Related Experiment Videos
Screening for left ventricular systolic dysfunction among patients with risk factors for heart failure
David W Baker1, Robert C Bahler, Robert S Finkelhor
1Department of Medicine and the Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill 60611, USA. dwbaker@northwestern.edu
Insights
Screening for left ventricular systolic dysfunction (LVSD) is feasible in high-risk patients, with a 7.9% prevalence found. Prior myocardial infarction and left ventricular hypertrophy were key predictors, suggesting value in early detection for heart failure prevention.
Area of Science:
- Cardiology
- Preventive Medicine
- Diagnostic Imaging
Background:
- Prevalence of left ventricular systolic dysfunction (LVSD) and feasibility of screening in at-risk individuals for heart failure (HF) remain undefined.
- This study aimed to determine LVSD prevalence using limited screening echocardiography in patients with HF risk factors but no prior HF diagnosis.
Purpose of the Study:
- To assess the prevalence of left ventricular systolic dysfunction (LVSD) in elderly patients with cardiovascular risk factors.
- To evaluate the feasibility and yield of screening echocardiography for LVSD in this population.
Main Methods:
- Included general medicine patients aged 60+ with hypertension, diabetes, coronary artery disease, or prior myocardial infarction (MI), excluding those with prior HF.
- Data collected via interview, chart review, electrocardiography (ECG), and echocardiography to determine left ventricular ejection fraction (LVEF < or =45%).
Main Results:
- Of 482 patients, 7.9% had LVEF < or =45%.
- Prevalence was higher in patients with prior MI (15.4%) versus without (6.7%).
- Prior MI and ECG-defined left ventricular hypertrophy were significant predictors of reduced LVEF.
Conclusions:
- Screening for LVSD in high-risk patients is feasible and yields substantial findings, even in those without prior MI.
- Low screening cost and available therapies for LVSD progression warrant clinical trials for high-risk subgroup screening.
Background:
The prevalence of left ventricular systolic dysfunction (LVSD) among individuals at risk for heart failure (HF) and the feasibility of screening have not been clearly defined. This study determined the prevalence of LVSD with the use of a limited screening echocardiogram among patients with risk factors for HF but no prior HF.
Methods:
General medicine patients > or =60 years of age with hypertension, diabetes, coronary artery disease, or previous myocardial infarction (MI) but no history of HF or reduced left ventricular ejection fraction (LVEF) were eligible. Medical history and symptoms of breathlessness were determined by interview and chart review; consenting patients underwent electrocardiography and echocardiography. The outcome was LVEF < or =45%, based on visual estimation from the echocardiogram.
Results:
Of the 482 patients who completed the study, only 1 patient could not have the LVEF visually estimated. A total of 7.9% of patients had LVEF < or =45%. The prevalence was 15.4% among those with a prior MI and 6.7% among those without prior MI. In multivariate analysis, prior MI (adjusted odds ratio, 2.75; 95% CI, 1.14 to 6.64) and probable or definite left ventricular hypertrophy by electrocardiography (adjusted odds ratio, 3.57; 95% CI, 1.22 to 10.48) were the strongest predictors of LVEF < or =45%.
Conclusions:
Screening for LVSD among high-risk patients is feasible and has substantial yield, even among patients without prior MI. In light of the low cost of screening and the available therapies to prevent progression of LVSD to overt HF, controlled clinical trials of screening high-risk subgroups appear to be justified.