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Asymptomatic left ventricular dysfunction in the community
1Department of Medical Cardiology, University of Glasgow Royal Infirmary, 10 Alexandra Parade, Glasgow, G31 6ER, Scotland. t. mcdonagh@bio.gla.ac.uk
Insights
Asymptomatic left ventricular dysfunction (ALVD) is common and linked to poor outcomes. Early detection using brain natriuretic peptide (BNP) tests can identify individuals at risk for chronic heart failure (CHF).
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarker Research
Background:
- Chronic heart failure (CHF) often stems from left ventricular dysfunction (LVD), frequently systolic.
- A significant phase of asymptomatic LVD (ALVD) precedes symptomatic CHF, impacting quality of life and survival.
- Ischemic heart disease is a primary cause of ALVD, which affects individuals as frequently as CHF.
Purpose of the Study:
- To review the epidemiology of asymptomatic left ventricular dysfunction (ALVD).
- To explore the potential of natriuretic peptide hormones, particularly brain natriuretic peptide (BNP), in detecting ALVD.
- To assess BNP's utility as a cost-effective screening tool for LVD.
Main Methods:
- Epidemiological review of ALVD prevalence and characteristics.
- Analysis of natriuretic peptide hormone levels (atrial natriuretic peptide and brain natriuretic peptide) in ALVD subjects.
- Evaluation of brain natriuretic peptide (BNP) accuracy and predictive values for detecting LVD.
Main Results:
- ALVD is as prevalent as CHF, primarily caused by ischemic heart disease, and associated with reduced quality of life and increased mortality.
- Elevated levels of natriuretic peptide hormones, including BNP, are observed in individuals with ALVD.
- BNP demonstrates high accuracy and a strong negative predictive value for detecting LVD in the general population.
Conclusions:
- ALVD is a significant condition with substantial morbidity and mortality, warranting screening.
- Brain natriuretic peptide (BNP) is a valuable and accurate biomarker for detecting LVD, even in asymptomatic individuals.
- BNP testing offers a cost-effective strategy for identifying individuals with LVD, optimizing specialist referrals and echocardiography use.
Abstract:
The syndrome of chronic heart failure (CHF) is usually attributable to left ventricular dysfunction (LVD), which is most commonly systolic in nature. Many patients who go on to develop heart failure pass through a phase in which they have significant systolic dysfunction but lack clinical symptoms and signs: so-called asymptomatic LVD (ALVD). Treatment of this asymptomatic phase with angiotensin-converting enzyme inhibitors can delay the progression to CHF and ameliorate its substantial morbidity and mortality. This article reviews the epidemiology of ALVD. ALVD is at least as prevalent as CHF, is mainly caused by ischemic heart disease, significantly impairs effort capacity, reduces quality of life, and is associated with a substantial mortality rate. As such, it would appear to satisfy many of the criteria required to screen for a disease. The natriuretic peptide hormones (atrial natriuretic peptide and brain natriuretic peptide ) are elevated in subjects with ALVD. BNP, in particular, has acceptable accuracy to detect LVD in the general population. In particular, it has a high negative predictive value meaning a low concentration makes the presence of significant LVD highly unlikely. As such it has the potential to be a cost-effective means of filtering subjects suspected of having LVD and allowing more appropriate use of tertiary referrals for specialist assessment and detailed echocardiography.