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621 CARDIOVASCULAR ABNORMALITIES AND DYSFUNCTION, BRACHIAL AND CENTRAL BLOOD PRESSURE, ARTERIAL STIFFNESS, AND BIOCHEMICAL PARAMETERS, WHICH ARE VITAL IN THE LAST STAGE OF LIFESPAN: THE PROTEGER STUDY

Objectives: To investigate the prognosis of cardiovascular abnormalities and dysfunction, brachial and central blood pressure, arterial stiffness and biochemical parameters, in an oldest-old population. Methods: We assessed cardiovascular abnormalities and dysfunction by ultrasonography and electrocardiography, blood pressure properties and arterial stiffness by blood pressure monitor and tonometry, and biochemical parameters by routine laboratory assay, and investigated their associations with all-cause mortality in a population of 331 hospitalized elderly patients (mean age ± standard deviation: 87±7 years). After a mean follow-up of 378 days, 110 deaths occurred. Results: As compared to survivors, patients with cardiovascular mortaility had significantly higher LV mass index and presence of atrial fibrillation (P=0.04 and P=0.004), but lower LV ejection fraction and creatinine clearance rate (CCr) (P=0.03 and P=0.001), and patients with all-cause mortality had higher presence of atrial fibrillation (P=0.002), but lower LV ejection fraction, albumin and CCr (P=0.002, P=0.002 and P<0.001). In Cox regression models after adjustment for age and gender, LV ejection fraction, atrial fibrillation, albumin and CCr could separately and significantly predict all-cause mortality. In multivariate Cox regression model with full adjustment, LV ejection fraction, atrial fibrillation, albumin and CCr were significant and independent predictors of overall mortality with a hazard ratio (HR) of 0.81, 1.93, 0.65 and 0.58, respectively. Conclusions: Even in the last stage of lifespan, cardiac systolic dysfunction and atrial fibrillation, as well as malnutrition and renal dysfunction, are crucial risk factors, which should be fully considered in the risk assessment strategy of the hospitalized elderly.