Key result
Lower SEVR predicts ~69% higher cardiovascular death risk in the elderly, linked to arterial stiffness.
Why the study?
Older adults are prone to myocardial ischemia from oxygen supply-demand imbalance, and this study aimed to explain subendocardial viability ratio (SEVR) decrease via hypertension-mediated organ damage and evaluate its mortality-prediction value.
Does a lower subendocardial viability ratio predict cardiovascular death and correlate with hypertension-mediated organ damage in elderly individuals?
Does a lower subendocardial viability ratio predict cardiovascular death and correlate with hypertension-mediated organ damage in elderly individuals?
In elderly individuals, a lower subendocardial viability ratio is associated with arterial stiffness, LV diastolic dysfunction, and an increased risk of cardiovascular mortality.
Lower SEVR may flag higher CV mortality risk in elderly; extends links to stiffness and diastolic dysfunction but leaves causal inference open.
Aims Older adults are prone to myocardial ischemia due to a subclinical imbalance between myocardial oxygen supply and demand. Subendocardial viability ratio (SEVR) serves as an index of this mismatch. This study amid to explain SEVR decrease from the point of hypertension-mediated organ damage (HMOD), and further investigate the ability of SEVR to predict mortality in the elderly population. Methods Data was extracted from a community-based cohort of elderly individuals aged over 65 years (2014-2022). SEVR was measured once using arterial tonometry. Cross-sectional relationship between SEVR levels and HMOD (including arterial stiffness, peripheral arterial disease, carotid plaque, left ventricular (LV) hypertrophy, LV diastolic dysfunction, chronic kidney dysfunction, and microalbuminuria) was assessed. Additionally, the predicted potential of SEVR to mortality was evaluated. Results A total of 3237 participants were enrolled (mean age: 71 ± 6 years, 57% female, mean SEVR value: 131 ± 23%). Over a median follow-up of 5.7 years, 233 cases of all-cause death, including 94 cardiovascular deaths were identified. Lower SEVR (≤ 131%) predicted cardiovascular death (HR= 1.69 [95% CI, 1.05-2.72]; P=0.032) but not all-cause death (HR= 1.15 [0.87-1.53]; P=0.327). SEVR decreased with increasing HMOD components (P for trend < 0.001). Multivariable regression analyses showed that decreased SEVR correlated with arterial stiffness (OR= 1.42 [1.13-1.77]; P=0.002) and LV diastolic dysfunction (OR= 2.01 [1.43-2.83]; P<0.001). Mediation analysis suggested that arterial stiffness influenced SEVR through augmentation pressure and index. Conclusions Elderly individuals with arterial stiffness and LV diastolic dysfunction were more likely to have lower SEVR, and SEVR decline was associated with increased cardiovascular mortality.the graphical abstract of the study
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Han et al. (2025) studied this question. Lower SEVR (≤131%) independently predicted cardiovascular death in elderly with HR=1.69, and was associated with arterial stiffness and LV diastolic dysfunction.
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