Most Cardiac Dysfunction Considered Subclinical Among Hispanic Patients

Left ventricular diastolic dysfunction is high among the Hispanic population, and overall cardiac dysfunction is mostly subclinical or unrecognized.

Cardiac dysfunction was mostly subclinical or unrecognized among Hispanic populations with a high rate of diastolic dysfunction, according to data from the ECHO-SOL (Echocardiographic Study of Latinos) study, which were published in Circulation: Heart Failure.

The ECHO-SOL study included 1818 Hispanic participants between the ages of 45 and 74 (mean age: 56.4 years; 42.6% male). All participants underwent an echocardiography examination to determine left ventricular systolic dysfunction (LVSD) or left ventricular diastolic dysfunction (LVDD), and clinical heart failure (HF) was self-reported. Those patients with cardiac dysfunction and without clinical HF were characterized with subclinical or unrecognized cardiac dysfunction.

“Cardiac dysfunction was present in almost half of the cohort due predominantly to diastolic dysfunction. This is important given the epidemic of HFpEF [heart failure with preserved ejection fraction], which is projected to increase in the United States,” the authors wrote. “Moreover, of all cardiac dysfunction, upwards of 95% was unrecognized or subclinical. Finally, there was a suggestion of differentially higher LVDD prevalence among certain Hispanic/Latino groups, in particular Central Americans, which may be more at risk.”

Researchers observed that 49.7% of the patients had LVSD and LVDD. The prevalence of LVSD was 3.6%, with most patients being  male and  more likely current smokers. The prevalence of LVDD was 50.3%, and these patients were mostly women, and more likely to have hypertension, diabetes, higher body mass index, and renal dysfunction (P<.05).

After adjustments for age and sex, researchers also found that individuals with Central American and Cuban backgrounds were almost 2-fold as likely to have LVDD compared with those patients of Mexican backgrounds.

The prevalence of clinical HF in participants with LVSD (HF with reduced EF) was 7.3%, while the prevalence of LVDD was 3.6%. Moreover, researchers  found that 96.1% of the observed cardiac dysfunction was subclinical or unrecognized.

When researchers compared patients with clinical cardiac dysfunction, coronary heart disease was the only factor that was independently associated with subclinical or unrecognized cardiac dysfunction (odds ratio: 0.1; 95% confidence interval: 0.1-0.4).

The authors noted that the rate of self-reported clinical HF was low, despite the high prevalence of stage A and stage B HF among the Hispanic/Latino populations. Income, educational level, or insurance status were not significantly associated with subclinical or unrecognized dysfunction, which suggests that the high presence of stage B HF goes further than these variables and requires additional research.

“Our study substantiates the need for aggressive risk factor modification in this at-risk population as recommended in the guidelines to prevent further cardiac remodeling and progression to clinical HF,” the authors concluded.


Mehta H, Armstrong A, Swett K, et al. Burden of systolic and diastolic left ventricular dysfunction among Hispanics in the United States: insights from the Echocardiographic Study of Latinos. Circ Heart Fail. 2016. doi: 10.1161/circheartfailure.115.002733.