Preclinical Heart Failure: A Dynamic Trajectory of Progression, Regression, and Risk

Understanding the transition from preclinical heart failure to its symptomatic stages, and its associated biomarker and Doppler echocardiographic changes, is crucial for prevention.

This was a retrospective cohort study using the STOP-HF (St. Vincent's Screening to Prevent Heart Failure) study. Median follow-up was 4.5 (interquartile range [IQR], 4.4-9.8) years. A total of 1425 participants were classified as stage A (at risk) or stage B (asymptomatic structural/functional abnormalities). Serial assessments included BNP (B-type natriuretic peptide), Doppler echocardiography, and cardiologist review. Progression to stage B required significant interval echocardiographic worsening, and regression required significant improvement. BNP levels and patient events between visits were recorded.

At visit 1, 67% (n=959) of individuals were stage A and 33% (n=466) stage B. By visit 2, 22% (n=214) of stage A had progressed to stage B (4.4±0.3 per 100 person-years), while 10% of stage B had progressed to stage C (1.6±0.2 per 100 person-years). Stage A progressors had higher baseline BNP (26.4 [IQR, 12.7-53.2] pg/mL) versus nonprogressors (12.6 [IQR, 6.2-25.1] pg/mL; P<0.001). In stage B, 18% (n=86) regressed to stage A (3.1±0.3 per 100 person-years) with lower baseline BNP (21.6 [IQR, 9.2-52.7] pg/mL) versus progressors to stage C (83 [IQR, 50.7-166] pg/mL) and remainers in stage B (51.1 [IQR, 17.9-85.7] pg/mL) and more favorable Doppler echocardiographic features. Event rates increased with progression and were similar for stage B to stage A regressors and stage A remainers.

Preclinical heart failure exhibits a bidirectional trajectory, with evidence of regression/stability supporting prevention. Incorporating natriuretic peptide screening enhances risk stratification and effectiveness of preventative screening/intervention services.