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The Epidemiology of “Asymptomatic” Left Ventricular Systolic Dysfunction: Implications for Screening

Thomas J. Wang, MD; Daniel Levy, MD; Emelia J. Benjamin, MD, ScM; and Ramachandran S. Vasan, MD
[+] Article and Author Information

From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Massachusetts General Hospital, Harvard Medical School, Boston Medical Center, and Boston University School of Medicine, Boston, Massachusetts; and the National Heart, Lung, and Blood Institute, Bethesda, Maryland. Note added in proof: Two important studies were published after the submission of our manuscript. Redfield and colleagues (81) recently published the full report of their Doppler echocardiographic survey of 2042 residents of Olmsted County, Minnesota. Among participants without CHF, 20.6% had mild diastolic dysfunction and 6.8% had moderate or severe diastolic dysfunction. Individuals with diastolic dysfunction had a higher mortality after adjustment for age, sex, and ejection fraction. In another recent study, Nielsen and colleagues (82) estimated the cost-effectiveness of brain natriuretic peptide for screening for LVSD, based on data from the Glasgow MONICA survey.


Acknowledgments: The authors thank Moira Pryde for administrative and research assistance with this manuscript.

Grant Support: By National Institutes of Health, National Heart, Lung, and Blood Institute grants 1U01-HL-66582 and K24 HL-04334-01A1 and contract N01-HC-25195. Dr. Wang is a recipient of an American College of Cardiology/Merck Adult Cardiology Fellowship Award.

Potential Financial Conflicts of Interest:Grants received: T.J. Wang (American College of Cardiology and Merck Pharmaceuticals).

Requests for Single Reprints: Ramachandran S. Vasan, MD, Framingham Heart Study, 73 Mt. Wayte Avenue, Suite 2, Framingham, MA 01702-5827; e-mail, vasan@fram.nhlbi.nih.gov.

Current Author Addresses: Drs. Wang, Levy, Benjamin, and Vasan: Framingham Heart Study, 73 Mt. Wayte Avenue, Suite 2, Framingham, MA 01702-5827.


Ann Intern Med. 2003;138(11):907-916. doi:10.7326/0003-4819-138-11-200306030-00012
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Congestive heart failure is a progressive disorder that is frequently preceded by asymptomatic left ventricular systolic dysfunction. We reviewed the epidemiology, diagnosis, and natural history of asymptomatic left ventricular systolic dysfunction and evaluated community-wide screening for this condition as a potential strategy to reduce the incidence of heart failure. Asymptomatic left ventricular systolic dysfunction has an estimated prevalence of 3% to 6%, and is at least as common in the community as systolic heart failure. Because it often occurs in the absence of known cardiovascular disease, this condition may go unrecognized and undertreated. In randomized trials, individuals with asymptomatic left ventricular systolic dysfunction have high rates of incident heart failure and death. However, little is known about the prognosis of individuals with this condition in the community, who have a substantially lower prevalence of myocardial infarction, have milder degrees of systolic dysfunction, and are older than patients enrolled in clinical trials. Current evidence is inadequate to support community-wide screening for asymptomatic left ventricular systolic dysfunction, either with echocardiography or with assays for natriuretic peptides. Given the increasing prevalence of heart failure, additional studies are needed to develop effective strategies to detect and optimally manage individuals with asymptomatic left ventricular dysfunction in the community.

Figures

Grahic Jump Location
Figure.
Chain of questions related to the epidemiology of asymptomatic left ventricular systolic dysfunction (ALVSD) and the effectiveness of screening(12-14).

ACE = angiotensin-converting enzyme; CHF = congestive heart failure.

Grahic Jump Location

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Summary for Patients

Screening for Asymptomatic Heart Failure

The summary below is from the full report titled “The Epidemiology of ‘Asymptomatic’ Left Ventricular Dysfunction: Implications for Screening.” It is in the 3 June 2003 issue of Annals of Internal Medicine (volume 138, pages 907-916). The authors are T.J. Wang, D. Levy, E.J. Benjamin, and R.S. Vasan.

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