Interesting innovations for the treatment of cardiovascular diseases in the elderly, and in particular ischemic myocardial damage, a disorder that affects the muscular tissue of the heart. A group of scientists from the Cardiology Department at Auxologico San Luca of Milan (among the structures of excellence for cardiology), of the Department of Medical, Surgical and Health Sciences at the University of Trieste, of the Department of Medicine and Surgery at the Bicocca University of Milan and of other research institutes has in fact just evaluated the ability of a particular parameter, called Sevr, to estimate the “health status” of the myocardium and predict long-term mortality in the elderly population, trying to identify a “threshold value” to be used as a possible alarm bell for timely intervention. The study was published on the pages of Journal of the American Geriatrical Society.
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What Sevr is, how it is measured and what it expresses
Sevr is the acronym for SubEndocardial Viability Ratio, i.e. “subendocardial viability ratio”. This is a useful parameter for measuring the state of health of the subendocardium, the innermost layer of the cardiac muscle, in particular compared to that of the outermost layers; it is given by the ratio of the heart pressure measured in the aorta during diastole (the period of relaxation of the heart after contraction) and that measured, at the same time, in the coronary arteries. In other words, Sevr reflects the balance between oxygen supply and demand at the subendocardial level. A high Sevr level indicates that the subendocardium is well oxygenated and perfused: in general, the greater the blood perfusion, the better the heart’s ability to function effectively even in conditions of stress or internal physical activity. On the other hand, a low Sevr level is a sign of subendocardial suffering, which may be due, for example, to the presence of coronary disorders.
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The study of Auxologico San Luca
For their study, the experts enrolled 828 elderly people (with an average age of 87.7 years and 78% of whom were female, almost all residents in retirement homes) and monitored them for 10 years, excluding them from the study. patients with cancer, severe dementia and very low level of autonomy. 735 patients died before the end of the study, and 24 were lost to subsequent clinical checks; the authors of the work recorded all adverse events every three months, from inclusion until the end of the study. The Sevr was estimated for each patient in a non-invasive way – which makes it an even more interesting parameter – by analyzing the carotid pressure waveform (recorded using arterial tonometry and applanation).
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The conclusions of the work
By putting together and analyzing the data collected over the decade of observation, the authors of the work have ascertained that the Sevr measurement is actually very reliable for estimating the myocardial perfusion damage compared to the workload of the left ventricle of the heart, and that it is therefore of an effective parameter to predict long-term mortality in the elderly population. “The lowest Sevr values - they write in the study – are associated with a higher 10-year total mortality compared to the average values and the highest values. A threshold value – 0.83 – was identified as a predictor of total mortality. Sevr, therefore, can be considered as a marker of ‘cardiovascular fragility’ and its non-invasive and accurate estimate could become an independent parameter, useful for evaluating the probability of survival in very elderly people”.