Congestive heart failure in old age: prevalence, mechanisms and 4-year prognosis in the Helsinki Ageing Study

Objective. To examine the prevalence, underlying diseases, abnormalities of left ventricular function and prognosis in congestive heart failure (CHF) of old age.
Design. A population-based clinical and echocardiographic study with a 4-year mortality follow-up.
Setting. University hospital.
Subjects. Five hundred and one individuals born in 1904, 1909 and 1914 (367 women).
Main outcome measures. Presence of CHF by clinical and chest radiograph criteria; left ventricular size and systolic function by echocardiography; grade of aortic and mitral valve lesions by Doppler echocardiography; 4-year total and cardiovascular mortality.
Results. Forty-one of 501 participants (8.2%) had CHF. Ischaemic heart disease (54%), hypertension (54%) and moderate-to-severe mitral or aortic valve disease (51%) were the main underlying conditions; 90% of patients had one or more of these diseases. Most individuals with CHF (28 of 39 patients, 72%) had normal left ventricular contractions at echocardiography. 'Diastolic CHF', defined as CHF with normal systolic left ventricular function and no regurgitant valve disease, was found in 51% (20 of 39 patients). The relative 4-year risk for death associated with CHF, adjusted for age and sex, was 2.1 (95% confidence interval 1.3–3.4) for all-cause mortality and 4.2 (CI 1.9–5.6) for cardiovascular mortality.
Conclusions. The prevalence of CHF in a population aged 75–86 years is approximately 8%. Ischaemic or valvular heart disease and hypertension are the main underlying conditions. At echocardiography, about 50% of the elderly with CHF have normal left ventricular systolic contractions in the absence of valve disease and an additional 20% have normal systolic function with mitral regurgitation. The presence of CHF doubles the age- and sex-adjusted risk of death from all causes, and quadruples the risk of cardiovascular death during 4-year follow-up.     

Prediction of Arrhythmia Risk Based on Signal-Averaged ECG in Postinfarction Patients

In patients surviving acute MI, identification of those at high risk for life-threatening ventricular tachyarrhythmias and/or sudden death is of great importance. Numerous strategies based on indices such as the degree of left ventricular dysfunction, complex ventricular arrhythmias, or parameters of autonomic dysfunction have not yet led to an effective identification of the individual patient at risk. During the past decade, many investigators have recorded low amplitude, high frequency components in the terminal QRS complex (so-called late potentials) from patients prone to sustained ventricular tachycardia. The SAECG has been used to predict life-threatening tachyarrhythmias in patients after acute MI and to screen for inducible ventricular tachycardia in patients with unexplained syncope or sustained ventricular tachycardia. This review article describes the most frequently applied methodology and clinical applications of the SAECG in post-MI patients and discusses the usefulness of noninvasive recordings in various other clinical settings.     

Calcific degeneration of the aortic valve in old age: is the development of flow obstruction predictable

Objective. Aortic valve calcification and stenosis become increasingly common with advancing age. This work aimed at assessing whether a time-dependent reduction of aortic valve area is detectable in an unselected elderly population and whether the rate of reduction can be predicted from clinical or biochemical characteristics. Design. A population-based prospective echocardiographic follow-up study. Setting. A university hospital. Subjects. In 1990, randomly selected persons born in 1904, 1909 and 1914 (total n=501) underwent a Doppler echocardiographic study of aortic valve and biochemical tests of glucose, lipid and calcium metabolism. In 1993, echocardiography was repeated in 333 survivors of the original cohorts. These individuals constitute the present study population. Main outcome measures. Three-year changes in the aortic valve area and velocity ratio (peak outflow tract velocity/peak aortic jet velocity) determined by Doppler echocardiography. Results. Aortic valve area decreased from a mean of 1.95 cm² (95% confidence interval of mean, 1.88–2.03 cm²) to 1.78 cm² (1.71–1.85 cm²) within 3 years (P<0.001). Concomitantly, the velocity ratio decreased from 0.75 (0.73–0.77) to 0.68 (0.67–0.70) (P<0.001). The changes in aortic valve area and velocity ratio were unrelated to age, sex, presence of hypertension, coronary artery disease or diabetes, and to all assessed biochemical characteristics. A weak positive statistical association was found between the decrease in aortic valve area and the body mass index at entry (r=0.16, P<0.01). Conclusions. A time-dependent reduction of the aortic valve flow orifice can be demonstrated in persons representing the general elderly population. The deterioration of aortic valve function within a span of 3 years is neither clinically nor biochemically predictable. A longer follow-up may be necessary to identify the risk factors of aortic valve stenosis in old age.     

Age-dependent influence of heart rate on Doppler indexes of left ventricular filling

Abstract. Background and objective . The Doppler indexes of left ventricular filling are related to age and heart rate. The aim of this study was to assess whether the influences of heart rate and age interactions (that is, whether the effect of heart rate on the Doppler indexes) is modified by age. Subjects and methods . The effects of atropine-induced heart rate increases on the transmitral velocities were compared in 10 younger healthy subjects aged 26–38 years and 12 older healthy subjects aged 50–67 years. Results . With a comparable total rise in heart rate (on average 20 beats min^-1), the peak early diastolic velocity decreased likewise in both groups (from 66±9 to 57±9 cm s^-1 in the younger age group and from 58 ± 15 to 47±13 cm s^-1 in the older age group). The peak atrial velocity remained unaltered in the older group (53 ± 16 vs. 52 ± 14 cm s^-1) but rose from 33 ± 6 to 44 ± 12 cm s^-1 in the younger (P = 0.02). The early-to-atrial peak velocity ratio decreased from 1.2 ± 0.6 to 1.0 ± 0.4 cm s^-1 in the older subjects and from 2.0 ± 0.5 to 1.4 ± 0.5 cm s^-1 in the younger subjects (P = 0.01). Changes in the other Doppler indexes were similar in both groups. Conclusions . The effect of heart rate on certain Doppler indexes of left ventricular filling is age-dependent. The peak velocity ratio cannot be interpreted without adjusting for heart rate in younger subjects, whilst in older people heart rate variation is of less importance.     

Prevalence of caries and salivary levels of mutans streptococci in 5-year-old children in relation to duration of breast feeding

Abstract – 144 children with a known breast feeding history were studied for their caries prevalence and level of salivary mutans streptococci. 19% of the children were exclusively breastfed for more than 9 months and 38% of the children were weaned after the age of 12 months (max. 34 months). The results of the study showed an equal caries prevalence at the age of 5 among children with a longer or shorter period of exclusive breast-feeding (x²= 3.68, 9 df, NS). Exclusive breast-feeding also did not affect the levels of salivary mutans streptococci (x²= 4.87, 9 df, NS). Children who were weaned late did not differ from those who were weaned early with respect to caries experience (x²= 6.12, 9 df, NS), level of salivary mutans streptococci (x²= 5.49, 9 df, NS) or presence of mutans streptococci (x²= 1.53, 4 df, NS). On the basis of our sample we concluded that breast feeding alone cannot be connected with an increased or lowered caries prevalence.     

Hypersensitivity to acetylsalicylic acid (ASA) and tartrazine in patients with asthma

One-hundred and forty asthmatics were tested perorally with acetylsalicylic acid (ASA), and/or with the azo-colour tartrazine; a fall in PEF of more than 20% was accepted as a positive result. About one quarter of the patients displayed a positive reaction to one of the two tested agents. No significant correlation was found between the reactions of these, and the presence of atopy, nasal polyposis, sinusitis, rhinitis, sensitivity to cold air, the age at onset, duration of asthma, or history of sensitivity to alcoholic drinks. The history suggested sensitivity to ingested, possibly coloured, food and drink, in only about one third of the tartrazine-positive cases. The ASA provocation tests were mainly applied to patients with doubtful or negative histories of sensitivity to ASA-containing drugs. The frequency of cross-reactivity between the two tested agents was statistically significant; patients reacting to tartrazine were for the most part, also sensitive to ASA. Tests for sensitivity to analgesics and food additives should be conducted as a routine measure in asthmatics, and sensitive patients should be given information on suitable medication and dietary control.     

Salivary immunoglobulins, lysozyme, pH, and microbial counts in children receiving anti-neoplastic therapy

Abstract – Salivary immunoglobulins, lysozyme, pH, and microbial counts were determined in 55 children with cancer diseases (37 cured subjects and 18 acute ones) and 103 healthy subjects. 5–10 ml unstimulated whole saliva was collected and pH, immunoglobulins and lysozyme were measured. Chairside dip-slide cultivations were used for microbiologic cultures. Reduced salivary pH and an increased amount of lysozyme were found in the saliva of those children who had been cured of their cancer diseases, but ongoing cancer disease or the treatment provided for it reduced pH and increased the amounts of lysozyme, lactobacillus, Streptococcus mutans and some immunoglobulins. These findings suggest that children with childhood cancer may be more susceptible to dental diseases than healthy ones.     

Validity of Hospital Discharge Data in a Prospective Epidemiological Study on Stroke and Myocardial Infarction

Abstract The validity and coverage of hospital records of stroke and myocardial infarction were evaluated in a Finnish epidemiological cohort consisting of 57000 men and women. Information on their hospitalizations after the baseline examination was obtained by record linkage to the National Hospital Discharge Register. As compared to data based on re-examination of survivors after five years, the discharge register covered 78.2 % of hospital treatments. A specific diagnosis code had been recorded for 81.7% of the definite strokes and for 84.7% of the definite myocardial infarctions. The 5-year incidence rates based on both hospital records and deaths were clearly lower than the rates previously reported from local registers of stroke and myocardial infarction in Finland. Although hospital discharge information underestimates morbidity in the population, the data are sufficiently valid for many epidemiological purposes, e.g. research on predictors of diseases.