Irit Stessman-Lande

Aging, resting pulse rate, and longevity.

To examine the relationship between resting pulse rate (RPR) and longevity in individuals aged 70 to 90.

Cardiac Structure and Function and Dependency in the Oldest Old

OBJECTIVES: To examine the association between cardiac function and activities of daily living (ADLs) in an age‐homogenous, community‐dwelling population born in 1920 and 1921.

Prevalence and Prognosis of Aortic Valve Disease in Subjects Older than 85 Years of Age

Although degenerative aortic valve disease is common with increasing age, limited data exist regarding prevalence and prognosis of aortic valve disease among the oldest old. Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed at home in 498 randomly selected subjects. Subjects were divided into 3 groups; normal subjects, subjects with valve calcium but without stenosis (AVC), and subjects with aortic stenosis (AS). Survival status at 5-year follow-up was assessed via the centralized population registry. AVC was noted in 55% of the study subjects and AS was seen in 8.2%. There were no significant differences between the 3 groups in any of the clinical parameters examined including risk factors for atherosclerotic heart disease. Of the 498 subjects, 107 (21%) had died at the time of 5-year follow-up. Five-year mortality was similar among the normal (17%) and AVC (20%) subjects but was significantly higher among the subjects with AS (46%; p <0.0001). AS was associated with a nearly fourfold increased likelihood of mortality (hazard ratio 3.7, 95% confidence interval 1.4 to 9.3). In conclusion, among subjects ≥85 years of age, the prevalence of AS is higher than previously reported and not associated with traditional vascular risk factors. AS but not AVC alone was independently predictive of 5-year mortality.

Left Ventricular Mass as a Risk Factor in the Oldest Old

In middle‐aged and “young elderly” cohorts, higher left ventricular mass (LVM) is associated with worse outcomes. The authors examined LVM and 5‐year mortality among community‐dwelling 85‐year‐old patients. A representative sample (n=526, born 1920–1921) from the Jerusalem Longitudinal Cohort Study underwent echocardiography at age 85. LVM was indexed by body surface area (LVM‐BSA) or height (LVM‐Ht). Patients with higher LVM were less educated and sedentary and had poorer self‐rated health, functional limitations, and increased comorbidity. Five‐year mortality was 21.7% (n=114). Adjusted 5‐year mortality rates were increased for the two upper quintiles of LVM‐BSA (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.05–3.06) and LVM‐Ht (HR, 2.2; 95% CI, 1.2–3.5). A step up in mortality occurred around the third quintile corresponding with LVM‐BSA 110 g/m2 or LVM‐Ht 51 g/m2.7. Among the oldest old, elevated LVM is significantly associated with mortality.

Pulmonary artery systolic pressure and mortality in the oldest old.

Objectives: The objectives of the study were to assess pulmonary artery systolic pressure, its association with clinical and echocardiographic variables and its impact on 5-year mortality in a community-dwelling population of the oldest old. Methods: Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed at home, with standard measurements being taken including tricuspid regurgitation (TR) velocity (n = 300). Survival status at 5-year follow-up was assessed via the centralized population registry. Results: The mean TR gradient in the study population as a whole was 30.5 ± 9.4 mm Hg. A significant relationship was noted between right-ventricular systolic pressure (RVSP) and left-atrial (LA) volume (r = 0.27, p < 0.0001), left-ventricular (LV) mass index (r = 0.26, p < 0.0001) and the ratio E/e (r = 0.19, p < 0.03). At the 5-year follow-up, 71 of the 300 subjects (23.7%) had died. TR gradient was significantly associated with mortality in both the unadjusted (HR 1.036, 95% CI 1.015-1.058; p < 0.007) and adjusted (HR 1.036, 95% CI 1.012-1.061; p < 0.0029) models. Conclusions: We demonstrate that RVSP is elevated and related to LV mass, LA volume and reduced diastolic function in the oldest old. An elevated RVSP is significantly associated with mortality in this population.

Cardiac Structure and Function and Renal Insufficiency in the Oldest Old

People over the age of 85 years have a high incidence of cardiovascular disease and chronic kidney disease.

Left atrial function and mortality in the oldest old

Previous studies demonstrated that left atrium (LA) size is associated with mortality in an elderly population. It remains unclear whether indices of LA function including reservoir, conduit, or booster elements of LA function provide incremental prognostic information.

Cardiac tamponade and coronary artery pseudoaneurysm after brachial arterial embolectomy, possible role for an aberrant origin of the right coronary artery

A patient developed hemopericardium shortly after left brachial arterial embolectomy using an embolectomy catheter. Evaluation disclosed evolving pseudoaneurysm of the right coronary artery that was successfully managed by stenting. Misplacement of the embolectomy catheter within the coronary vessel was facilitated by an anomalous origin of the right coronary artery. This complication highlights the importance of correct insertion of the embolectomy catheter using the markers to avoid maladvancement and damage to central vessels.

CARDIAC STRUCTURE AND FUNCTION AND FRAILTY IN THE OLDEST OLD

Frailty is a biological syndrome reflecting a state of decreased physiologic reserve and vulnerability to stressors of increasing importance in cardiovascular disease given the aging of the population. The relationship between frailty and indices of cardiac structure and function remain unclear,

Response to the Paper by Demirkol et al. Entitled ‘The Effect of Age on Right Ventricular Diastolic Function Parameters'

Unfortunately, these parameters were not systemically examined in our study cohort [2] . We join with Demirkol et al. [1] in calling for future studies to assess the effect of aging on right ventricular diastolic function. The authors would like to thank Demirkol et al. [1] for their thoughtful comments. We agree that echocardiographic assessment of right ventricular diastolic function has potential utility in many clinical scenarios including the effect of aging on cardiac and pulmonary function. Published online: December 11, 2014