Cardiology Department, Cardiocenter "Medika," St. Petersburg, Russian Federation.
Cardiology Department, Saint Petersburg State University Hospital, St. Petersburg, Russian Federation.
Acta Cardiol. 2023 Jun;78(4):409-416. doi: 10.1080/00015385.2022.2121538. Epub 2022 Oct 3.
Atherosclerosis and coronary artery disease (CAD) are a common condition and cause of death in the elderly population. There are difficulties with risk assessment in the elderly as the objectification of their symptomatic status can be challenging due to neuromuscular weakness, physical deconditioning or neurological, orthopaedic, peripheral vascular, or respiratory limitations. Non-invasive coronary artery velocity assessment by Doppler method at rest could be helpful in the elderly population. To evaluate the prognostic role of coronary artery ultrasound assessment in a non-selected elderly population in everyday clinical practice.
One hundred forty-five patients, aged ≥75years (99 women; 80 ± 4 years), formed the study group. Left coronary artery flows were scanned in addition to conventional echocardiography. During a median follow-up of 26 months, 16 deaths and 2 non-fatal MI occurred.
In multivariable analysis, maximal coronary velocity was the only independent predictor for mortality (heart rate [HR]: 1.02, 95%, CI: 1.01-1.04, < .0005) and for mortality/MI (HR: 1.02, 95%, CI: 1.01-1.03, < .0001). The value of 110 cm/s maximal coronary flow velocity (CFL) in the proximal segments of left arteries was the best predictor for death, sensitivity 50%, specificity 90%, < .005. The annual mortality rate was 16.6% persons/year for patients with elevated CFL ≥110 cm/s. The value 81 cm/s was the best predictor for death/MI, sensitivity 61%, specificity 80%, < .0005; annual mortality rate was 11.2% persons/year for patients with elevated CFL ≥81 cm/s ( < .0001).
Doppler CFL scanning during routine echocardiography is a feasible and valuable tool for assessment of short-term prognosis in elderly patients.
动脉粥样硬化和冠状动脉疾病（CAD）是老年人的常见病症和死亡原因。由于老年人的神经肌肉无力、身体适应不良或神经、骨科、外周血管或呼吸系统的限制，其症状状态的客观化具有一定难度，因此风险评估存在困难。通过多普勒方法在休息时对冠状动脉进行无创速度评估可能对老年人群有益。本研究旨在评估在日常临床实践中，对非选择性老年人群进行冠状动脉超声评估的预后作用。
145 名年龄≥75 岁的患者（99 名女性；80±4 岁）组成了研究组。除了常规超声心动图外，还对左冠状动脉血流进行了扫描。在中位数为 26 个月的随访期间，发生了 16 例死亡和 2 例非致死性心肌梗死。
多变量分析显示，最大冠状动脉速度是死亡率的唯一独立预测因素（心率[HR]：1.02，95%置信区间：1.01-1.04， < 0.0005）和死亡率/心肌梗死（HR：1.02，95%置信区间：1.01-1.03， < 0.0001）。左前降支近端节段最大冠状动脉流速（CFL）110cm/s 的值是死亡的最佳预测因子，敏感性为 50%，特异性为 90%， < 0.005。CFL≥110cm/s 的患者每年死亡率为 16.6%。CFL 值 81cm/s 是死亡/心肌梗死的最佳预测因子，敏感性为 61%，特异性为 80%， < 0.0005；CFL≥81cm/s 的患者每年死亡率为 11.2%， < 0.0001。
在常规超声心动图检查期间进行多普勒 CFL 扫描是评估老年患者短期预后的一种可行且有价值的工具。
