Asymptomatic Left Ventricular Dysfunction Yields High Risk for Incident Heart Failure

Data from a meta-analysis indicate that asymptomatic left ventricular systolic dysfunction (ALVSD) and diastolic dysfunction (ALVDD) are independently associated with a high risk for incident heart failure (HF).

Despite the risk for asymptomatic left ventricular dysfunction (ALVD; stage B HF) progressing to clinical (stage C) HF, precise population-based estimates of this relationship are limited, the researchers noted.

This led them to conduct a systematic review of literature from Medline and Embase, including cohort studies that reported on the progression from ALVSD or ALVDD to overt HF.

The resulting meta-analysis featured 13 reports based on 11 studies, totaling 25 369 patients and 3034 incident HF cases.

During follow-up (mean, 7.9 years), the absolute risks for progression to HF was 8.4 per 100 person-years (95% confidence interval [CI], 4-12.8) in patients with ALVSD and 2.8 per 100 person-years (95% CI, 1.9-3.7) in patients with ALVDD. Conversely, patients with no evidence of ventricular dysfunction had a risk for progression to HF of 1.04 per 100 person-years (95% CI, 0-2.2).

When researchers examined the combined maximally adjusted relative risk (RR), they found a similar trend, with a higher RR reported in ALVSD patients (4.6; 95% CI, 2.2-9.8) than ALVDD patients (1.7; 95% CI, 1.3-2.2).

“Our data show a significantly and alarmingly high absolute and relative risk of progression from ALVD to overt HF, much higher for systolic than for diastolic dysfunction,” the researchers wrote. “Sustained efforts are needed to further clarify the progression rate across various subpopulations especially racial/ethnic minorities, the sequence of progression, and the type(s) of HF to which these entities progress.”

The researchers added that the findings indicate the need for “a more aggressive pharmacological and lifestyle management of patients with ALVD and for defining viable screening strategies, as well as testing and implementation of preemptive cost-effective interventions in order to reduce the burden of HF in our communities.”

Reference

Echouffo-Tcheugui JB, Erqou S, Butler J, Yancy CW, Fonarow GC.  Assessing the risk of progression for asymptomatic left ventricular dysfunction to overt heart failure: A systematic overview and meta-analysis. JACC: Heart Fail. 2015. doi:10.1016/j.jchf.2015.09.015.