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Updated: Jun 26, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
[Screening for asymptomatic left ventricular systolic dysfunction in high-risk patients. Preliminary experience with
Luigi Tarantini1, Giovanni Cioffi, Andrea Di Lenarda
1Dipartimento di Cardiologia, Ospedale San Martino, Belluno. gitarant@yahoo.com
Insights
A new screening strategy using electrocardiogram (ECG) and B-type natriuretic peptide (BNP) effectively identifies patients with asymptomatic left ventricular systolic dysfunction (ALVSD). This approach significantly reduces the need for echocardiography, lowering costs and aiding heart failure prevention.
Area of Science:
- Cardiology
- Preventive Medicine
- Diagnostic Imaging
Context:
- Asymptomatic left ventricular systolic dysfunction (ALVSD) increases heart failure (HF) risk and mortality.
- Early detection of ALVSD is crucial for timely intervention.
- Current gold standard echocardiography is impractical for widespread screening.
Purpose:
- To evaluate the feasibility and effectiveness of a hierarchical screening program for ALVSD.
- To utilize electrocardiogram (ECG) and serum B-type natriuretic peptide (BNP) for ALVSD detection in high-risk patients.
- To assess the cost-effectiveness of this screening strategy.
Summary:
- A prospective study enrolled high-risk patients (aged ≥55 with ≥2 HF risk factors or ≥70 with ≥1 HF risk factor).
- Sequential ECG, BNP, and echocardiography were performed; ALVSD defined as LVEF ≤50%.
- The program identified 95% of ALVSD cases, saving 53% of echocardiograms and reducing costs.
Impact:
- ECG and BNP are effective tools for detecting ALVSD in high-risk populations.
- A cost-effective screening program using ECG and BNP can aid HF prevention.
- This strategy supports primary and secondary prevention efforts for heart failure.
Background:
Patients with asymptomatic left ventricular systolic dysfunction (ALVSD) have an increased risk of heart failure (HF) and a worse life expectancy. Since valuable therapies may prevent such dismal evolution, screening programs for ALVSD have recently been advocated to detect as early as possible such ominous condition. Echocardiography represents the gold standard for the assessment of ALVSD but its indiscriminate use in screening programs is impractical. Clinical multivariate risk assessment associated with ECG and serum brain natriuretic peptide (BNP) may be a feasible strategy to screen ALVSD. We prospectively sought to investigate the feasibility and effectiveness of a screening program for ALVSD based on ECG and BNP used in a hierarchical sequence in patients at high risk for HF.
Methods:
Patients > or =55 years old with > or =2 risk factors for HF or > or =70 years old with > or =1 risk factor for HF entered the study performing sequentially ECG, BNP and echocardiographic evaluation. ALVSD was defined as a left ventricular ejection fraction < or =50%.
Results:
Thirty-three of 122 enrolled patients (27%) had ALVSD. They were older, presented more frequently a history of chemotherapy exposure, had often bundle branch block and higher BNP levels. No patient without any major abnormalities (atrial fibrillation, left ventricular hypertrophy, STT alterations of ischemic/strain origin, pathologic Q wave, bundle branch block) on ECG (n=31, 24.4%) had ALVSD. Among the 91 patients with abnormal ECG, ALVSD was observed in 33 (36%). The area under the receiver operating characteristic curve to detect ALVSD by BNP was 0.86 (confidence interval 0.79-0.94, p<0.0001) and BNP values of > or =43 pg/ml showed a sensitivity and a specificity of 94% and 57%, respectively. The proposed screening program was able to identify 95% (31/33) of patients with ALVSD saving 53% of echocardiographic examinations with a substantial reduction of the costs to diagnose ALVSD.
Conclusions:
Our prospective investigation confirms that ECG and BNP may be useful in detecting ALVSD in high-risk patients. A cost-effective screening program based on such simple and low-cost diagnostic tests might be employed for the prevention of HF in primary and secondary prevention programs in high-risk patients.
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