Abstract 14064: Slow Gait Speed Associated with Advanced Endothelial Dysfunction in Elderly Patients with ST-Segment Elevation Myocardial Infarction

Abstract

Background: Recent studies have shown that slow gait speed, as a clinical marker of physical dysfunction, is associated with high cardiovascular risk among the elderly. Endothelial dysfunction may reflect vascular vulnerability and can predict cardiovascular events. The aim of this study was to investigate whether slow gait speed was associated with advanced endothelial dysfunction among the elderly patients with ST-segment elevation myocardial infarction (STEMI).

Methods: We studied 58 patients with STEMI over 65 years old who underwent successful reperfusion therapy and participated in the cardiac rehabilitation program according to Japanese guidelines. Two hundred meters walking was performed 1 to 2 weeks after admission, and walking time was measured. Patients with walking disturbance because of cerebral vascular disease were excluded in this study. To evaluate endothelial function, reactive hyperemia-peripheral arterial tonometry index (RHI) was measured using Endo-PAT 2000 at discharge early in the morning before breakfast. Biochemical markers (creatine kinase [CK], estimated glomerular filtration rate [eGFR], and brain natriuretic peptide [BNP]) and left ventricular ejection fraction (LVEF) by left ventriculography were measured 1 to 2 weeks after admission.

Results: Mean age was 74.9 ± 6.5 years old and 75% were male. Mean gait speed was 0.75 ± 0.16 meter/second. Gait speeds were not associated with infarction size (max CK level: r = -0.36, p = 0.79), cardiac systolic function (LVEF: r = 0.16, p = 0.92), BNP level (r = -0.13, p = 0.34) and renal function (eGFR: r = -0.11, p = 0.42). RHI was positively correlated with gait speeds (r = 0.44, p = 0.001), and was negatively correlated with age (r = -0.53, p < 0.01). By multiple linear regression analysis including age, gender and traditional cardiovascular risk factors, only gait speed was significantly associated with RHI (β = 0.48, partial R² = 0.23 , p = 0.004).

Conclusion: Slow gait speed was significantly associated with advanced endothelial dysfunction in elderly patients with STEMI. Advanced endothelial dysfunction might be a cause of poor prognosis among patients with slow gait speed.