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. 2024 Nov 21:55:101558.
doi: 10.1016/j.ijcha.2024.101558. eCollection 2024 Dec.

From geriatric assessment to inflammation. A pilot, observational, study about frailty components in older patients with persistent atrial fibrillation

Stefano Fumagalli  1 , Giulia Ricciardi  1 , Claudia Di Serio  1 , Elisa Berni  1 , Giancarlo La Marca  2   3 , Giuseppe Pieraccini  2 , Riccardo Romoli  2 , Emanuele Santamaria  1 , Giulia Spanalatte  1 , Camilla Cagnoni  1 , Arianna Tariello  1 , Giada Alla Viligiardi  1 , Agostino Virdis  4 , Igor Diemberger  5   6 , Andrea Ungar  1 , Niccolò Marchionni  1
Affiliations

From geriatric assessment to inflammation. A pilot, observational, study about frailty components in older patients with persistent atrial fibrillation

Stefano Fumagalli et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Atrial fibrillation (AF) is the most common arrhythmia diagnosed at an older age. AF is associated with frailty, a condition possibly justifying the higher rate of complications and mortality in aged individuals. This study was aimed at describing the characteristics correlated to frailty in older AF subjects.

Methods: After having excluded a < 3 months major surgery procedure, cancer or other conditions associated with activation of inflammation, and a life expectancy < 12 months, we consecutively enrolled patients ≥ 65 years with persistent AF. They underwent a Comprehensive Geriatric Assessment evaluation. In particular, Mini-Mental State Examination, 15-item Geriatric Depression Scale and Short-Physical Performance Battery (SPPB) described, respectively, cognitive profile, depressive symptoms and physical performance. A venous blood sample was collected to measure interleukin-6 (IL-6; marker of low-grade inflammation) and acylcarnitines, expression of mitochondrial dysfunction and abnormal energy production.

Results: Overall, 49 patients (mean age: 76 ± 6 years; women 30.6 %) were studied. Cluster analysis described two different patterns; the second (N = 18, 36.7 %), when compared to the first one (N = 31, 63.3 %), was characterized by a worse phenotype, identified by the simultaneous presence of lower body mass index, higher CHA2DS2-VASc score (index of clinical complexity), worse SPPB functional performance, and high IL-6 levels. Second cluster patients had a higher concentration of 13 of the 35 acylcarnitines evaluated and increased 5-year mortality. All these features can outline a frail condition.

Conclusions: Body size, clinical complexity, physical performance and low-grade inflammation seem to rapidly and adequately describe frailty.

Keywords: Acylcarnitines; Atrial fibrillation; Frailty; Inflammation; Older patients; Physical performance.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
(Panel A) Graphical representation of the inverse association between IL and 6 and SPPB scores; the better the physical performance, the lower the cytokine concentration. (Panel B) Different levels of C12:1 and C18:1 acylcarnitines by cluster of older AF patients. The concentration is significantly higher in subjects with the worse phenotype.
Fig. 2
Fig. 2
(Panel A) Kaplan-Meier analysis of survival by cluster; at the follow-up evaluation, patients with the better phenotype – blue line − are characterized by lower all-cause mortality than the worse phenotype subjects – burgundy line. (Panel B) The four variables associated with cluster definition (i.e., low BMI, CHA2DS2-VASc and SPPB scores, and IL-6), also reciprocally interacting, could cause the frail status in older patients with persistent atrial fibrillation. Abbreviations. BMI: body mass index; CHF: chronic heart failure; IL-6: interleukin-6; TIA: transient ischaemic attack; SPPB: Short-Physical Performance Battery; TEE: thrombo-embolic event.
See this image and copyright information in PMC

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