Effect of age on body balance and on the results of the video head impulse test in patients with heart failure

Nascimento, Gizele Francisco Ferreira do; Diniz Júnior, José; Diniz, Rosiane Viana Zuza; Hyppolito, Miguel Angelo; Mantello, Erika Barioni

doi:10.1590/2317-6431R-2023-278en

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Original Article • Audiol., Commun. Res. 28 • 2023 • https://doi.org/10.1590/2317-6431R-2023-278en copy

Effect of age on body balance and on the results of the video head impulse test in patients with heart failure

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

to verify whether there is an association between the clinical assessment of balance and the gain in the vestibulo-ocular reflex with advancing age in patients with heart failure.

Methods

analytical-descriptive, observational cross-sectional study, which included patients diagnosed with heart failure, divided into two groups by age (G1, under 60 years old and G2, 60 years old or older). The patients were evaluated through anamnesis, cardiac assessment, clinical assessment of body balance (cerebellar function screening and assessment of static and dynamic balance) and instrumental assessment of vestibular function (Video Head Impulse Test-vHIT). The findings were described and compared through inferential statistical analysis.

Results

34 patients with a mean age of 55 years and 9 months, mostly men (71.49%). There was no association between vestibulo-ocular reflex gain, symmetry of the semicircular canals and body balance with advancing age. Associations were observed between the results of the Unterberger-Fukuda test with the gain in the vestibulo-ocular reflex of the right lateral and left posterior semicircular canals and with the percentages of symmetry of the anterior semicircular canals for patients in Group 2. In Group 1, an association was observed between the results of the Unterberger-Fukuda test and the symmetry values of the anterior semicircular canals and the gain in the vestibulo-ocular reflex of the left anterior and right posterior semicircular canals.

Conclusion

there was no association between the results of the clinical assessment of body balance and the vHIT findings with advancing age in patients with heart failure. However, there was a difference between the gain of the specific vestibulo-ocular reflex for some semicircular canals, with higher rates of alteration in the dynamic balance test, in both groups. The results of the applied tests allowed characterize the predominance of chronic vestibular hypofunction of peripheral origin in patients with heart failure, regardless of age group.

Keywords:
Heart failure; Head pulse test; Vertigo; Vestibular tests; Cardiovascular diseases

Test	Results
Sharpened Romberg test	Normal (%)	Abnormal (%)
Group 1 (n=21)	42.86	57.14
Group 2 (n=13)	7.69	92.31
Unterberger-Fukuda Stepping test	Normal (%)	Abnormal (%)
Group 1 (n=21)	28.58	71.42
Group 2 (n=13)	23.07	76.07

SCC		Mean	SD	Median	Min	Max
Group 1 (n = 21)
Gain in the canals
Right Lateral		0.96	0.15	0.94	0.68⁺	1.38
Left Lateral		0.86	0.13	0.87	0.61⁺	1.24
Right Anterior		0.68⁺	0.22	0.75	0.63⁺	1.01
Left Anterior		0.61⁺	0.24	0.59⁺	0.10⁺	1.11
Right Posterior		0.62⁺	0.29	0.55⁺	0.18⁺	1.19
Left Posterior		0.67⁺	0.30	0.64⁺	0.34⁺	1.04
Symmetry (%)
Lateral		10%	0.08	0.08	0.04	0.30
Anterior		26%⁺	0.19	0.19	0.01	0.90
Posterior		30%⁺	0.20	0.27	0.08	0.70
Group 2 (n=13)
Gain in the canals
Right Lateral		0.92	0.20	0.93	0.54⁺	1.30
Left Lateral		0.75⁺	0.23	0.77⁺	0.24⁺	1.03
Right Anterior		0.59⁺	0.24	0.52⁺	0.10⁺	1.01
Left Anterior		0.50⁺	0.21	0.52⁺	0.10⁺	0.78
Right Posterior		0.51⁺	0.17	0.54⁺	0.13⁺	0.84
Left Posterior		0.50⁺	0.36	0.32⁺ + Abnormal value	0.10⁺	1.24
Symmetry (%)
Lateral		20%	0.22	0.08	0.02	0.71
Anterior		40%⁺	0.24	0.35	0.00	0.99
Posterior		39%⁺	0.32	0.53	0.00	0.99
Comparison between groups (G1-G2)
Gain in the canals - P-value
Right Lateral		0.4761
Left Lateral		0.0922
Right Anterior		0.2334
Left Anterior		0.2107
Right Posterior		0.2620
Left Posterior		0.0525
Symmetry - P-value
Lateral	0.0591
Anterior	0.0777
Posterior	0.4591

SCCs	Saccade classification	Occurrence (%)		PR Score (%)		Latency (ms)		Amplitude (º/s)
		Mean		Mean		Mean		Mean
		G1	G2	G1	G2	G1	G2	G1	G2
Right Lateral	Covert	36	10.66	26.37	60.25	130.33	88	82.33	83.55
Right Lateral	Overt	15.25	60.8	26.37	60.25	348.66	282.66	86.25	107.33
Left Lateral	Covert	15.57	34.5	20.87	62.5	94.57	101	104.25	144.5
Left Lateral	Overt	29.85	57	20.87	62.5	306.57	257.25	110.85	142.75
Right Anterior	Covert	5.76	12	13.44	19	99.50	109	59.77	36.5
Right Anterior	Overt	NA	NA	13.44	19	NA	NA	NA	NA
Left Anterior	Covert	43.30	NA	42.80	0	115.66	NA	60.33	NA
Left Anterior	Overt	28	NA	42.80	0	159	NA	79.66	NA
Right Posterior	Covert	30.2	19	36	15.5	98.8	108	63.4	57.5
Right Posterior	Overt	21.6	11	36	15.5	258	436	173.33	63
Left Posterior	Covert	NA	NA	0	0	NA	NA	NA	NA
Left Posterior	Overt	NA	NA	0	0	NA	NA	NA	NA

	Effect	Estimated difference	p-value	Confidence interval (95%)		Mean of Compared Variables
Left anterior SCC gain	UFT (G1- G2)	0.13983333	0.1098	-0.03346792	0.31313459	Abnormal UFT	Normal UFT
	Group 1 (Abnormal - Normal)	-0.30133333	0.0054 ^* * Statistically significant P-value	-0.50638614	-0.09628052	0.52	0.82
	Group 2 (Abnormal - Normal)	-0.10766667	0.4375	-0.38710654	0.17177321	0.48	0.74
Right lateral SCC gain	GROUP (G1- G2)	-0.01716667	0.8014	-0.15529363	0.12096030	Abnormal UFT	Normal UFT
	Group 1 (Abnormal - Normal)	-0.00133333	0.9868	-0.16476736	0.16210069	0.96	0.96
	Group 2 (Abnormal - Normal)	-0.22700000	0.0460*	-0.44972304	-0.00427696	0.86	1.06
Right posterior SCC gain	GROUP (G1- G2)	0.17583333	0.0667	-0.01290251	0.36456918	Abnormal UFT	Normal UFT
	Group 1 (Abnormal - Normal)	-0.34433333	0.0037*	-0.56764860	-0.12101807	0.52	0.86
	Group 2 (Abnormal - Normal)	0.00066667	0.9965	-0.30366074	0.30499407	0.51	0.51
Left posterior SCC gain	GROUP (G1- G2)	0.13433333	0.2038	-0.07683394	0.34550060	Abnormal UFT	Normal UFT
	Group 1 (Abnormal - Normal)	-0.17033333	0.1741	-0.42018982	0.07952315	0.62	0.80
	Group 2 (Abnormal - Normal)	-0.34900000	0.0449*	-0.68949699	-0.00850301	0.40	0.75
Symmetry between anterior SCCs	GROUP (G1- G2)	-0.08616667	0.3085	-0.25604419	0.08371086	Abnormal UFT	Normal UFT
	Group 1 (Abnormal - Normal)	0.07333333	0.4620	-0.12766847	0.27433513	28%	20%
	Group 2 (Abnormal - Normal)	0.28566667	0.0415*	0.01174739	0.55958595	47%	18%

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[1] Conflict of interests: No.