Abstract：
BACKGROUND: A mismatch between myocardial oxygen supply and demand is the most common cause of ischemic myocardial injury in older persons. The subendocardial viability ratio (SEVR) can usefully estimate the degree of myocardial perfusion relative to left-ventricular workload. The aim of the present study was to evaluate the ability of SEVR to predict long-term mortality in the older population. Additionally, we aimed to identify the SEVR cutoff value best predicting total mortality.
METHODS: This is a multicenter, longitudinal study involving a large population of individuals older than 80 years living in nursing homes. Patients with cancer, severe dementia, and very low level of autonomy were excluded from the study. Participants were monitored for 10 years. Adverse outcomes were recorded every 3 months from inclusion to the end of the study. SEVR reflects the balance between subendocardial oxygen supply and demand, and was estimated non-invasively by analyzing the carotid pressure waveform recorded by applanation arterial tonometry.
RESULTS: A total of 828 people were enrolled (mean age: 87.7 ± 4.7 years, 78% female). 735 patients died within 10 years and 24 were lost to follow-up. SEVR was inversely associated with mortality at univariate Cox-regression model (risk ratio, 0.683 per unit increase in SEVR; 95% confidence interval (CI) [0.502-0.930], p = 0.015) and in a model including age, sex, body mass index, Activity of Daily Living index and Mini-Mental State Examination score (risk ratio, 0.647; 95% CI [0.472-0.930]). The lowest tertile of SEVR was associated with higher 10-years total mortality than the middle (p < 0.001) and the highest (p < 0.004) tertile. A SEVR cutoff value of 83% was identified as the best predictor of total mortality.
CONCLUSIONS: SEVR may be considered as a marker of \"cardiovascular frailty.\" An accurate non-invasive estimation of SEVR could be a useful and independent parameter to assess survival probability in very old adults.
BACKGROUND: NCT00901355, registered on ClinicalTrials.gov website.
METHODS: This is a multicenter, longitudinal study involving a large population of individuals older than 80 years living in nursing homes. Patients with cancer, severe dementia, and very low level of autonomy were excluded from the study. Participants were monitored for 10 years. Adverse outcomes were recorded every 3 months from inclusion to the end of the study. SEVR reflects the balance between subendocardial oxygen supply and demand, and was estimated non-invasively by analyzing the carotid pressure waveform recorded by applanation arterial tonometry.
RESULTS: A total of 828 people were enrolled (mean age: 87.7 ± 4.7 years, 78% female). 735 patients died within 10 years and 24 were lost to follow-up. SEVR was inversely associated with mortality at univariate Cox-regression model (risk ratio, 0.683 per unit increase in SEVR; 95% confidence interval (CI) [0.502-0.930], p = 0.015) and in a model including age, sex, body mass index, Activity of Daily Living index and Mini-Mental State Examination score (risk ratio, 0.647; 95% CI [0.472-0.930]). The lowest tertile of SEVR was associated with higher 10-years total mortality than the middle (p < 0.001) and the highest (p < 0.004) tertile. A SEVR cutoff value of 83% was identified as the best predictor of total mortality.
CONCLUSIONS: SEVR may be considered as a marker of \"cardiovascular frailty.\" An accurate non-invasive estimation of SEVR could be a useful and independent parameter to assess survival probability in very old adults.
BACKGROUND: NCT00901355, registered on ClinicalTrials.gov website.
摘要：
背景：心肌氧供应和需求之间的不匹配是老年人缺血性心肌损伤的最常见原因。心内膜下活力比（SEVR）可以有效地估计相对于左心室工作负荷的心肌灌注程度。本研究的目的是评估SEVR预测老年人长期死亡率的能力。此外,我们旨在确定预测总死亡率的最佳SEVR临界值.
方法：这是一个多中心，纵向研究涉及居住在疗养院的80岁以上的大量人群。癌症患者,严重的痴呆,研究中排除了非常低的自主性。参与者被监测了10年。从纳入研究到研究结束，每3个月记录一次不良结果。SEVR反映了心内膜下氧气的供需平衡,并通过分析压平动脉眼压测量记录的颈动脉压力波形进行非侵入性评估。
结果：共纳入828人（平均年龄：87.7±4.7岁，78%女性）。735例患者在10年内死亡，24例失去随访。SEVR与单变量Cox回归模型的死亡率呈负相关(风险比，SEVR每单位增加0.683；95%置信区间(CI)[0.502-0.930]，p=0.015)，并且在包括年龄的模型中，性别,身体质量指数,日常生活活动指数和简易精神状态考试成绩(风险比，0.647；95%CI[0.472-0.930]）。与中等(p<0.001)和最高(p<0.004)三位数相比，SEVR的最低三位数与较高的10年总死亡率相关。83％的SEVR临界值被确定为总死亡率的最佳预测指标。
结论：SEVR可能被认为是“心血管衰弱”的标志。“对SEVR进行准确的非侵入性估计可能是评估老年人生存概率的有用且独立的参数。
背景：NCT00901355，在ClinicalTrials.gov网站上注册。
方法：这是一个多中心，纵向研究涉及居住在疗养院的80岁以上的大量人群。癌症患者,严重的痴呆,研究中排除了非常低的自主性。参与者被监测了10年。从纳入研究到研究结束，每3个月记录一次不良结果。SEVR反映了心内膜下氧气的供需平衡,并通过分析压平动脉眼压测量记录的颈动脉压力波形进行非侵入性评估。
结果：共纳入828人（平均年龄：87.7±4.7岁，78%女性）。735例患者在10年内死亡，24例失去随访。SEVR与单变量Cox回归模型的死亡率呈负相关(风险比，SEVR每单位增加0.683；95%置信区间(CI)[0.502-0.930]，p=0.015)，并且在包括年龄的模型中，性别,身体质量指数,日常生活活动指数和简易精神状态考试成绩(风险比，0.647；95%CI[0.472-0.930]）。与中等(p<0.001)和最高(p<0.004)三位数相比，SEVR的最低三位数与较高的10年总死亡率相关。83％的SEVR临界值被确定为总死亡率的最佳预测指标。
结论：SEVR可能被认为是“心血管衰弱”的标志。“对SEVR进行准确的非侵入性估计可能是评估老年人生存概率的有用且独立的参数。
背景：NCT00901355，在ClinicalTrials.gov网站上注册。
