Clinical profile of patients with advanced age and inflammatoric dilated cardiomyopathy on endomyocardial biopsy

Background Endomyocardial biopsy （EMB） is an important tool when patients with inflammatoric cardiomyopathy （DCMi） are evaluated. We aimed to assess the clinical profile of elderly patients with DCMi on EMB. Methods Retrospective study of all consecutive patients hospitalized from January 2007 to December 2011 with clinical suspicion of DCMi undergoing EMB. Patients with evidence of DCMi on EMB （Group 1 〉 70 years, n = 85; Group 3 〈 70 years; n = 418） were compared to patients of the same age group without evi- dence of DCMi on EMB （Group 2 〉 70 years, n = 45; Group 4 〈 70 years; n = 147）. Results Among 24,275 patients treated at our institu- tion during the study period, 695 had clinical suspicion of DCMi and underwent EMB; 503 （2.1%） patients had DCMi on EMB. There were more male patients in Group 1, mean age was 74 ~ 2.8 years, mean ejection fraction was 38% q- 14%. On presentation, signs of hemody- namic compromise （NYHA functional class IIUIV, low cardiac output/index, and low cardiac power index） were more frequent in Group 1. EMB revealed viral genome in 78% of the patients, parvovirus B 19 （PVB） was frequently encountered in both age groups （Group 1： 69.4% vs. Group 2： 59.6%）; detection of more than one viral genome was more frequent in Group 1 （21.2% vs. 11.2%; P = 0.02） whereas the extent of immune response was significantly lower in individuals with advanced age. Conclusions In patients 〉 70 years with DCMi on EMB signs of hemodynamic compromise, detection of multiple viral genomes together with an overall lower extent of immune response were more frequently observed.

Cardiac catheterisation in nonagenarians： Single center experience

Objective To explore the treatment, procedure related risks, and outcomes of patients older than 90 years of age undergoing cardiac catheterization. Methods We retrospectively studied 32 patients ≥ 90 years （93.0 ± 1.2 years） who underwent cardiac catheterisation in a tertiary specialist hospital （0.2% of 14,892 procedures during three years）. The results were compared to a patient cohort younger than 90 years of age. Results Baseline characteristics revealed a higher prevalence of diabetes （P 〈 0.001）, chronic obstructive pulmonary disease （P 〈 0.04）, previous myocardial infarction （P 〈 0.02）, and complex coronary anatomy （SYNTAX score 33 vs. 19） in nonagenarians. Patients 〈 90 years of age showed more hyperlipidemia （P 〈 0.01） and previous percutaneous coronary interventions （P 〈 0.015）. Nonagenarians underwent coronary angiography more often for acute coronary syndrome （ACS） （P 〈 0.003）, were presented more often in cardiogenic shock （P 〈 0.003）, and were transferred faster to coronary angiography in cases ofACS （P 〈 0.0001）. The observed in-hospital mortality rate （13% study group vs. 1% control group; P 〈 0.003） in nonagenarians was lower than the calculated rate of thrombolysis in myocardial infarction （TIMI） and global registry of acute cardiac events （GRACE） mortality and strongly influenced by the severity of clinical presentation and the presence of co-morbidities. Conclusion Despite the common scepticism that cardiac catheterisation exposes patients 〉 90 years to an unwarranted risk, our data demonstrate an acceptable incidence of complications and mortality in this group of patients.