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The effect of frailty on cardiovascular structure and function: insights from the UK Biobank

Session Poster session 1

Speaker Mihir Sanghvi

Congress : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Dimensions, Volumes and Mass
  • Session type : Poster Session
  • FP Number : P145

Authors : M M Sanghvi (London,GB), N Aung (London,GB), J A Cooper (London,GB), K Fung (London,GB), J M Paiva (London,GB), E Lukaschuk (Oxford,GB), S K Piechnik (Oxford,GB), S Neubauer (Oxford,GB), SE Petersen (London,GB)

Authors:
M M Sanghvi1 , N Aung1 , J A Cooper1 , K Fung1 , J M Paiva1 , E Lukaschuk2 , S K Piechnik2 , S Neubauer2 , SE Petersen1 , 1Queen Mary University of London, William Harvey Research Institute - London - United Kingdom of Great Britain & Northern Ireland , 2University of Oxford Centre for Clinical Magnetic Resonance Research - Oxford - United Kingdom of Great Britain & Northern Ireland ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii91

Introduction
As populations age and become more multimorbid, there is increasing focus on composite measures of health. Frailty is one such example and is defined as a decline in physiological reserve leading to impaired resistance to stressors. There is emerging evidence linking cardiovascular disease and frailty, however the effect of frailty on the structure of the heart is less clearly elucidated.

Purpose
This study examines the impact of frailty on left ventricular and left atrial structure and function which may provide insights into the mechanistic effect of frailty on cardiovascular disease.

Methods
The UK Biobank is a population study examining older adults resident in the United Kingdom. Measurement of frailty was per Fried’s pentad including: physical activity (bottom 20% on International Physical Activity Questionnaire (IPAQ)), weakness (bottom 20% of handgrip strength), unintentional weight loss (self-reported unintentional weight loss over one year), tiredness (self-reported tiredness) and slow gait speed (self-reported usual walking speed). Patients measured as frail in 1-2 markers were categorised as pre-frail; those measured as frail in =3 markers were categorised as frail. Differences in left ventricular and left atrial structure and function between non-frail, pre-frail and frail participants was assessed by multivariable regression adjusting for age, sex, ethnicity, weight and height; effect estimates are presented as percentage change.

Results
After adjustment, pre-frail and frail participants when compared to non-frail participants demonstrated smaller end-diastolic volumes (pre-frail -3.1%, -4.3% to -1.9%; frail -4.7%, -8.0% to -1.2%; p for trend <0.00001), end-systolic volumes (pre-frail -3.2%, -4.8% to -1.5%; frail -5.0%, -9.8% to 0.0%; p for trend = 0.0001), left ventricular mass (pre-frail -3.5%, -4.7% to -2.3%; frail -3.8%, -7.3% to -0.2%; p for trend <0.0001) and left atrial maximal volume (pre-frail -4.1%, -6.2% to -2.1%; frail -7.7%, -13.4% to -1.5%; p for trend <0.00001). There was no change in left ventricular ejection fraction.

Conclusion
Participants determined as pre-frail or frail demonstrate smaller chamber volumes and smaller left ventricular mass than non-frail participants. Traditional cardiovascular risk factors associated with atherosclerosis such as hypertension and high body mass index are associated with larger chambers and high left ventricular mass. This may indicate that the effect of frailty on cardiovascular health may be mediated by processes other than atherosclerosis.



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