Cardiovascular profile in critically ill elderly medical patients: prevalence, mortality and length of stay.

PURPOSE: Data are demonstrating the increase in utilization of critical care by the elderly. Around 11% of ICU patients are ≥80years-old. METHODS: An observational retrospective study was conducted between 2003 and 2011, including elderly patients (≥80years old) admitted from medical services to the intensive care unit (ICU) in a tertiary university hospital. The final sample size was N=202. RESULTS: Mortality rates were: ICU 34.1%, in-hospital 44% and 1-year cumulative mortality 55.4% (20.4% for hospital survivors). Multivariate analysis showed that APACHE II score: OR 1.10, 95% CI (1.03-1.18), SAPS II score: OR 1.03, 95% CI (1.01-1.06), a score <3 on the Cruz Roja Hospital mental scale: 0.51 OR, 95% CI (0.01-0.57) and ICU admission for cardiovascular disease: OR 5.05, 95% CI (1.98-12.84) were independently associated with mortality ICU. Factors independently associated with 1-year mortality were: dyslipidemia OR 7.25 (1.47-35.60), chronic kidney failure OR 13.23, 95% CI (2.28-76.6), stroke OR 10.44, 95% CI (2.26-48.25) and antihypertensive treatment OR 0.08, 95% CI (0.01-0.48). In multiple linear regression, ICU length of stay was associated with mechanical ventilation B coefficient 6.41, 95% CI (1.18-11.64) and in-hospital length of stay was related to age: B coefficient -2.17, 95% CI (-4.02 to -0.33). CONCLUSIONS: Prevalence of cardiovascular risk factors and cardiovascular disease was high, and basal cardiovascular treatment was underused. Primary diagnosis for cardiovascular disease at ICU admission should be assessed as predictor of ICU mortality. Intensifying cardiovascular basal treatment could decrease 1-year mortality. Cardiovascular profile did not show an effect on in-hospital mortality and length of stay.

Influence of multiple blood pressure measurements on the estimation of the ankle-brachial index and the consequent diagnosis of peripheral artery disease.

OBJECTIVE: The ankle-brachial index (ABI) is the most useful and efficient tool for assessing the presence of peripheral artery disease (PAD). The aim of this study was to evaluate the effect of multiple sequential blood pressure (BP) measurements on the estimation of the ABI and the consequent diagnosis of PAD in a high vascular risk population. METHODS: This is a cross-sectional study of 71 patients admitted to the Cardiology Department or evaluated as outpatients in the Internal Medicine Department at our institution. The ABI was calculated with the first blood pressure (BP) measurement in the arm with the higher BP (dominant arm; method A) and with the average of the second and third measurements in that same arm (method B). The results of both methods were compared. RESULTS: No statistically significant difference was found for the numerical value of ABI between the methods. The κ correlation index for agreement in the diagnosis of PAD between the methods was 0.87 (95% confidence interval: 0.74-0.99). CONCLUSION: Multiple BP measurements had no impact on the final ABI or on the subsequent diagnosis of PAD.

A Study on the Relationship between Serum Beta 2-Microglobulin Levels, Underlying Chronic Kidney Disease, and Peripheral Arterial Disease in High-Vascular-Risk Patients.

BACKGROUND: Serum beta 2-microglobulin (B2M) levels have been found to be increased in patients with peripheral arterial disease (PAD), yet it is still unknown whether B2M correlates with PAD intensity. OBJECTIVES: We aim to evaluate the correlation between B2M and the ankle-brachial index (ABI) values in high-vascular-risk patients. METHODS: This is a cross-sectional study of 63 high-vascular-risk patients admitted to the Cardiology Department or evaluated as outpatients in the Internal Medicine Department of our institution. Patients were classified into two groups according to their ABI: patients without PAD (n = 44, ABI values between 0.9 and 1.4) and patients with PAD (n = 19, ABI values lower than 0.9 or higher than 1.4). We performed univariate and multivariate analysis based on a multiple linear regression model. RESULTS: Serum B2M levels were higher in patients with pathological ABI values than in those without PAD (2.36 ± 1.13 vs. 1.80 ± 0.65 mg/L; P<0.05). We found no correlation between B2M and ABI in our total population (r = -0.12) or in patients with PAD (r = -0.09; NS for both comparisons). Age, gender, arterial hypertension, estimated glomerular filtration rate (eGFR), uric acid, total cholesterol, and LDL-cholesterol correlated with B2M in the univariate analysis. In the final linear regression model, eGFR, uric acid and total cholesterol correlated independently with B2M (P<0.01). CONCLUSION: We found no correlation between B2M levels and ABI values in high-vascular-risk patients that could usefully help in the subsequent diagnosis of PAD. However, we observed a significant correlation between B2M and eGFR, even when renal function was only slightly impaired.

White-coat hypertension in the elderly. Echocardiographic analysis. A substudy of the EPICARDIAN project.

The aims of this study were to investigate echocardiographic abnormalities in the elderly and to evaluate differences between those who are normotensive and those who have white-coat hypertension or sustained hypertension. The study used data on a subsample of participants in the EPICARDIAN project who came from the Lista district of Madrid, Spain. Of the 271 included, 61 (22.5%) were normotensive, 81 (29.9%) had white-coat hypertension and 129 (49.6%) had sustained hypertension. The left ventricular mass index was significantly different between the subgroups: 94.9 g/m2 in normotensives, 125.6 g/m2 in those with white-coat hypertension and 136.3 g/m2 in those with sustained hypertension (P< .001). The prevalence of left ventricular hypertrophy, defined using Deveraux's criteria, was 13.2% in normotensives, 49.1% in those with white-coat hypertension and 54.3% in those with sustained hypertension (P=.00007). White-coat hypertension is not a innocuous finding in the elderly because its implications for cardiac health are closer to those of sustained hypertension than to those of normal blood pressure.

Hipertensión arterial de bata blanca en ancianos. Análisis ecocardiográfico. Subestudio del proyecto EPICARDIAN / White-coat hypertension in the elderly. echocardiographic analysis. A substudy of the EPICARDIAN project

El objetivo fue evaluar las alteraciones ecocardiográficas en ancianos y analizar las diferencias entre normotensos, hipertensos de bata blanca e hipertensos permanentes. Los datos proceden de una submuestra del proyecto EPICARDIAN perteneciente al barrio de Lista (Madrid). De los 271 pacientes, 61 fueron clasificados como normotensos (22,5%); 81, como hipertensos de bata blanca (29,9%) y 129, como hipertensos permanentes (49,6%). El índice de masa del ventrículo izquierdo (IMV) según los subgrupos fue 94,9 g/m2 (normotensos), 125,6 g/m2 (hipertensos de bata blanca) y 136,3 g/m2 (hipertensos mantenidos) (p < 0,001). La prevalencia de hipertrofia ventricular izquierda (HVI) por el criterio Deveraux fue del 13,2% (normotensos), el 49,1% (hipertensos de bata blanca) y el 54,3% (hipertensos permanentes) (p = 0,00007). La hipertensión arterial de bata blanca en ancianos no es una situación inocua, ya que su repercusión cardiaca se acerca más a la de la hipertensión permanente que a la de la normotensión (AU)

The aims of this study were to investigate echocardiographic abnormalities in the elderly and to evaluate differences between those who are normotensive and those who have white-coat hypertension or sustained hypertension. The study used data on a subsample of participants in the EPICARDIAN project who came from the Lista district of Madrid, Spain. Of the 271 included, 61 (22.5%) were normotensive, 81 (29.9%) had white-coat hypertension and 129 (49.6%) had sustained hypertension. The left ventricular mass index was significantly different between the subgroups: 94.9 g/m2 in normotensives, 125.6 g/m2 in those with white-coat hypertension and 136.3 g/m2 in those with sustained hypertension (P<.001). The prevalence of left ventricular hypertrophy, defined using Deveraux’s criteria, was 13.2% in normotensives, 49.1% in those with white-coat hypertension and 54.3% in those with sustained hypertension (P=.00007). Whitecoat hypertension is not a innocuous finding in the elderly because its implications for cardiac health are closer to those of sustained hypertension than to those of normal blood pressure (AU)

An analysis of cardiac remodeling in the elderly population. EPICARDIAN study.

The aims of this study were to investigate left ventricular morphology in a sample of elderly Spanish individuals and to assess differences between hypertensives and normotensives. Data were obtained from a subsample (N=242) of participants in the EPICARDIAN study who live to the Lista district of Madrid: they included 191 (78.8%) hypertensives and 51 (21.2%) normotensives. Left ventricular remodeling patterns were classified as: type I (normal), type II (concentric remodeling), type III (concentric hypertrophy) or type IV (eccentric hypertrophy). The overall prevalences were: 74 (30.5%) type I, 62 (25.9%) type II, 53 (21.8%) type III and 53 (21.8%) type IV. A comparison of hypertensives and normotensives showed that the prevalences were: 42 (22.3%) type I, 50 (26.1%) type II, 50 (26.1%) type III and 49 (25.5%) type IV in hypertensives and 31 (60%) type I, 13 (26%) type II, 3 (6%) type III and 4 (8%) type IV in normotensives (P< .0005). Ventricular remodeling without hypertrophy was common in the elderly, an observation that could have prognostic implications.

Análisis del remodelado cardiaco en población anciana. Estudio EPICARDIAN / An analysis of cardiac remodeling in the elderly population. EPICARDIAN study

El objetivo es evaluar la morfología del ventrículo izquierdo en una muestra de ancianos españoles y analizar las diferencias entre hipertensos y normotensos. Los datos proceden de una submuestra (n = 242) del proyecto EPICARDIAN perteneciente al barrio de Lista (Madrid) con 191 (78,8%) hipertensos y 51 (21,2%) normotensos. Los patrones de remodelado del ventrículo izquierdo definidos fueron: tipo I (normal), tipo II (remodelado concéntrico), tipo III (hipertrofia concéntrica) y tipo IV (hipertrofia excéntrica). La prevalencia respecto al total de la población fue 74 (30,5%) tipo I, 62 (25,9%) tipo II, 53 (21,8%) tipo III y 53 (21,8%) tipo IV. La comparación entre hipertensos y normotensos mostró que las prevalencias fueron: 42 (22,3%) tipo I, 50 (26,1%) tipo II, 50 (26,1%) tipo III y 49 (25,5%) tipo IV en el primer grupo y 31 (60%) tipo I, 13 (26%) tipo II, 3 (6%) tipo III y 4 (8%) tipo IV entre los normotensos (p < 0,0005). El remodelado ventricular sin hipertrofia es frecuente en ancianos, hecho que puede tener implicaciones pronósticas (AU)

The aims of this study were to investigate left ventricular morphology in a sample of elderly Spanish individuals and to assess differences between hypertensives and normotensives. Data were obtained from a subsample (N=242) of participants in the EPICARDIAN study who live to the Lista district of Madrid: they included 191 (78.8%) hypertensives and 51 (21.2%) normotensives. Left ventricular remodeling patterns were classified as: type I (normal), type II (concentric remodeling), type III (concentric hypertrophy) or type IV (eccentric hypertrophy). The overall prevalences were: 74 (30.5%) type I, 62 (25.9%) type II, 53 (21.8%) type III and 53 (21.8%) type IV. A comparison of hypertensives and normotensives showed that the prevalences were: 42 (22.3%) type I, 50 (26.1%) type II, 50 (26.1%) type III and 49 (25.5%) type IV in hypertensives and 31 (60%) type I, 13 (26%) type II, 3 (6%) type III and 4 (8%) type IV in normotensives (P < .0005). Ventricular remodeling without hypertrophy was common in the elderly, an observation that could have prognostic implications (AU)

Echocardiographic findings in an elderly population. Influence of arterial hypertension. The EPICARDIAN study.

The aim of this study was to determine the prevalence of left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD) and left ventricular systolic dysfunction (LVSD) in a group of elderly Spanish individuals. Data were obtained on a subgroup of 371 individuals from the Lista district of Madrid, Spain who were taking part in the EPICARDIAN study. In hypertensive subjects, the prevalence of LVH was 51.8%-61.8%, that of LVDD was 86%, and that of LVSD was 6.2%. In normotensive subjects, the prevalences were 14%-30% for LVH, 86% for LVDD, and 6% for LVSD. The isovolumic relaxation time was 115+/-33 ms in the hypertensive group and 105+/-24 ms in the normotensive group. In this study, the only factor that differentiated between the diagnoses of LVDD due to age and LVDD due to hypertension was a longer isovolumic relaxation time.

Hallazgos ecocardiográficos en población anciana. Influencia de la hipertensión arterial. Estudio EPICARDIAN / Echocardiographic Findings in an Elderly Population. Influence of Arterial Hypertension. The EPICARDIAN Study

El objetivo fue evaluar la prevalencia de hipertrofia ventricular izquierda (HVI), disfunción diastólica (DDVI) y disfunción sistólica (DSVI) del ventrículo izquierdo en una muestra de ancianos españoles. Los datos proceden de una submuestra del proyecto EPICARDIAN perteneciente al barrio de Lista (Madrid). Las prevalencias en pacientes hipertensos fueron: HVI, 51,8-61,8%; DDVI, 86%, y DSVI, 6%. En normotensos: HVI, 14-30%; DDVI, 81%, y DSVI, 6,2%. El tiempo de relajación isovolumétrica (TRI) fue 115 ± 33 ms en hipertensos y 105 ± 24 ms en normotensos. La mayor prolongación del TRI fue el único factor que estableció el diagnóstico diferencial entre la DDVI asociada a la edad y la asociada a hipertensión

The aim of this study was to determine the prevalenceof left ventricular hypertrophy (LVH), left ventriculardiastolic dysfunction (LVDD) and left ventricular systolic dysfunction (LVSD) in a group of elderly Spanishindividuals. Data were obtained on a subgroup of 371individuals from the Lista district of Madrid, Spain whowere taking part in the EPICARDIAN study. Inhypertensive subjects, the prevalence of LVH was51.8%–61.8%, that of LVDD was 86%, and that of LVSDwas 6.2%. In normotensive subjects, the prevalenceswere 14%–30% for LVH, 86% for LVDD, and 6% forLVSD. The isovolumic relaxation time was 115±33 ms inthe hypertensive group and 105±24 ms in thenormotensive group. In this study, the only factor thatdifferentiated between the diagnoses of LVDD due to ageand LVDD due to hypertension was a longer isovolumicrelaxation time (AU)

Preoperative uracil, tegafur, and concomitant radiotherapy in operable rectal cancer: a phase II multicenter study with 3 years' follow-Up.

PURPOSE: To assess tolerance and efficacy of preoperative treatment with uracil/tegafur and radiotherapy (RT) followed by surgery and postoperative flurouracil (FU)/leucovorin (LV) in patients with rectal cancer. PATIENTS AND METHODS: Patients (n = 94) with potentially resectable tumors, ultrasound at stages T2N+ (n = 4), T3 (n = 77), T4 (n = 13) were treated with UFT (400 mg/m2/d, 5 days a week for 5 weeks) and concomitant RT to the pelvis (45 Gy; 1.8 Gy/d over 5 weeks). Patients underwent surgery 5 to 6 weeks later followed by four cycles of FU/LV. Primary end points included downstaging, pathologic responses, and sphincter-preserving surgery. Secondary end points were recurrence-free survival and overall survival. RESULTS: All patients received the full RT dose. Fifteen patients (16%) needed UFT dose reduction. Preoperative G3+ toxicities included diarrhea (14%), leukopenia (1%), thrombocytopenia (1%), and nausea (4%). The downstaging rate was 54%, pathologic complete response (pCR) was 9% and, in an additional 23%, there were only residual microscopic foci. When cellular viability criteria were taken into account, the pCR was 15%. From 43 patients with abdominoperineal resection indication, 11 (25%) had sphincter-preserving surgery performed. Postoperative scheduled chemotherapy dose was not administered to 24% of patients because of G3+ toxicity (diarrhea, 8%; mucositis, 9%; and leukopenia, 7%). Patients with downstaging had significantly higher survival and recurrence-free survival rates than those without. At 3 years, actuarial patterns of failure were pelvic, 5% and distant, 11%. OS was 75%. CONCLUSION: UFT combined with RT is safe and effective. In resectable rectal cancer, if preoperative treatment is considered, this approach can be an option.