Natural history of asymptomatic left ventricular systolic dysfunction in the community.

Wang TJ, Evans JC, Benjamin EJ, Levy D, LeRoy EC, Vasan RS
Circulation. 2003 108 (8): 977-82

PMID: 12912813 · DOI:10.1161/01.CIR.0000085166.44904.79

BACKGROUND - Information is limited regarding the rates of progression to congestive heart failure (CHF) and death in individuals with asymptomatic left ventricular systolic dysfunction (ALVD). We sought to characterize the natural history of ALVD, by studying unselected individuals with this condition in the community.

METHODS AND RESULTS - We studied 4257 participants (1860 men) from the Framingham Study who underwent routine echocardiography. The prevalence of ALVD (visually estimated ejection fraction [EF]50%, n=4128) and ALVD (n=129) were 0.7 and 5.8 per 100 person-years, respectively. After adjustment for cardiovascular disease risk factors, ALVD was associated with a hazards ratio (HR) for CHF of 4.7 (95% CI 2.7 to 8.1), compared with individuals without ALVD. An elevated risk of CHF after ALVD was observed even in individuals without prior myocardial infarction or valvular disease, with an adjusted HR of 6.5 (CI 3.1 to 13.5). Mild ALVD (EF 40% to 50%, n=78) and moderate-to-severe ALVD (EF <40%, n=51) were associated with adjusted HRs for CHF of 3.3 (CI 1.7 to 6.6) and 7.8 (CI 3.9 to 15.6), respectively. ALVD was also associated with an increased mortality risk (adjusted HR 1.6, CI 1.1 to 2.4). The median survival of ALVD subjects was 7.1 years.

CONCLUSIONS - Individuals with ALVD in the community are at high risk of CHF and death, even when only mild impairment of EF is present. Additional studies are needed to define optimal therapy for mild ALVD.

MeSH Terms (26)

Adult Aged Aged, 80 and over Age Distribution Age of Onset Cohort Studies Comorbidity Disease-Free Survival Disease Progression Echocardiography Female Follow-Up Studies Heart Failure Humans Incidence Male Massachusetts Middle Aged Prevalence Proportional Hazards Models Risk Assessment Risk Factors Stroke Volume Survival Rate Systole Ventricular Dysfunction, Left

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