200A ABSTRACTS - Cardiac Function and Heart Failure POSTER SESSION 1162 The Hazards of Being Elderly Tuesday, April 01, 2003, 9:00 a.m.-l I:00 a.m. McCormick Place, Hall A Presentation Hour: IO:00 a.m.-l 1:00 a.m. 1162-82 Diastolic Dysfunction in Elderly Patients Referred to the Heart Failure Diagnostic Clinic Nicolas Wisniacki. Pam Aimson, Chris Harrison, Michael Lye, University of Lnerpool, Liverpool, United Kingdom Background: Diastolic heart failure (DHF) accounts for a sianificant number of oatients with heart failure (HF) both in hospital settings and the community, and its proportion increases with aoe. HF diaanostic clinic (HFDC) have an imoortant role detectina cases of HF 1” the community. However, diastolic dysfunction (DD) has not been included as a cause of HF in several studies of HFDC. The objective of our study was to describe cardiac abnormalities associated with DHF in a group of elderly patients referred to a HFDC, and evaluates their association with the clinical diagnosis of HF. Methods: 130 elderly patients (a65 years old) referred to the HFDC within a 6 months period were included. Diagnosis of HF was made according to the Framingham criteria supported by pulmonary oedema on the chest X-ray. All patients’ underwent echocardio- graphic evaluation wth the operator unaware of the cllnical diagnosis. Results: 62 patients (63.1%) had cllnical diagnosis of HF. Patients with clinical HF were more likely lo be diabetic (17.1% vs. 2.1% p=O.Ol), and have atrial fibrillation (13.4% vs. 0% p=O.O07) and left ventricular hypertrophy on the ECG (14.6% vs. 4.1% p=O.O5). Patients without clinical HF were more likely to have normal ECG (56.3% vs. 39% ~~0.05) and an obstructive pattern in the pulmonary function test (p=O.O3). Echocardiographic findings: Clinical HF (n=82) No clinical HF (n- p 48) Ejection fraction (EF) ~40% 9 (11%) 0 0.02 left ventricular hypertrophy 41 (50%) 16 (32.7%) 0.04 left atrial enlargement 35 (43.2%) 5 (10.2%) 0.000 1 EIA ratio < 0.5 25 (30.9%) 12 (24.5%) 0.43 Deceleration time >280 msec. 20 (24.7%) IO (20.4%) 0.57 lsovolumic relaxation time > 105 msec 58 (71.6%) 24 (49%) 0.01 EF >40% and> 2 parameters associated 50 (61%) 11 (22.9%) o.oM) with DD 1 Conclusion: DD IS frequently found in elderly patients referred to a HFDC. The majority of patients with clinical diagnosis of HF have 2 or more abnormal parameters of DD. 1162-83 Determinants of Left Atrial Volume and Dimension: A Prospective Study Teresa S. Tsang, Marion E. Barnes Kent R. Bailey, James B. Seward, Mayo Clinic, Rochester, MN Background: Left atrial (LA) enlargement occurs with advancing age and is associated with increased risk of atrial fibrillation (AF) and stroke. Clinical and subclinical determi- nants of LA size have not been well characterized. Methods: Consecutive patients referred for a clinically-indicated echocardiogram, who were, on the date of examination. ZO years of age, wlthout congenital heart disease, pacemaker, or prosthetic valves, and willing lo provide verbal consent, were included in this prospective study. &plane LA volume by the area-length method was measured pro- spectively, in additton to M-mode L4 dimension and other routine echocardlographic parameters. Demographic information and details of medical history were obtalned from clinical records. Linear and logistic regression models were developed to identify deter- minants of LA dimension and LA volume. Results: The study population consisted of 416 patients (232 men), mean age 71 * 8 years. In a multivariate model, LA volume was associated with body surface area (BSA), hlstorv of AF. svstemlc hvoeflension. oeak mitral earlv fillina velxitv (a diastolic function _, _ I ,, parameter), lefi ventricular (LV) mass (all P<O.OOl), valvular heart disease greater than mild fP=O.O09). and conoestive heart failure fP=O.O071. LA volume was inverselv associ- ated with LV ejection fracbon (P=O.O34). Parameters for age and sex did not reach statis- tical significance once LA volume was adjusted for BSA. Similarly, M-mode LA dimension was Independently related lo history of AF, systemic hypertension, peak mitral early velocity, LV mass and ejection fraction. LA dimension was also strongly associated with age, sex, weight, and coronary artery disease. Conclusions: LA size is associated with history of AF, valvular disease, congestive heart failure, coronary artery disease, LV mass, and LV diastolic and systolic abnormali- ties. In contrast to the findings for LA dimension, the effect of age on LA volume did not reach statistical significance. Sex was also not a significant determinant of LA volume once BSA has been taken into account. JACC March 19,2003 1162-84 Diastolic Left Ventricular Filling Patterns in Diastolic VSrSuS SyStOlic Congestive Heart Failure of the Elderly: The Cardiovascular Heart Study John S. Gottdiener, Gerard P. Aurigemma, Dalane W. Kitzman, Alice M. Arnold, Cheryl S. Egher, Karen M. Fowls, Jeffrey C. Hill, St. Francis Hospital, Roslyn, NY, National Heart, Lung, and Blood Institute, Bethesda, MD Lefi ventricular (LV) diastolic filling patterns based on peak early (E) and late (A) filling velocity on echo are well described in congestive heart failure (CHF) usually in patients with decreased ejection fraction (EF) (sysHF). However, in elderly with CHF, LV EF is often normal (2 55%) i.e diastolic HF (diasHF). The Cardiovascular (CV) Health Study (HS) is a prospective community based study of risk factors for CV disease (D) in 5,888 elderly participants (ppts). We analyzed LV filling in a nested case control study of 182 ppts (av age 79 + 6, range 68-99, 47% women) with CHF evaluation in 1994.5, of whom 174 had complete echo data. Case controls were 417 ppts without CHF (54% with sub- clinical CVD, 19% with prevalent CVD) matched to age and gender. Filling pattern defini- tions: “normal” = 0.8-I .5 and normal LA volume (determined from 2D echo in healthy participants using ellipsoid model); “impaired relaxation” = VA 1.8. Gender distribution was: controls (n=417), men 45%; dia.sHF (n=95), men 42%; sysHF(n=87), men 63% (pc ,004 diasHF vs sysHF). Conclusions: DiaHF in elderly is more common in women. SysHF, is more common in men. There are gender differences between filling patterns in population controls and sysHF, but not diasHF. SysHF and diasHF are associated mostly with impaired relaxation and pseudonormal patterns of LV filling. CHF is uncommon in the presence of normal filling. However, abnormal filling is common in the absence of CHF Filling Pattern Normal Impaired relaxation Controls 12 (32%) 165 (49%) Diastolic HF 6 (9%) 33 (47%) Systolic HF 1 (2%) 1 (46%) Pseudonormal Restrictive 25 (35%) 16 65 (17%) (27%) 10 (2%) 17 6 (9%) (25%) (pc.001 dias HF vs controls; p =.019 diastolic HF vs systolic HF) 1162-85 Plasma Levels of Inflammatory C-Reactive Protein and Interleukin-6 Predict Outcome in Elderly Patients With Stroke Antonello Silvestri, Mauricio Wajngatlen, Crlstiana Vitale, Otavio Gebara, Massimo Fini, Jo& Antonio F. Ramires. Giuseooe M. Rosano, San Raffaele, Roma, Italy, INCOR, Sao Paula, Brazil C-Reactive protein (CRP) is associate with unfavorable outcome in patients with acute ischemic syndromes and in patients with chronic stable angina. Elevated CRP levels suggestive of heightened Inflammatory state in vascular conditions are often associated with elevated Interleukin-6 (IL-6) levels. The predictive importance of CRP and IL-6 lev- els in patients with ischemic stroke has never been elucidated. To this end we studied among 647 consecutive elderly patients (>65 years) those with documented ischaemic stroke, presence of significant carotid atherosclerosis and absence of atrial fibrillation. The study population included 150 patients (74 men, 76 women mean age 74+2) Patients underwent evaluation of high senibve CRP and IL-6 levels at baseline, during hospitalization and at discharge. In-hospital was 6%, 1 year mortality was 15% and another cerebrovascular event occurred in 12% of patients. Patients with in-hospital events had significantly higher CRP and IL-6 levels than patients wIthout events (3.el.l vs i.9fl.9 mg/l. p-zO.01 and 13.8fi.4 vs 6.3t2.1 pgiml, p<O.Ol, respectively). Also CRP and IL-6 levels were significantly higher in those pabents with an event within 3 months of discharge compared to those patients without an event (3.6kl.3 vs 1 .I$.7 mgll, p<O.Ol and 14.223.7 vs 5.4il.6 pg/ml, p<O.Oi, respectively). Both baseline CRP levels and IL-6 were predictor of future in-hospital and 3 months future cerebrovascular events while high CRP and IL-6 levels at baseline were not associated with a poor 1 year prognosis. Elevated CRP levels were associated with an unfavorable outcome only when IL-6 levels were also elevated. In a stepwise multivariate analysis IL-6 levels were stronger predictor of outcome than CRP. In conclusion elevated CRP and IL-6 levels may identify elderly patients at increased medium term risk while do not predict one year events in this subset of patients. CRP lev- els predict events only when they are coupled with IL-6 levels. 1162-86 Is Enhanced External Counterpulsation the Preferred Treatment for Chronic Stable Angina in Select Patients 75 Years and Older? Georgiann C. Linnemeier, Elizabeth D. Kennard, Sheryl F. Kelsey, Ozlem Soran, University of Pittsburgh, Pittsburgh, PA Background: Elderly patients are at high risk for morbidity and mortality associated with invasive coronary interventions. Enhanced external counterpulsation (EECP) has been demonstrated to be safe and effective in treating angina in patients 275 years of age; however, its effect on long-term cardiac event-free survival is unknown. Methods: Of 1552 patients consecutively enrolled in the International EECP Patient Reglstiy, 347 were 275 years (E) and 1205 were ~75 years (Y).EECP was adminlstered to each group with similar total treatment hours and completion rates. Results: E differed significantly from Y in history of symptomatic congestive heart failure Downloaded From: http://173.193.11.214/ on 02/19/2013