PS-BPC05-4: DIASTOLIC FUNCTION AND STROKE VOLUME MEASURED BY ECHOCARDIOGRAPHY IS RELATED TO PROGRESSION OF FRAILTY IN ELDERLY HYPERTENSIVE OUTPATIENTS

Abstract

Objective: In hypertensive patients, echocardiographic measures of cardiac structure and function were related to cognitive dysfunction and frailty in cross sectional studies; however, longitudinal relationship of these parameters has not been elucidated. We investigated whether stroke volume and diastolic function in echocardiography was predictive of worsening of cognitive function and frailty for 3 years. Design and Methods: Among 330 hypertensive patients who were registered in the frailty clinic and underwent echocardiography, 93 patients were followed up for 3 years. We evaluated stroke volume and diastolic function in echocardiography, frailty status evaluated as Kihon checklist (KCL), and cognitive function measured as mini mental state examination (MMSE) and Montreal cognitive assessment (MoCA). Results: Patients’ mean age was 78.8 ± 7.1 years old (58% male). KCL score remained or decreased in 50 (54 %) patients after 3 years of follow up (7.1 ± 4.7 points to 5.7 ± 4.7), and increased in 43 (46 %) patients (6.1 ± 4.1 to 8.9 ± 4.4). Between those whose KCL score increased and remained or decreased, there were no statistical difference in history of hypertension, heart failure, diabetes mellitus, stroke and type of antihypertensives; however, MMSE and MoCA score at follow up was higher in patients whose KCL score remained or decreased (MMSE: 27.8 ± 2.5 vs 26.7 ± 3.3, p = 0.24, MoCA: 22.2 ± 4.0 vs 20.7 ± 5.2, p¬ = 0.036). Ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’) at baseline was lower in patients whose KCL score remained or decreased (E/e’ septal 11.8 ± 3.0 vs 14.4 ± 5.5 p = 0.01). Other value for diastolic function was not related to the change of KCL score. Logistic regression analysis revealed E/e’ septal was independently associated with an increased KCL score even after adjusting for age, sex, BMI, history of hypertension, diabetes mellitus, heart failure, and KCL score at baseline (p = 0.036, odds ratio = 0.89). On the other hand, E/e’ was not significantly different in the parallel analysis according to domains of physical function, nutritional state, cognitive function, and depressive mood in KCL. Systolic volume in echocardiography at baseline was related to change in physical function in KCL at follow up (r = -0.226, p = 0.028). Conclusions: E/e’ in echocardiography at baseline was predictive of worsening of frailty status, measured as KCL score, at 3 years later.