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Published on: February 20, 2017
Use of Clinical and Echocardiographic Evaluation to Assess the Risk of Heart Failure
Elizabeth Potter1, Quan Huynh1, Kawa Haji2
1Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Insights
Echocardiography effectively reclassifies heart failure (HF) risk in intermediate-risk patients. Combining clinical data with echocardiographic markers like global longitudinal strain improves HF prediction accuracy.
Area of Science:
- Cardiology
- Medical Diagnostics
- Preventive Medicine
Background:
- Clinical and echocardiographic features are known predictors of incident heart failure (HF).
- Optimal strategies for integrating these features into HF risk evaluation remain unclear.
Purpose of the Study:
- To define an effective method for incorporating echocardiography into HF risk assessment.
- To develop and validate a risk stratification algorithm combining clinical and echocardiographic data.
Main Methods:
- Trained and validated a risk stratification algorithm using clinical data and echocardiographic markers of stage B HF (SBHF).
- SBHF markers included abnormal global longitudinal strain (GLS), diastolic dysfunction, or left ventricular hypertrophy.
- Utilized classification and regression tree analysis on training (n=926) and validation (n=355) cohorts.
Main Results:
- Abnormal GLS was the strongest independent predictor of HF (HR: 2.92).
- Echocardiography reclassified 61% of intermediate-risk patients to a lower-risk category.
- The integrated model improved HF prediction accuracy compared to the ARIC score alone (C-statistic: 0.83 vs 0.78).
Conclusions:
- Clinical risk assessment adequately identifies low and high HF risk individuals.
- Echocardiographic evaluation significantly enhances risk stratification, particularly for intermediate-risk patients.
- Abnormal GLS and diastolic function are key echocardiographic markers for improved HF risk prediction.
Background:
Clinical and echocardiographic features predict incident heart failure (HF), but the optimal strategy for combining them is unclear.
Objectives:
This study sought to define an effective means of using echocardiography in HF risk evaluation.
Methods:
The same clinical and echocardiographic evaluation was obtained in 2 groups with HF risk factors: a training group (n = 926, followed to 7 years) and a validation group (n = 355, followed to 10 years). Clinical risk was categorized as low, intermediate, and high using 4-year ARIC (Atherosclerosis Risk In Communities) HF risk score cutpoints of 9% and 33%. A risk stratification algorithm based on clinical risk and echocardiographic markers of stage B HF (SBHF) (abnormal global longitudinal strain [GLS], diastolic dysfunction, or left ventricular hypertrophy) was developed using a classification and regression tree analysis and was validated.
Results:
HF developed in 12% of the training group, including 9%, 18%, and 73% of low-, intermediate-, and high-risk patients. HF occurred in 8.6% of stage A HF and 19.4% of SBHF (P < 0.001), but stage A HF with clinical risk of ≥9% had similar outcome to SBHF. Abnormal GLS (HR: 2.92 [95% CI: 1.95-4.37]; P < 0.001) was the strongest independent predictor of HF. Normal GLS and diastolic function reclassified 61% of the intermediate-risk group into the low-risk group (HF incidence: 12%). In the validation group, 11% developed HF over 4.5 years; 4%, 17%, and 39% of low-, intermediate-, and high-risk groups. Similar results were obtained after exclusion of patients with known coronary artery disease. The echocardiographic parameters also provided significant incremental value to the ARIC score in predicting new HF admission (C-statistic: 0.78 [95% CI: 0.71-0.84] vs 0.83 [95% CI: 0.77-0.88]; P = 0.027).
Conclusions:
Clinical risk assessment is adequate to classify low and high HF risk. Echocardiographic evaluation reclassifies 61% of intermediate-risk patients.
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