Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the
G P Aurigemma1, J S Gottdiener, L Shemanski
1Department of Medicine, University of Massachusetts Medical School, Worceter 01655, USA. aurigemg@ummhc.org
Insights
Echocardiography can predict congestive heart failure (CHF) risk, even with normal ejection fraction. Subclinical systolic and diastolic dysfunction identified by echocardiography are key indicators of future CHF development.
Area of Science:
- Cardiology
- Medical Imaging
- Preventive Medicine
Background:
- Subclinical systolic and diastolic dysfunction can precede clinical congestive heart failure (CHF).
- Noninvasive echocardiographic indices may identify patients at risk for developing CHF.
- Predictive value of midwall shortening and Doppler mitral inflow patterns for CHF is understudied.
Purpose of the Study:
- To assess the predictive ability of echocardiographic indices of systolic and diastolic function for incident congestive heart failure (CHF).
Main Methods:
- Studied 2,671 participants free of heart disease in the Cardiovascular Health Study.
- Collected clinical and quantitative echocardiographic data.
- Followed participants for a mean of 5.2 years to identify incident CHF cases.
Main Results:
- 170 participants (6.4%) developed CHF during follow-up.
- 96% of incident CHF cases had normal or borderline ejection fraction (EF) at baseline.
- Fractional shortening (endocardial and midwall) and peak Doppler E independently predicted incident CHF; both high and low E/A ratios were also predictive.
Conclusions:
- Approximately half of CHF cases in this population occurred with normal or borderline EF.
- Echocardiographic signs of subclinical systolic dysfunction and diastolic filling abnormalities predict subsequent CHF.
- Left ventricular hypertrophy with depressed midwall shortening indicates particularly high risk for subsequent CHF.
Objectives:
We sought to assess the ability of echocardiographic indices of systolic and diastolic function to predict incident congestive heart failure (CHF).
Background:
Noninvasive indices of subclinical systolic and/or diastolic dysfunction that can be used to identify patients in a transition phase between normal cardiac function and clinical CHF would be valuable. Though midwall shortening and Doppler mitral inflow patterns are seemingly well suited to predict subsequent CHF, the predictive value of these indices has not been investigated.
Methods:
We studied 2,671 participants in the Cardiovascular Health Study who were free of coronary heart disease, CHF or atrial fibrillation. Clinical and quantitative echocardiographic data were obtained in all participants.
Results:
At a mean follow-up of 5.2 years (range 0 to 6 years), 170 participants (6.4% of the cohort) developed CHF. Although 96% of these participants had normal or borderline ejection fraction (EF) at baseline, only 57% had normal or borderline EF at the time of hospitalization. In multivariate modeling, fractional shortening at the endocardium (relative risk [RR] 1.85 per 10-unit decrease, confidence interval [CI] 1.27 to 2.39), fractional shortening at the midwall (RR 1.29 per five-unit decrease, 95% CI 1.11-1.51) and peak Doppler peak E (RR 1.15 for each 0.1 M/s increment; CI 1.02 to 1.21) independently predicted incident CHF. Both high and low Doppler E/A ratios were predictive of incident CHF.
Conclusions:
Roughly half the occurrences of CHF in this population are associated with normal or borderline EF. Echocardiographic findings suggestive of subclinical contractile dysfunction and diastolic filling abnormalities are both predictive of subsequent CHF. The standard (FSendo) and refined (FSmw) parameters of systolic function performed similarly in this regard, though subjects with left ventricular hypertrophy and depressed FSmw are at particularly high risk for subsequent CHF.
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