Cardiac Structure and Function and Frailty in the Oldest Old

Background: Frailty is a biologic syndrome relecting 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, particularly in the "oldest old". The objective of this study was to examine the association between cardiac function and frailty in an age-homogenous, community-dwelling population of subjects 85-6 years of age.

Methods: Subjects were recruited at ages 85-6 from the Jerusalem Longitudinal Cohort Study that has followed an age homogenous cohort of Jerusalem residents. Subjects underwent echocardiography at their place of residence with standard echocardiographic assessment of cardiac structure and function. Frailty was defined based on criteria of grip strength, slowness, physical activity level, fatigue and shrinking with subjects fulfilling at least 3 criteria being defined as frail.

Results: 405 subjects (193 males, 212 females) were enrolled in the study. Subjects defined as frail has significantly lower ejection fraction as compared to the non-frail group (53.7 +\- 0.09% vs 56.4 +\- 0.09%; p< 0.04). In addition frail subjects had increased left ventricular mass index (130.6 +\- 36.2 g/m2 vs. 119.2 +/- 31.1 g/m2; p< 0.03) and left atrial volume index (41.9 +\- 14.7 cc/m2 vs. 36.7 +\- 13.1 cc/m2; p< 0.001). Indices of diastolic function (E/e`) were not significantly different between the two groups (11.5 vs. 11.8; p = NS).

Conclusions: In this age-homogenous cohort of the oldest old, structural changes and indices of systolic but not diastolic function were assoiated with frailty.