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Heart failure (HF) is prevalent in advanced ages. Our objective was to assess the impact of frailty on 1-year mortality in older patients with ambulatory HF.Our data come from the FRAGIC study (Spanish acronym for "Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly outpatients with heart failure"), a multicenter prospective registry conducted in 16 Spanish hospitals including outpatients ≥ 75 years with HF followed up by cardiology services in Spain.We included 499 patients with a mean age of 81.4±4.3 years, of whom 193 (38%) were women. A total of 268 (54%) had left ventricular ejection fraction40%, and 84.6% was in NYHA II functional class. The FRAIL scale identified 244 (49%) pre-frail and 111 (22%) frail patients. Frail patients were significantly older, were more frequently female (both, P.001), and had higher comorbidity according to the Charlson index (P=.017) and a higher prevalence of geriatric syndromes (P.001). During a median follow-up of 371 [361-387] days, 58 patients (11.6%) died. On multivariate analysis (Cox regression model), frailty detected with the FRAIL scale was marginally associated with mortality (HR=2.35; 95%CI, 0.96-5.71; P=.059), while frailty identified by the visual mobility scale was an independent predictor of mortality (HR=2.26; 95%CI, 1.16-4.38; P=.015); this association was maintained after adjustment for confounding variables (HR=2.13; 95%CI, 1.08-4.20; P=.02).In elderly outpatients with HF, frailty is independently associated with mortality at 1 year of follow-up. It is essential to identify frailty as part of the comprehensive approach to elderly patients with HF.

[Aims]: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome with multiple underlying causes.Wild-type transthyretin (TTR) amyloidosis (ATTRwt) is an underdiagnosed cause of HFpEF that might benefit from new specific treatments. ATTRwt can be diagnosed non-invasively by mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (mTc-DPD) scintigraphy. We sought to determine the prevalence of ATTRwt among elderly patients admitted due to HFpEF. [Methods and results]: We prospectively screened all consecutive patients .60 years old admitted due to HFpEF [left ventricular (LV) ejection fraction .50%] with LV hypertrophy (.12mm).All eligible patientswere offered a mTc-DPD scintigraphy. The study included 120 HFpEF patients (59% women, 82+8 years). A total of 16 patients (13.3%; 95% confidence interval: 7.2.19.5) showed a moderate-to-severe uptake on the mTc-DPD scintigraphy. All patients with a positive scan underwent genetic testing of the TTR gene, and no mutationswere found. An endomyocardial biopsywasperformed in four patients, confirmingATTRwt inall cases. There were no differences in age, gender, hypertension, diabetes, coronary artery disease, or atrial fibrillation between ATTRwt patients and patients with other HFpEF forms. Although patients with ATTRwt exhibited higher median N-terminal pro-brain natriuretic peptide (6467 vs. 3173 pg/L; P . 0.019), median troponin I (0.135 vs. 0.025 mg/L; P, 0.001), mean LV maximal wall thickness (17+3.4 vs. 14+2.5 mm; P . 0.001), rate of pericardial effusion (44 vs. 19%; P . 0.047), and rate of pacemakers (44 vs. 12%; P . 0.004), clinical overlap between ATTRwt and other HFpEF forms was high. [Conclusion]: ATTRwt is an underdiagnosed disease that accounts for a significant number (13%) of HFpEF cases. The effect of emerging TTR-modifying drugs should be evaluated in these patients., This work was partially supported by Pfizer Inc. through an Investigator Initiated Research Grant.

BACKGROUND: Information is limited about the classification accuracy of electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in the presence of myocardial infarction (MI). METHODS: We evaluated LVH classification accuracy for a set of 16 ECG criteria and some combinations derived from them in 1642 patients (105 with MI) suspected of coronary heart disease with two‐dimensional echocardiography evaluation and a standard 12‐lead ECG recorded at the same time. Patients with left bundle branch block had previously been excluded. Measures of classification accuracy included sensitivity, specificity, likelihood ratios, and positive and negative predictive values. RESULTS: Diagnostic accuracy varied widely for different LVH criteria. The criteria with the best overall performance had highest sensitivity in the presence of MI and sensitivities of approximately 30% with relatively low specificities ranging from 72% to 78%. However, the classification accuracy for them was similar to that for patients without MI. The prevalence of LVH in patients with MI was higher (56%) than in those with no MI (31%). Classification accuracy of the best single previously published LVH criteria was comparable to that of the best combinations of any three of them. CONCLUSIONS: The classification accuracy of LVH criteria in the presence of MI is comparable to that in patients without MI, in part possibly due to the higher LVH prevalence in the MI group. The presence of a well‐validated computer database facilitates comparative evaluation of ECG‐LVH criteria and derivation of optimal combinations of criteria for any given clinical application.