Asymptomatic left ventricular dysfunction in the community
- Theresa A. McDonagh MBChB, MD
- … show all 1 hide
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The syndrome of chronic heart failure (CHF) is usually attributable to left ventricular dysfunction (LVD), which is most commonly systolic in nature. Many patients who go on to develop heart failure pass through a phase in which they have significant systolic dysfunction but lack clinical symptoms and signs: so-called asymptomatic LVD (ALVD). Treatment of this asymptomatic phase with angiotensinconverting enzyme inhibitors can delay the progression to CHF and ameliorate its substantial morbidity and mortality. This article reviews the epidemiology of ALVD. ALVD is at least as prevalent as CHF, is mainly caused by ischemic heart disease, significantly impairs effort capacity, reduces quality of life, and is associated with a substantial mortality rate. As such, it would appear to satisfy many of the criteria required to screen for a disease. The natriuretic peptide hormones (atrial natriuretic peptide [ANP] and brain natriuretic peptide [BNP]) are elevated in subjects with ALVD. BNP, in particular, has acceptable accuracy to detect LVD in the general population. In particular, it has a high negative predictive value meaning a low concentration makes the presence of significant LVD highly unlikely. As such it has the potential to be a cost-effective means of filtering subjects suspected of having LVD and allowing more appropriate use of tertiary referrals for specialist assessment and detailed echocardiography.
- The SOLVD Investigators: Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 1992, 327:685–691. CrossRef
- McDonagh TA, Morrison CE, Lawrence A, et al.: Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population. Lancet 1997, 350:829–833. CrossRef
- Mosterd A, Hoes AW, deBruyne MC, et al.: Prevalence of heart failure and left ventricular dysfunction in the general population — the Rotterdam study. Eur Heart J 1999, 20:447–455. CrossRef
- Lauer M, Evans J, Levy D: Prognostic implications of subclinical left ventricular dilatation and systolic dysfunction in men free of overt cardiovascular disease (the Framingham Heart Study). Am J Cardiol 1992, 70:1180–1184. CrossRef
- Vasan RS, Larson MG, Benjamin EJ, et al.: Left ventricular dilation and the risk of congestive heart failure in people without myocardial infarction. N Engl J Med 1997, 336:1350–1355. CrossRef
- Gardin JM, Siscovick D, Anton-Culver H, et al.: Sex, age, and disease affect echocardiographic left ventricular mass and systolic function in the free-living elderly. Cardiovascular Health Study. Circulation 1995, 91:1739–1748.
- Eriksson H, Svardsudd K, Larsson B, et al.: Risk factors for heart failure in the general population: the study of men born in 1913. Eur Heart J 1989, 10:647–656.
- McDonagh TA, Cunningham AD, McMurray J, et al.: Mortality and left ventricular systolic dysfunction in an urban population. Heart 1998, 79:129.
- Pfeffer MA, Braunwald E, Moye LA, et al.: Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med 1992, 327:669–677. CrossRef
- Kober L, Torp-Pedersen C, Carlsen JE, et al.: A clinical trial of the angiotensin-converting enzyme trandolapril in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 1995, 327:1670–1676. CrossRef
- Rose G, Barker DJP: Epidemiology for the uninitiated. In Anonymous 2nd ed. London: British Medical Journal, 1986.
- McKee PA, Castelli WP, McNamara PM, Kannel WB: The natural history of congestive heart failure: the Framingham study. N Engl J Med 1971, 285:1441–1446. CrossRef
- Schocken DD, Arrieta MI, Leaverton PE, Ross EA: Prevalence and mortality rate of congestive heart failure in the United States. J Am Coll Cardiol 1992, 20:301–306. CrossRef
- Parameshwar J, Poole Wilson PA, Sutton GC: Heart failure in a district general hospital [see comments]. J Coll Physicians London 1992, 26:139–142.
- Stewart AL, Greenfield S, Hays RD, et al.: Functional status and well being of patients with chronic conditions. Results of the Medical Outcomes Study. JAMA, 1989, 762:907–913. CrossRef
- McMurray J, Hart W: The economic impact of heart failure on the UK national health service [abstract]. Eur Heart J 1993, 14(suppl):P848-P848.
- McMurray J, Davie A: The pharmacoeconomics of ACE inhibitors in chronic heart failure. Pharmacoeconomics 1996, 9:188–197. CrossRef
- Tsevat J, Duke D, Goldman L, et al.: Cost-effectiveness of captopril therapy after myocardial-infarction. J Am Coll Cardiol 1995, 26:914–919. CrossRef
- Willenheimer R: Assessment of left ventricular dysfunction and remodeling by determination of atrioventricular plane displacement and simplified echocardiography. Scand Cardiovasc J 1998, 32:5–31. CrossRef
- Murray JA, Chinn N, Peterson DR: Influence of left ventricular function on early prognosis in atherosclerotic heart disease. Am J Cardiol 1974, 33:159. CrossRef
- Nelson NB, Cohn PF, Garlin R: Prognosis in medically treated coronary artery disease. Influence of ejection fraction compared to other parameters. Circulation 1975, 52:408–412.
- Francis GS, Benedict C, Johnstone DE, et al.: Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the Studies of Left Ventricular Dysfunction (SOLVD). Circulation 1990, 82:1724–1729.
- Lerman A, Gibbons RJ, Rodeheffer RJ, et al.: Circulating N-terminal atrial natriuretic peptide as a marker for symptomless left-ventricular dysfunction [see comments]. Lancet 1993, 341:1105–1109. CrossRef
- Wei CM, Heublein DM, Perrella MA, et al.: Natriuretic peptide system in human heart failure. Circulation 1993, 88:1004–1009.
- Motwani JG, McAlpine H, Kennedy N, Struthers AD: Plasma brain natriuretic peptide as an indicator for angiotensin-converting-enzyme inhibition after myocardial infarction [see comments]. Lancet 1993, 341:1109–1113. CrossRef
- McDonagh TA, Robb SD, Murdoch DR, et al.: Biochemical detection of left ventricular systolic dysfunction. Lancet 1998, 351:9–13. CrossRef
- Kohno M, Fukui T, Horio T, et al.: Cardiac hypertrophy and brain natriuretic peptide in experimental hypertension. Am J Physiol 1994, 266:R451-R457. This study contains important information on the negative predictive accuracy of BNP in detecting LVD in the community.
- Clarkson PBM, Whelldon NM, MacFadyen RJ, et al.: Effects of brain natriuretic peptide on exercise hemodynamics and neurohormones in isolated diastolic heart failure. Circulation 1996, 93:2037–2042.
- Asymptomatic left ventricular dysfunction in the community
Current Cardiology Reports
Volume 2, Issue 5 , pp 470-474
- Cover Date
- Print ISSN
- Online ISSN
- Current Medicine Group
- Additional Links
- Author Affiliations
- 1. Department of Medical Cardiology, University of Glasgow Royal Infirmary, 10 Alexandra Parade, G31 6ER, Glasgow, Scotland