Chronic heart failure in elderly people: clinical course and prognosis depending on the functional state of left ventricle
Larina V. N., Bart B. Ya., Dergunova E. N., Alieva Z. I.
Keywords: age, left ventricle, prognosis, CHF
DOI: 10.18087 / rhfj.2012.2.1657
Relevance. Chronic HF still has a high prevalence rate and poor clinical outcome, particularly in older age groups. Objective. Study of CHF course, quality of life and prognosis in patients at the age of 60 years and older who have been followed up in outpatient clinics for a long period of time. Materials and methods. Depending on LVEF level, 248 patients with CHF II–IV FC (NYHA) were divided into 2 groups: the 1st group included 119 patients with LVEF≤45 %, the 2nd one included 129 patients with LVEF >45 %. Results. CHF patients with preserved LVEF were older than patients with reduced LVEF (р=0.014). In II FC 59.7 % patients with preserved LVEF and 12.6 % with reduced LVEF corresponded (р<0.001). 34.5 % patients with reduced LVEF and only 2.9 % – with preserved LVEF had IV FC (p<0.001). Hypothyroidism (р=0.005), obesity (р<0.001), lipid disorders (р=0.005) and LV hypertrophy (р<0.001) occurred more often in CHF patients with preserved LVEF, than in patients with reduced LVEF. Quality of life in both groups is comparable (р=0.084). Patients with reduced LVEF walked shorter distance in 6 minutes, than patients with preserved LVEF [260 (200–380) m and 325 (250–390) m, relatively, р=0.003]. Restrictive and possibly pseudonormal types of disorders were registered more often in patients with LVEF≤45 % in comparison with patients with LVEF>45 %, in whom poorer LV compliance prevailed. Lethal risk in elderly CHF patients with reduced LVEF was 5 time higher than risk of death of preserved LVEF patients (OR 5.35). Predictors of lethal outcome in elderly CHF patients were CHF FC (OR 1.45), LVEF (OR –0.54) and hyperuricemy (OR 2.93). Conclusion. Elderly CHF patients with preserved LVEF have more легкое течение заболевания, they have more often an extracardiac accompanying pathology and better survival rate, that that of patients with reduced LVEF. Predictors of lethal outcome in elderly patients with CHF were FC, LVEF and hyperuricemy.
- Cleland JGF, Swedberg K, Follath F et al. The EuroHeart Failure Survey programme – a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J. 2003;24 (5):442–463.
- Komajda M, Hanon O, Hochadel M et al. Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro Heart Failure Survey II. Eur Heart J. 2009;30 (4):478–486.
- Butler J, Kalogeropoulos AP, Georgiopoulou VV et al. Systolic blood pressure and incident heart failure in the elderly. The Cardiovascular Health Study and the Health, Ageing and Body Composition Study. Heart. 2011;97 (16):1304–1311.
- Hogg K, Swedberg K, McMurray J. Heart Failure with preserved left ventricular systolic function. Epidemiology, Clinical Characteristics, and Prognosis. J Am Coll Cardiol. 2004;43 (3):317–327.
- Tribouilloy C, Rusinaru D, Mahjoub H et al. Prognosis of heart failure with preserved ejection fraction: a 5 year prospective population-based study. Eur Heart J. 2008;29 (3):339–347.
- Levey AS, Coresh J, Greene T et al. Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem. 2007;53 (4):766–772.
- Levey AS, Bosch JP, Lewis JB et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130 (6):461–470.
- Бойцов С. А. Центральные и периферические механизмы патогенеза хронической сердечной недостаточности. Журнал Сердечная Недостаточность. 2005;6 (2):78–83.
- Отрохова Е. В. Новый подход к оценке диастолической функции левого желудочка. Ультразвуковая и функциональная диагностика. 2006; 4:81–95.
- Bursi F, Weston SA, Redfield MM et al. Systolic and diastolic heart failure in the community. JAMA. 2006;296 (18):2209–2216.
- Pieske B. Heart Failure with preserved ejection fraction – a growing epidemic or ‘The Emperor’s New Clothes? Eur J Heart Fail. 2011;13 (1):11–13.
- Martos R, Baugh J, Ledwidge M et al. Diastolic heart failure: evidence of increased myocardial collagen turnover linked to diastolic dysfunction. Circulation. 2007;115 (7):888–895.
- McMurray JJ, Carson PE, Komajda M et al. Heart failure with preserved ejection fraction: clinical characteristics of 4133 patients enrolled in the I-PRESERVE trial. Eur J Heart Fail. 2008;10 (2):149–156.
- Lewis EF, Lamas GA, O’Meara E et al. CHARM Investigators. Characterization of health-related quality of life in heart failure patients with preserved versus low ejection fraction in CHARM. Eur J Heart Fail. 2007;9 (1):83–91.
- Hoekstra T, Lesman-Leegte I, van Veldhuisen DJ et al. Quality of life is impared similarly in heart failure patients with preserved and reduced ejection fraction. Eur J Heart Fail. 2011;13 (9):1013–1018.
- Zile MR,Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation. 2002;105 (11):1387–1393.
- Davis BR, Kostis JB, Simpson LM et al for the ALLHAT Collaborative Research Group. Heart failure with preserved and reduced left ventricular ejection fraction in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. Circulation. 2008;118 (22):2259–2267.
- Lesman-Leegte I, Jaarsma T, Van Veldhuisen DJ. Quality of life in patients with preserved and depressed left ventricular function. Eur Heart J. 2005;26 (5):525–526.
- Owan TE, Hodge DO, Herges RM et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355 (3):251–259.
- Fonarow GC, Stough WG, Abraham WT et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol. 2007;50 (8):768–777.
- Guder G, Frantz S, Bauersachs J et al. Reverse epidemiology in systolic and nonsystolic heart failure: cumulative prognostic benefit of classical cardiovascular risk factors. Circ Heart Fail. 2009;2 (6):563–571.
- Kalantar-Zadeh K, Block G, Horwich T, Fonarow GC. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol. 2004;43 (8):1439–1444.
- Horwich TB, Fonarow GC. Reverse epidemiology beyond dialysis patients: chronic heart failure, geriatrics, rheumatoid arthritis, COPD, and AIDS. Semin Dial. 2007;20 (6):549–553.
- Mahjoub H, Rusinaru D, Souliere V et al. Long-term survival in patients older than 80 years hospitalised for heart failure. A 5‑year prospective study. Eur J Heart Fail. 2008;10 (1):78–84.
- De Groote P, Mouquet F, Lamblin N et al. Serum uric acid is a powerful predictor of survival in patients with stable chronic heart failure receiving beta-blocker therapy. Circulation. 2007;116: II 650.
- Kittleson M, John M, Bead V et al. Increased levels of uric acid predict haemodynamic compromise in patients with heart failure independently of B-type natriuretic peptide levels. Heart. 2007;93 (3):365–367.
- Ekundayo OJ, Dell’Italia LJ, Sanders PW et al. Association between hyperuricemia and incident heart failure among older adults: a propensity-matched study. Int J Cardiol. 2010;142 (3):279–287.
- Alcaino H, Greig D, Chiong M et al. Serum acid correlates with extracellular superoxide dismutase activity in patients with chronic heart failure. Eur J Heart Fail. 2008;10 (7):646–651.
- Manzano L, Babalis D, Roughton M et al. SENIORS Investigators. Predictors of clinical outcomes in elderly patients with heart failure. Eur J Heart Fail. 2011;13 (5):528–536.
Larina V. N., Bart B. Ya., Dergunova E. N., Alieva Z. I. Chronic heart failure in elderly people: clinical course and prognosis depending on the functional state of left ventricle. Russian Heart Failure Journal. 2012;13(2):67-72