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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Screening for ventricular remodeling
Douglas S Lee1, Thomas J Wang, Ramachandran S Vasan
1Framingham Heart Study, MA 01702, USA.
Insights
Screening for preclinical heart failure (HF) in asymptomatic individuals is crucial. Current methods using natriuretic peptides (NP) show suboptimal performance, but novel sequential strategies may improve detection of left ventricular (LV) remodeling.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarker Research
Background:
- Current guidelines advocate for early heart failure (HF) prevention by identifying preclinical disease.
- Left ventricular (LV) remodeling, a precursor to HF, is a key target in asymptomatic populations.
- Assessing LV mass, systolic, and diastolic dysfunction are potential screening targets.
Purpose of the Study:
- To evaluate the effectiveness of plasma natriuretic peptides (NP) for screening asymptomatic individuals for LV remodeling.
- To explore the utility of sequential screening strategies in identifying asymptomatic LV systolic dysfunction cost-effectively.
Main Methods:
- Review of investigations on plasma NP performance for detecting LV remodeling phenotypes.
- Analysis of NP performance in general populations versus high-risk subgroups (e.g., older men with hypertension).
- Examination of recent reports on sequential screening strategies combining NP and echocardiography.
Main Results:
- Plasma NP performance is generally suboptimal for identifying LV remodeling in the general asymptomatic population.
- Targeting high-risk individuals improves NP performance for detecting LV remodeling.
- LV systolic dysfunction prevalence in women is too low to warrant general screening.
- Sequential screening strategies show promise for cost-effective identification of asymptomatic LV systolic dysfunction.
Conclusions:
- Current NP screening for LV remodeling in asymptomatic individuals has limitations.
- Sequential screening approaches combining NP and echocardiography may offer a more effective and cost-efficient solution.
- Further research is needed to validate these sequential screening strategies for population-wide application.
Abstract:
Current guidelines emphasize the importance of preventing heart failure (HF) by targeting people with preclinical forms of the disease. Accordingly, there is considerable interest in identifying left ventricular (LV) remodeling, the fundamental substrate for HF, in asymptomatic individuals in the community. Increased LV mass and asymptomatic LV systolic and LV diastolic dysfunction are the remodeling phenotypes that could be potentially considered for population-wide screening. Plasma levels of natriuretic peptides (NP) have been extensively investigated for such screening purposes. However, a majority of investigations suggest that their performance characteristics are suboptimal for identifying LV remodeling phenotypes unless high-risk individuals (eg, older men with hypertension) are targeted. In general, the prevalence of LV systolic dysfunction in women is too low to justify screening. In recent reports, sequential screening strategies combining urine and plasma NP or plasma NP and hand-held portable echocardiography have been advocated as potential approaches to identify asymptomatic LV systolic dysfunction in a cost-effective manner. Additional studies are warranted to confirm these findings.
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