Association Between Myocardial Strain and Frailty in CHS
Annabel X. Tan, Sanjiv J. Shah, Jason L. Sanders, Bruce M. Psaty, Chenkai Wu, Julius M. Gardin, Carmen A. Peralta, Anne B. Newman, Michelle C. Odden
Abstract
Background: Myocardial strain, measured by speckle-tracking echocardiography, is a novel measure of subclinical cardiovascular disease and may reflect myocardial aging. We evaluated the association between myocardial strain and frailty—a clinical syndrome of lack of physiological reserve. Methods: Frailty was defined in participants of the CHS (Cardiovascular Health Study) as having ≥3 of the following clinical criteria: weakness, slowness, weight loss, exhaustion, and inactivity. Using speckle-tracking echocardiography data, we examined the cross-sectional (n=3206) and longitudinal (n=1431) associations with frailty among participants who had at least 1 measure of myocardial strain, left ventricular longitudinal strain (LVLS), left ventricular early diastolic strain rate and left atrial reservoir strain, and no history of cardiovascular disease or heart failure at the time of echocardiography. Results: In cross-sectional analyses, lower (worse) LVLS was associated with prevalent frailty; this association was robust to adjustment for left ventricular ejection fraction (adjusted odds ratio, 1.32 [95% CI, 1.07–1.61] per 1-SD lower strain; P =0.007) and left ventricular stroke volume (adjusted OR, 1.32 [95% CI, 1.08–1.61] per 1-SD lower strain; P =0.007). In longitudinal analyses, adjusted associations of LVLS and left ventricular early diastolic strain with incident frailty were 1.35 ([95% CI, 0.96–1.89] P =0.086) and 1.58 ([95% CI, 1.11–2.27] P =0.013, respectively). Participants who were frail and had the worst LVLS had a 2.2-fold increased risk of death (hazard ratio, 2.20 [95% CI, 1.81–2.66]; P <0.0001). Conclusions: In community-dwelling older adults without prevalent cardiovascular disease, worse LVLS by speckle-tracking echocardiography, reflective of subclinical myocardial dysfunction, was associated with frailty. Frailty and LVLS have an additive effect on mortality risk.