled using a prospective database between 2015 and 2017. Primary endpoint was incidence of cardiac death. Cross‐sectional psoas muscle area at the L3 vertebral level was obtained by computed tomography, and PMI was calculated by height. Reduced PMI was defined as a PMI below the 25th sex‐specific percentile. Patients were also classified by their left ventricular ejection fraction (EF) as having either heart failure with a reduced ejection fraction (HFrEF, EF < 50%) or heart failure with a preserved ejection fraction (HFpEF, EF ≥ 50%). The median follow‐up period was 1.8 years. There were 44 cardiac deaths (21%) during the study period. Patients with reduced PMI had significantly higher cardiac death rates than those with preserved PMI (33% vs. 17%, log‐rank test P = 0.006). In subgroup analysis, HFpEF patients with reduced PMI had significantly higher cardiac death rates than those with preserved PMI (38% vs. 16%, log‐rank test P = 0.006); conversely, HFrEF patients had comparable cardiac death rates regardless of their PMI group (27% for reduced PMI vs. 18% for preserved PMI, log‐rank test P = 0.24). Multivariate Cox proportional hazards model revealed that patients with reduced PMI had a 2.3‐fold higher risk of cardiac death compared with patients with preserved PMI (95% confidence interval 1.23–4.42, P = 0.01). Conclusions Reduced PMI helps to predict long‐term outcome in patients with HFpEF but not HFrEF.
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Affiliation(s)
- Koichiro Matsumura
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Wakana Teranaka
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Hiroshi Matsumoto
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Kenichi Fujii
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Satoshi Tsujimoto
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Munemitsu Otagaki
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Shun Morishita
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Kenta Hashimoto
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Hiroki Shibutani
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Yoshihiro Yamamoto
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
| | - Ichiro Shiojima
- Department of Cardiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka, 5708507, Japan
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Wołoszyn-Horák E, Salamon R, Chojnacka K, Brzosko A, Bieda Ł, Standera J, Płoszaj K, Stępień E, Nowalany-Kozielska E, Tomasik A. Frailty syndrome in daily practice of interventional cardiology ward-rationale and design of the FRAPICA trial: A STROBE-compliant prospective observational study. Medicine (Baltimore) 2020; 99:e18935. [PMID: 32000408 PMCID: PMC7004665 DOI: 10.1097/md.0000000000018935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The effect of frailty on short and long term results of interventional treatment of coronary heart disease is not well defined. The evaluation of frailty may be helpful in appointment of most suitable treatment option and timing of patient follow-up. The frailty syndrome in daily practice of interventional cardiology ward (FRAPICA) study objective is to evaluate prognostic capability of the Fried frailty scale and instrumental activities of daily living scale (IADL) in elderly patients with symptomatic coronary heart disease.This is a single center, prospective, observational study. Patients aged ≥65 years are eligible. The objectives are to report Fried frailty scale and IADL scale dispersion before hospital discharge and to assess predictive impact of both scores. The endpoints are: success of interventional treatment, its complications (procedure related myocardial infarction, dye-induced renal function deterioration, loss of blood), 3-year mortality, either all-cause and cardiovascular, re-infarction, re-intervention, stroke, new-onset heart failure, any hospital readmission, and a combination of all above mentioned. Secondary analyses will focus on distinct clinical patient presentations, sub-classifications of frailty for modeling of long-term risk.FRAPICA trial will improve understanding of the associations between frailty syndrome, cardiovascular system diseases, their invasive treatment, and short and long-term outcomes. It will allow for more individualized assessment of risk and will identify new goals for interventions. (ClinicalTrials.gov Identifier NCT03209414).
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Affiliation(s)
- Ewa Wołoszyn-Horák
- II Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice
| | - Robert Salamon
- II Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice
| | - Katarzyna Chojnacka
- II Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice
| | - Aleksandra Brzosko
- II Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice
| | - Łukasz Bieda
- II Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice
| | - Jakub Standera
- II Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice
| | | | - Ewa Stępień
- Department of Medical Physics, Faculty of Physics, Institute of Physics, Astronomy and Applied Computer Science of the Jagiellonian University, Cracow, Poland
| | - Ewa Nowalany-Kozielska
- II Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice
| | - Andrzej Tomasik
- II Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice
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Livshits G, Kalinkovich A. Inflammaging as a common ground for the development and maintenance of sarcopenia, obesity, cardiomyopathy and dysbiosis. Ageing Res Rev 2019; 56:100980. [PMID: 31726228 DOI: 10.1016/j.arr.2019.100980] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022]
Abstract
Sarcopenia, obesity and their coexistence, obese sarcopenia (OBSP) as well as atherosclerosis-related cardio-vascular diseases (ACVDs), including chronic heart failure (CHF), are among the greatest public health concerns in the ageing population. A clear age-dependent increased prevalence of sarcopenia and OBSP has been registered in CHF patients, suggesting mechanistic relationships. Development of OBSP could be mediated by a crosstalk between the visceral and subcutaneous adipose tissue (AT) and the skeletal muscle under conditions of low-grade local and systemic inflammation, inflammaging. The present review summarizes the emerging data supporting the idea that inflammaging may serve as a mutual mechanism governing the development of sarcopenia, OBSP and ACVDs. In support of this hypothesis, various immune cells release pro-inflammatory mediators in the skeletal muscle and myocardium. Subsequently, the endothelial structure is disrupted, and cellular processes, such as mitochondrial activity, mitophagy, and autophagy are impaired. Inflamed myocytes lose their contractile properties, which is characteristic of sarcopenia and CHF. Inflammation may increase the risk of ACVD events in a hyperlipidemia-independent manner. Significant reduction of ACVD event rates, without the lowering of plasma lipids, following a specific targeting of key pro-inflammatory cytokines confirms a key role of inflammation in ACVD pathogenesis. Gut dysbiosis, an imbalanced gut microbial community, is known to be deeply involved in the pathogenesis of age-associated sarcopenia and ACVDs by inducing and supporting inflammaging. Dysbiosis induces the production of trimethylamine-N-oxide (TMAO), which is implicated in atherosclerosis, thrombosis, metabolic syndrome, hypertension and poor CHF prognosis. In OBSP, AT dysfunction and inflammation induce, in concert with dysbiosis, lipotoxicity and other pathophysiological processes, thus exacerbating sarcopenia and CHF. Administration of specialized, inflammation pro-resolving mediators has been shown to ameliorate the inflammatory manifestations. Considering all these findings, we hypothesize that sarcopenia, OBSP, CHF and dysbiosis are inflammaging-oriented disorders, whereby inflammaging is common and most probably the causative mechanism driving their pathogenesis.
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Affiliation(s)
- Gregory Livshits
- Human Population Biology Research Unit, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel.; Adelson School of Medicine, Ariel University, Ariel, Israel..
| | - Alexander Kalinkovich
- Human Population Biology Research Unit, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
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Lee MY, Leonardi A, Begley TJ, Melendez JA. Loss of epitranscriptomic control of selenocysteine utilization engages senescence and mitochondrial reprogramming ☆. Redox Biol 2019; 28:101375. [PMID: 31765888 PMCID: PMC6904832 DOI: 10.1016/j.redox.2019.101375] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 11/17/2022] Open
Abstract
Critically important to the maintenance of the glutathione (GSH) redox cycle are the activities of many selenocysteine-containing GSH metabolizing enzymes whose translation is controlled by the epitranscriptomic writer alkylation repair homolog 8 (ALKBH8). ALKBH8 is a tRNA methyltransferase that methylates the wobble uridine of specific tRNAs to regulate the synthesis of selenoproteins. Here we demonstrate that a deficiency in the writer ALKBH8 (Alkbh8def), alters selenoprotein levels and engages senescence, regulates stress response genes and promotes mitochondrial reprogramming. Alkbh8def mouse embryonic fibroblasts (MEFs) increase many hallmarks of senescence, including senescence associated β-galactosidase, heterocromatic foci, the cyclin dependent kinase inhibitor p16Ink4a, markers of mitochondrial dynamics as well as the senescence associated secretory phenotype (SASP). Alkbh8def cells also acquire a stress resistance phenotype that is accompanied by an increase in a number redox-modifying transcripts. In addition, Alkbh8def MEFs undergo a metabolic shift that is highlighted by a striking increase in the level of uncoupling protein 2 (UCP2) which enhances oxygen consumption and promotes a reliance on glycolytic metabolism. Finally, we have shown that the Alkbh8 deficiency can be exploited and corresponding MEFs are killed by glycolytic inhibition. Our work demonstrates that defects in an epitransciptomic writer promote senescence and mitochondrial reprogramming and unveils a novel adaptive mechanism for coping with defects in selenocysteine utilization. Deficiencies in selenocysteine utilization engages cellular senescence and the senescence associated secretory phenotype. Alkbh8 deficiency promotes mitochondrial elongation, increased oxygen consumption and a reliance on glycolytic metabolism. Cellular adaptions to Alkbh8 deficiency confer stress resistance.
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Affiliation(s)
- May Y Lee
- Nanobioscience Constellation, Colleges of Nanoscale Science & Engineering, SUNY Polytechnic Institute, 257 Fuller Rd., Albany, NY, 12203, USA
| | - Andrea Leonardi
- Nanobioscience Constellation, Colleges of Nanoscale Science & Engineering, University at Albany, 257 Fuller Rd., Albany, NY, 12203, USA
| | - Thomas J Begley
- Nanobioscience Constellation, Colleges of Nanoscale Science & Engineering, SUNY Polytechnic Institute, 257 Fuller Rd., Albany, NY, 12203, USA; Nanobioscience Constellation, Colleges of Nanoscale Science & Engineering, University at Albany, 257 Fuller Rd., Albany, NY, 12203, USA; The RNA Institute, College of Arts & Sciences, University at Albany, 1400 Washington Ave., Albany, NY, 12222, USA
| | - J Andrés Melendez
- Nanobioscience Constellation, Colleges of Nanoscale Science & Engineering, SUNY Polytechnic Institute, 257 Fuller Rd., Albany, NY, 12203, USA.
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30
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Uchmanowicz I, Nessler J, Gobbens R, Gackowski A, Kurpas D, Straburzynska-Migaj E, Kałuzna-Oleksy M, Jankowska EA. Coexisting Frailty With Heart Failure. Front Physiol 2019; 10:791. [PMID: 31333480 PMCID: PMC6616269 DOI: 10.3389/fphys.2019.00791] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 06/04/2019] [Indexed: 12/25/2022] Open
Abstract
People over 65 years of age constitute over 80% of patients with heart failure (HF) and the incidence of HF is 10 per 1,000 in people aged above 65 years. Approximately 25% of older patients with HF exhibit evidence of frailty. Frail patients with cardiovascular disease (CVD) have a worse prognosis than non-frail patients, and frailty is an independent risk factor for incident HF among older people. Planning the treatment of individuals with HF and concomitant frailty, one should consider not only the limitations imposed by frailty syndrome (FS) but also those associated with the underlying heart disease. It needs to be emphasized that all patients with HF and concomitant FS require individualized treatment.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Jadwiga Nessler
- Department of Coronary Heart Disease, Institute of Cardiology, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Robbert Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Andrzej Gackowski
- Department of Coronary Heart Disease, Institute of Cardiology, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Donata Kurpas
- Department of Family Medicine, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Straburzynska-Migaj
- Department of Cardiology, Faculty of Medicine, Poznan University of Medical Science, Poznan, Poland
| | - Marta Kałuzna-Oleksy
- Department of Coronary Heart Disease, Institute of Cardiology, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Ewa A Jankowska
- Cardiology Department, Centre for Heart Diseases, 4th Military Clinical Hospital in Wrocław, Wrocław, Poland
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The Role of Depression and Anxiety in Frail Patients with Heart Failure. Diseases 2019; 7:diseases7020045. [PMID: 31248108 PMCID: PMC6631213 DOI: 10.3390/diseases7020045] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 12/12/2022] Open
Abstract
An increased interest regarding the impact of frailty on the prognosis of cardiovascular disease (CVD) has been observed in the last decade. Frailty is a syndrome characterized by a reduced biological reserve that increases the vulnerability of an individual in relation to stressors. Among the patients with CVD, a higher incidence of frailty has been reported in those with heart failure (HF). Regardless of its conceptualizations, frailty is generally associated with negative outcomes in HF and an increased risk of mortality. Psychological factors, such as depression and anxiety, increase the risk of negative outcomes on the cardiac function and mortality. Depression and anxiety are found to be common factors impacting the heart disease and quality of life (QoL) in patients with HF. Depression is considered an independent risk factor of cardiac-related incidents and death, and a strong predictor of rehospitalization. Anxiety seems to be an adequate predictor only in conjunction with depression. The relationship between psychological factors (depression and anxiety) and frailty in HF has hardly been documented. The aim of this paper is to review the reported data from relevant studies regarding the impact of depression and anxiety, and their effects on clinical outcomes and prognosis in frail patients with HF.
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32
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Morin D, Long R, Panel M, Laure L, Taranu A, Gueguen C, Pons S, Leoni V, Caccia C, Vatner SF, Vatner DE, Qiu H, Depre C, Berdeaux A, Ghaleh B. Hsp22 overexpression induces myocardial hypertrophy, senescence and reduced life span through enhanced oxidative stress. Free Radic Biol Med 2019; 137:194-200. [PMID: 31047988 DOI: 10.1016/j.freeradbiomed.2019.04.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/12/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Abstract
H11 kinase/Hsp22 (Hsp22) is a small heat shock protein, which, when overexpressed cardiac specifically in transgenic (TG) mice, induces stable left ventricular (LV) hypertrophy. Hsp22 also increases oxidative phosphorylation and mitochondrial reactive oxygen species (ROS) production, mechanisms mediating LV hypertrophy, senescence and reduced lifespan. Therefore, we investigated whether ROS production mediates LV hypertrophy, senescence and reduced life span in Hsp22 TG mice. Survival curves revealed that TG mice had a 48% reduction in their mean life span compared to wild type (WT) mice. This was associated with a significant increase in senescence markers, such as p16, p19 mRNA levels as well as the percentage of β-galactosidase positive cells and telomerase activity. Oxidized (GSSG)/reduced (GSH) glutathione ratio, an indicator of oxidative stress, and ROS production from 3 major cellular sources was measured in cardiac tissue. Hearts from TG mice exhibited a decrease in GSH/GSSG ratio together with increased ROS production from all sources. To study the role of ROS, mice were treated with the antioxidant Tempol from weaning to their sacrifice. Chronic Tempol treatment abolished oxidative stress and overproduction of ROS, and reduced myocardial hypertrophy and Akt phosphorylation in TG mice. Tempol also significantly extended life span and prevented aging markers in TG mice. Taken together these results show that overexpression of Hsp22 increases oxidative stress responsible for the induction of hypertrophy and senescence and ultimately reduction in life span.
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Affiliation(s)
- Didier Morin
- U955-IMRB, Equipe 03, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Créteil, France.
| | - Romain Long
- U955-IMRB, Equipe 03, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Créteil, France
| | - Mathieu Panel
- U955-IMRB, Equipe 03, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Créteil, France
| | - Lydie Laure
- U955-IMRB, Equipe 03, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Créteil, France
| | - Adela Taranu
- U955-IMRB, Equipe 03, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Créteil, France
| | - Cindy Gueguen
- U955-IMRB, Equipe 03, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Créteil, France
| | - Sandrine Pons
- U955-IMRB, Equipe 03, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Créteil, France
| | - Valerio Leoni
- Laboratory Medicine, Desio Hospital, University of Milano Bicocca, Milan, Italy
| | - Claudio Caccia
- Laboratory of Clinical Pathology and Medical Genetics, Institute Neurologico IRCCS Carlo Besta, Milano, Italy
| | - Stephen F Vatner
- Department of Cell Biology and Molecular Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, USA
| | - Dorothy E Vatner
- Department of Cell Biology and Molecular Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, USA
| | - Hongyu Qiu
- Department of Cell Biology and Molecular Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, USA
| | - Christophe Depre
- Department of Cell Biology and Molecular Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, USA
| | - Alain Berdeaux
- U955-IMRB, Equipe 03, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Créteil, France
| | - Bijan Ghaleh
- U955-IMRB, Equipe 03, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, Créteil, France
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Uchmanowicz I, Młynarska A, Lisiak M, Kałużna-Oleksy M, Wleklik M, Chudiak A, Dudek M, Migaj J, Hinterbuchner L, Gobbens R. Heart Failure and Problems with Frailty Syndrome: Why it is Time to Care About Frailty Syndrome in Heart Failure. Card Fail Rev 2019; 5:37-43. [PMID: 30847244 PMCID: PMC6396065 DOI: 10.15420/cfr.2018.37.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Frailty syndrome (FS) is an independent predictor of mortality in cardiovascular disease and is found in 15–74% of patients with heart failure (HF). The syndrome has a complex, multidimensional aetiology and contributes to adverse outcomes. Proper FS diagnosis and treatment determine prognosis and support the evaluation of treatment outcomes. Routine FS assessment for HF patients should be included in daily clinical practice as an important prognostic factor within a holistic process of diagnosis and treatment. Multidisciplinary team members, particularly nurses, play an important role in FS assessment in hospital and primary care settings, and in the home care environment. Raising awareness of concurrent FS in patients with HF patients and promoting targeted interventions may contribute to a decreased risk of adverse events, and a better prognosis and quality of life.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia Poland
| | - Magdalena Lisiak
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | | | - Marta Wleklik
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | - Anna Chudiak
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | - Magdalena Dudek
- Department of Cardiology, Poznan University of Medical Sciences Poland
| | - Jacek Migaj
- Department of Cardiology, Poznan University of Medical Sciences Poland
| | - Lynne Hinterbuchner
- Department for Internal Medicine and Cardiology, Salzburg University Hospital Austria
| | - Robbert Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen the Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp Antwerp, Belgium
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34
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Age-Dependent Protein Expression of Serine/Threonine Phosphatases and Their Inhibitors in the Human Cardiac Atrium. Adv Med 2019; 2019:2675972. [PMID: 30719459 PMCID: PMC6334353 DOI: 10.1155/2019/2675972] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 11/22/2018] [Accepted: 11/29/2018] [Indexed: 12/20/2022] Open
Abstract
Heart failure and aging of the heart show many similarities regarding hemodynamic and biochemical parameters. There is evidence that heart failure in experimental animals and humans is accompanied and possibly exacerbated by increased activity of protein phosphatase (PP) 1 and/or 2A. Here, we wanted to study the age-dependent protein expression of major members of the protein phosphatase family in human hearts. Right atrial samples were obtained during bypass surgery. Patients (n=60) were suffering from chronic coronary artery disease (CCS 2-3; New York Heart Association (NYHA) stage 1-3). Age ranged from 48 to 84 years (median 69). All patients included in the study were given β-adrenoceptor blockers. Other medications included angiotensin-converting enzyme (ACE) or angiotensin-receptor-1 (AT1) inhibitors, statins, nitrates, and acetylsalicylic acid (ASS). 100 µg of right atrial homogenates was used for western blotting. Antibodies against catalytic subunits (and their major regulatory proteins) of all presently known cardiac serine/threonine phosphatases were used for antigen detection. In detail, we studied the expression of the catalytic subunit of PP1 (PP1c); I1 PP1 and I2 PP1, proteins that can inhibit the activity of PP1c; the catalytic subunit of PP2A (PP2Ac); regulatory A-subunit of PP2A (PP2AA); regulatory B56α-subunit of PP2A (PP2AB); I1 PP2A and I2 PP2A, inhibitory subunits of PP2A; catalytic and regulatory subunits of calcineurin: PP2BA and PP2BB; PP2C; PP5; and PP6. All data were obtained within the linear range of the assay. There was a significant decline in PP2Ac and I2 PP2A expression in older patients, whereas all other parameters remained unchanged with age. It remains to be elucidated whether the decrease in the protein expression of I2 PP2A might elevate cardiac PP2A activity in a detrimental way or is overcome by a reduced protein expression and thus a reduced activity of PP2Ac.
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35
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[Prevention of frailty and cognitive impairment in elderly patients with heart failure]. Nihon Ronen Igakkai Zasshi 2019; 56:107-114. [PMID: 31092774 DOI: 10.3143/geriatrics.56.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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36
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The Relationship between Dietary Habits and Frailty in Rural Japanese Community-Dwelling Older Adults: Cross-Sectional Observation Study Using a Brief Self-Administered Dietary History Questionnaire. Nutrients 2018; 10:nu10121982. [PMID: 30558211 PMCID: PMC6316041 DOI: 10.3390/nu10121982] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/30/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022] Open
Abstract
To develop effective nutritional interventions for preventing frailty, the specific problems associated with the dietary habits of individuals based on sex differences must be identified. The purpose of this study was to evaluate the association between dietary habits and frailty in rural Japanese community-dwelling older adults. We recruited 800 participants, aged 65 and older, who underwent a comprehensive health examination between November 2015 and December 2017. Dietary habits were assessed by a brief self-administered dietary history questionnaire. Frailty was determined using either the Kihon Checklist (KCL) or the Japanese version of the Cardiovascular Health Study (J-CHS). The percentage of frail older adults was 8.4% according to KCL and 4.0% according to J-CHS. Various kinds of nutrient intakes, including three major nutrients, minerals, and vitamins in frail men, according to KCL, were the lowest. By contrast, there were no differences in nutrient intake between the robust, prefrail, and frail female groups according to KCL. We found significant associations of the intakes of soluble dietary fiber, potassium, folate, and vitamin C with a frail status in men (p = 0.035, 0.023. 0.012, and 0.007, respectively), and an association of the intake of vitamin C with a frail status in women (p = 0.027) according to J-CHS. Attention should be paid to the diagnostic criteria of frailty and to sex differences, when nutritional interventions for the prevention of frailty are planned.
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37
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Vicent L, Martínez-Sellés H, Ariza-Solé A, Lucia A, Emanuele E, Bayés-Genís A, Fernández-Avilés F, Martínez-Sellés M. A panel of multibiomarkers of inflammation, fibrosis, and catabolism is normal in healthy centenarians but has high values in young patients with myocardial infarction. Maturitas 2018; 116:54-58. [PMID: 30244779 DOI: 10.1016/j.maturitas.2018.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 06/20/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Frailty confers a poor prognosis as it portends an increased risk of disability, dependence, and mortality. Although frailty is generally associated with aging, a marked interindividual variability exists. We compared a range of serum biomarkers of inflammation, fibrosis, and catabolism in three distinct cohorts, consisting of young patients with myocardial infarction, age-matched healthy volunteers, and disease-free centenarians. STUDY DESIGN Prospective observational registry study. MAIN OUTCOME MEASURES Serum levels of five biomarkers were measured in the three study groups. RESULTS Disease-free centenarians had significantly lower (all p < 0.01) serum biomarker levels than young patients with myocardial infarction (growth differentiation factor 15: 877 ± 299 vs. 1062 ± 358 pg/mL; matrix metalloproteinase (MMP)-1: 1.7 ± 0.9 vs. 3.2 ± 1.2 ng/mL; MMP-2 174 ± 38 vs. 214 ± 44 ng/mL; MMP-9 325 ± 73 vs. 407 ± 54 ng/mL; and carboxy-terminal telopeptide of collagen type I: 3.3 ± 1 vs. 4.2 ± 1.3 ng/mL). No significant differences in biomarker concentrations between healthy controls and centenarians were identified. CONCLUSIONS Disease-free centenarians had significantly lower levels of inflammation, fibrosis, and catabolism biomarkers than young patients with myocardial infarction. Advanced aging per se is not invariably associated with these biomarkers.
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Affiliation(s)
- Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | | | - Albert Ariza-Solé
- Servei de Cardiologia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alejandro Lucia
- Universidad Europea and Research Institute Hospital 12 de Octubre ('i+12)', Madrid, Spain
| | | | - Antoni Bayés-Genís
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, UAB, Barcelona, Spain
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain; Universidad Complutense, Madrid, Spain; Universidad Europea, Madrid.
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38
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Bottiger BA, Nicoara A, Snyder LD, Wischmeyer PE, Schroder JN, Patel CB, Daneshmand MA, Sladen RN, Ghadimi K. Frailty in the End-Stage Lung Disease or Heart Failure Patient: Implications for the Perioperative Transplant Clinician. J Cardiothorac Vasc Anesth 2018; 33:1382-1392. [PMID: 30193783 DOI: 10.1053/j.jvca.2018.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Indexed: 12/13/2022]
Abstract
The syndrome of frailty for patients undergoing heart or lung transplantation has been a recent focus for perioperative clinicians because of its association with postoperative complications and poor outcomes. Patients with end-stage cardiac or pulmonary failure may be under consideration for heart or lung transplantation along with bridging therapies such as ventricular assist device implantation or venovenous extracorporeal membrane oxygenation, respectively. Early identification of frail patients in an attempt to modify the risk of postoperative morbidity and mortality has become an important area of study over the last decade. Many quantification tools and risk prediction models for frailty have been developed but have not been evaluated extensively or standardized in the cardiothoracic transplant candidate population. Heightened awareness of frailty, coupled with a better understanding of distinct cellular mechanisms and biomarkers apart from end-stage organ disease, may play an important role in potentially reversing frailty related to organ failure. Furthermore, the clinical management of these critically ill patients may be enhanced by waitlist and postoperative physical rehabilitation and nutritional optimization.
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Affiliation(s)
- Brandi A Bottiger
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology & Critical Care, Duke University, Durham, NC
| | - Alina Nicoara
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology & Critical Care, Duke University, Durham, NC
| | - Laurie D Snyder
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC
| | - Paul E Wischmeyer
- Division of Critical Care Medicine, Department of Anesthesiology & Critical Care, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Jacob N Schroder
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University, Durham, NC
| | - Chetan B Patel
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC
| | - Mani A Daneshmand
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University, Durham, NC
| | - Robert N Sladen
- Department of Anesthesiology, Columbia University, New York, NY
| | - Kamrouz Ghadimi
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology & Critical Care, Duke University, Durham, NC; Division of Critical Care Medicine, Department of Anesthesiology & Critical Care, Duke University, Durham, NC.
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Abstract
Frailty is a complex clinical syndrome associated with ageing and chronic illness, resulting from multiple organ impairment; physiological reserves decrease and vulnerability to stressors increase. The role of frailty in cardiovascular disease has become increasingly recognised. Up to 79% of patients with heart failure are frail. Moreover, frailty is associated with a worse quality of life and poor prognosis. This review summarises the available literature on frailty in HF and highlights indications for its management.
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Affiliation(s)
- Cristiana Vitale
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana Rome, Italy
| | - Ilaria Spoletini
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana Rome, Italy
| | - Giuseppe Mc Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana Rome, Italy
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40
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Karuppagounder V, Arumugam S, Babu SS, Palaniyandi SS, Watanabe K, Cooke JP, Thandavarayan RA. The senescence accelerated mouse prone 8 (SAMP8): A novel murine model for cardiac aging. Ageing Res Rev 2017; 35:291-296. [PMID: 27825897 DOI: 10.1016/j.arr.2016.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 01/23/2023]
Abstract
Because cardiovascular disease remains the major cause of mortality and morbidity world-wide, there remains a compelling need for new insights and novel therapeutic avenues. In this regard, the senescence-accelerated mouse prone 8 (SAMP8) line is a particularly good model for studying the effects of aging on cardiovascular health. Accumulating evidence suggests that this model may shed light on age-associated cardiac and vascular dysfunction and disease. These animals manifest evidence of inflammation, oxidative stress and adverse cardiac remodeling that may recapitulate processes involved in human disease. Early alterations in oxidative damage promote endoplasmic reticulum stress to trigger apoptosis and cytokine production in this genetically susceptible mouse strain. Conversely, pharmacological treatments that reduce inflammation and oxidative stress improve cardiac function in these animals. Therefore, the SAMP8 mouse model provides an exciting opportunity to expand our knowledge of aging in cardiovascular disease and the potential identification of novel targets of treatment. Herein, we review the previous studies performed in SAMP8 mice that provide insight into age-related cardiovascular alterations.
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41
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Musculoskeletal health and frailty. Best Pract Res Clin Rheumatol 2017; 31:145-159. [DOI: 10.1016/j.berh.2017.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 12/20/2022]
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42
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Carazo M, Sadarangani T, Natarajan S, Katz SD, Blaum C, Dickson VV. Prognostic Utility of the Braden Scale and the Morse Fall Scale in Hospitalized Patients With Heart Failure. West J Nurs Res 2016; 39:507-523. [PMID: 27531001 DOI: 10.1177/0193945916664077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Geriatric syndromes are common in hospitalized elders with heart failure (HF), but association with clinical outcomes is not well characterized. The purpose of this study ( N = 289) was to assess presence of geriatric syndromes using Joint Commission-mandated measures, the Braden Scale (BS) and Morse Fall Scale (MFS), and to explore prognostic utility in hospitalized HF patients. Data extracted from the electronic medical record included sociodemographics, medications, clinical data, comorbid conditions, and the BS and MFS. The primary outcome of mortality was assessed using Social Security Death Master File. Statistical analysis included Cox proportional hazards models to assess association between BS and MFS scores and all-cause mortality with adjustment for known clinical prognostic factors. Higher risk BS and MFS scores were common in hospitalized HF patients, but were not independent predictors of survival. Further study of the clinical utility of these scores and other measures of geriatric syndromes in HF is warranted.
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Affiliation(s)
- Matthew Carazo
- 1 New York University School of Medicine, New York City, USA.,2 Drexel University College of Medicine, Philadelphia, PA, USA
| | - Tina Sadarangani
- 3 New York University Rory Meyers College of Nursing, New York City, USA
| | - Sundar Natarajan
- 1 New York University School of Medicine, New York City, USA.,4 Veterans Affairs New York Harbor Healthcare System, New York City, USA
| | - Stuart D Katz
- 1 New York University School of Medicine, New York City, USA
| | - Caroline Blaum
- 1 New York University School of Medicine, New York City, USA
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