Ischemic preconditioning in the younger and aged heart

: Ischemic preconditioning is the effect of brief ischemic episodes which protect the heart from the following more prolonged ischemic episode. This mechanism is effective in younger but not in aged heart. The age-related reduction of ischemic preconditioning has been demonstrated in experimental models and in elderly patients. Preinfarction angina, a clinical equivalent of ischemic preconditioning, reduces mortality in adult but not in elderly patients with acute myocardial infarction. Physical activity or caloric restriction is partially capable to preserve the cardioprotective effect of ischemic preconditioning in the aging heart. More importantly, physical activity and caloric restriction in tandem action completely preserve the protective mechanism of ischemic preconditioning. Accordingly, the protective mechanism of preinfarction angina is preserved in elderly patients with a high grade of physical activity or a low body-mass index. Thus, both physical activity and caloric restriction are confirmed as powerful anti-aging interventions capable to restore age-dependent reduction of a critical endogenous protective mechanism such as ischemic preconditioning

Charlson Comorbidity Index does not predict long-term mortality in elderly subjects with chronic heart failure

Methods: long-term mortality after 12-year follow-up in 125 subjects with CHF and 1,143 subjects without CHF was studied. Comorbidity was evaluated using CCI.Findings: in elderly subjects stratified for CCI (1-3 and >= 4), mortality was higher in non-CHF subjects with CCI >= 4 (52.4% versus 70%, P < 0.002) but not in those with CHF (75.9% versus 77.6%, P = 0.498, NS). Cox regression analysis on 12 years mortality indicated that both CCI (HR = 1.15; 95% CI = 1.01-1.31; P = 0.035) and CHF (HR = 1.27; 95% CI = 1.04-8.83; P = 0.003) were predictive of mortality. When Cox analysis was performed by selecting the presence and the absence of CHF, CCI was predictive of mortality in the absence but not in the presence of CHF.Conclusion: CCI does not predict long-term mortality in elderly subjects with CHF

Role of permanent atrial fibrillation (AF) on long-term mortality in community-dwelling elderly people with and without chronic heart failure (CHF)

Permanent AF is characterized by an increased mortality in elderly subjects with CHF. Moreover, AF increased the risk of mortality also in elderly subjects without CHF. Thus, we examined long-term mortality in community-dwelling elderly people with and without CHF. A total of 1332 subjects aged 65 and older were selected from the electoral rolls of Campania, a region of southern Italy. The relationship between AF and mortality during a 12-year follow-up in 125 subjects with CHF and in 1.143 subjects without CHF were studied. Elderly subjects showed a higher mortality in those with respect to those without AF (72.1% vs. 51.8%; p < 0.01). Similarly, elderly subjects without CHF showed a higher mortality in those with respect to those without AF (61.8% vs. 49.8%; p < 0.05). In contrast, elderly subjects with CHF showed a similar mortality in those with respect to those without AF (74.7% vs. 82.4%; p = 0.234). Multivariate analysis shows that AF was predictive of mortality in all elderly subjects (Hazard Risk = HR = 1.39, 95% confidence interval (CI) = 1.25-2.82; p < 0.001). When the analysis was conducted considering the presence and the absence of CHF, AF was strongly predictive of mortality in elderly subjects without CHF (HR = 1.95, 95% CI = 1.25-4.51; p < 0.001) but not in those with CHF (HR = 1.12, 95% CI = 0.97-3.69; p = 0.321). We concluded that AF is able to predict long-term mortality in elderly subjects. Moreover, AF is strongly predictive of long-term mortality in the absence but not in the presence of CHF. (C) 2011 Elsevier Ireland Ltd. All rights reserved

Mortality and heart rate in the elderly: role of cognitive impairment

Mortality related to heart rate ( HR) increase in the elderly has not yet been well established. To ascertain the relationships among cognitive impairment ( CI), mortality, and HR increase, the authors prospectively studied a random sample of elderly subjects stratified according to presence or absence of CI. Elderly subjects randomly selected in 1991 ( n = 1332) were followed up for 12 years. Mortality was established in 98.1% of the subjects. When HR was stratified in quartiles (< 69,70-75,76-80, and > 80 bpm), mortality was linearly associated with increased HR in all ( from 47.7 to 57.0; r(2) = .43, p = .019) and in subjects without ( from 41.7 to 51.1%; r(2) = .50, p = .043) but not in those with CI ( from 57.5 to 66.1; r(2) = .20, p = .363). Cox regression analysis, adjusted for several variables, shows that HR doesn't predict mortality in all subjects ( RR 0.69; 95% CI = 0.27-1.73) or in those with CI ( RR 0.91; 95% CI = 0.81-1.02). In contrast, HR predicts mortality in subjects without CI ( RR 1.10; 95% CI = 1.00-1.22). Hence, HR increase is a predictor of mortality in elderly subjects without CI. However, when considering all elderly subjects and those with CI, HR increase seems to have no effect on mortality. Thus, CI should be considered when focusing on HR increase as risk factor for mortality in the elderly

Waist circumference but not body mass index predicts long-term mortality in elderly subjects with chronic heart failure

OBJECTIVESTo examine whether waist circumference (WC) and body-mass index (BMI) can predict long-term mortality in elderly subjects with and without chronic heart failure (CHF).DESIGNLongitudinal evaluation with a 12-year follow-up.SETTINGCampania, a region of southern Italy.PARTICIPANTSOne thousand three hundred thirty-two subjects aged 65 and older selected from the electoral rolls of Campania.MEASUREMENTSThe relationship between WC or BMI and mortality during a 12-year follow-up in 125 subjects with and 1,143 subjects without CHF.RESULTSMortality increased as WC increased in elderly subjects without CHF (from 47.8% to 56.7%, P=.01), and the increase was even greater in patients with CHF (from 58.1% to 82.0%, P=.01). In contrast, mortality decreased as BMI increased in elderly subjects without CHF (from 53.8% to 46.1%, P0 =.046) but not in those with CHF. According to Cox regression analysis, BMI protected against long-term mortality in the absence but not in the presence of CHF. In the absence of CHF, WC was associated with a 2% increased risk of long-term mortality for each 1-cm greater WC (Hazard Ratio (HR)=1.02, 95% confidence interval (CI)=1.01-1.03; P <.001), versus 5% increased in the presence of CHF (HR=1.06, 95% CI=1.02-1.10; P <.001).CONCLUSIONWC, but not BMI, is predictive of long-term mortality in elderly individuals with CHF and to a lesser extent in those without CHF

Unexplained falls are frequent in patients with fall-related injury admitted to Orthopaedic wards: the UFO Study (Unexplained Falls in Older patients)

To evaluate the incidence of unexplained falls in elderly patients affected by fall-related fractures admitted to orthopaedic wards, we recruited 246 consecutive patients older than 65 (mean age 82 \ub1 7 years, range 65-101). Falls were defined "accidental" (fall explained by a definite accidental cause), "medical" (fall caused directly by a specific medical disease), "dementia-related" (fall in patients affected by moderate-severe dementia), and "unexplained" (nonaccidental falls, not related to a clear medical or drug-induced cause or with no apparent cause). According to the anamnestic features of the event, older patients had a lower tendency to remember the fall. Patients with accidental fall remember more often the event. Unexplained falls were frequent in both groups of age. Accidental falls were more frequent in younger patients, while dementia-related falls were more common in the older ones. Patients with unexplained falls showed a higher number of depressive symptoms. In a multivariate analysis a higher GDS and syncopal spells were independent predictors of unexplained falls. In conclusion, more than one third of all falls in patients hospitalized in orthopaedic wards were unexplained, particularly in patients with depressive symptoms and syncopal spells. The identification of fall causes must be evaluated in older patients with a fall-related injury

Synergic Effect of Fludrocortisone and Disopyramide in an Elderly Patient with Orthostatic Syncope

Orthostatic hypotension (OH) is a debilitating condition very common in the elderly that may leads to syncope. There is no single drug able to limit the fall in blood pressure in patients affected by OH when standing. In addition, the presence of hyperkinetic arrhythmias may worsen the fall in orthostatic blood pressure especially in elderly patients affected by OH. Unfortunately most of antiarrhythmic therapies lead to a decrease in blood pressure contrasting the effect of OH treatment. By contrast, disopyramide seems to have an anticholinergic effect that could play an important role in limiting the fall in blood pressure in participants with hyperkinetic arrhythmias and OH. We report a case of successful combination therapy of fludrocortisone, disopyramide and nonpharmacologic treatment in an elderly participant affected by neurogenic orthostatic OH and hyperkinetic arrhythmias with a poor quality of life and frequent syncope episodes

An Experimental Investigation on Energy Performance of The Hybrid Photovoltaic Thermal System

Climate change is a worldwide recognized problem, and its mitigation identified as one of the most significant challenges. The way to achieve this purpose is to reduce greenhouse gases (GHG) emissions through the energy system using renewables. The change from an energy system based on fossil fuels to renewable sources-based one is necessary on which the world community agrees. A photovoltaic thermal (PV/T) panel is a system that can produce both electricity and thermal energy simultaneously in one integrated system. This paper deals with hybrid energy systems, specifically a hybrid system to produce power and thermal energy from solar sources consisting of photovoltaic thermal modules. The hybrid system consists of 7 hybrid photovoltaic panels installed on the roof of the laboratory. This paper presents a study for experimental data obtained from a measurement campaign of the thermal and electrical behavior of a PV/T system in single and series models

Clinical Application of Ischemic Preconditioning in the Elderly

A mild stress such as brief ischemic episodes may protect the heart from a successive and more prolonged myocardial ischemia (ischemic preconditioning). This phenomenon is considered a typical “hormetic mechanism” by which the heart is immunized from pathological insults such as myocardial ischemia. This mechanism is reduced with aging and it may be restored and/or preserved by drugs such as adenosine or nicorandil, a mitochondrial KATP channels, and lifestyle interventions such as physical activity and/or hypocaloric diet. Moreover, since the mechanisms involved in cardiac ischemic preconditioning have been established basic and clinical investigators are encouraged to test several drug in well-controlled animal and human studies in order to prevent and/or restore the age-related reduction of ischemic preconditioning