Screening for left ventricular systolic dysfunction: is imaging a solution?

To address the heart failure burden, our focus needs to shift to disease prevention. Strategies to initially screen for heart failure precursors such as asymptomatic left ventricular systolic dysfunction have been evaluated, including clinical scores, the 12-lead electrocardiogram, and natriuretic peptides. However, their specificity limits their broad application as screening tools in asymptomatic populations. High-quality images are now available from hand-carried cardiac ultrasound devices, at a fraction of the capital cost of standard echocardiography with favorable diagnostic performance, especially when experienced staff perform the imaging. Questions that remain to be addressed include how we should select the target population to screen, who should perform the screening studies, how much training is required, and how often screening studies should be performed.