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Echocardiographic screening for non-ischaemic stage B heart failure in the community.

Abstract：

AIMS:Incident heart failure (HF) continues to pose a common and serious problem. We sought to examine the value of echocardiographic predictors of new HF in a community-based elderly population at risk for HF, independent of and incremental to clinical evaluation. METHODS AND RESULTS:Asymptomatic patients ≥65 years old, with ≥1 HF risk factor (hypertension, type 2 diabetes, or obesity) were recruited from the community; patients with valve disease, reduced ejection fraction (EF), and atrial fibrillation (AF) were excluded. Patients underwent standard clinical evaluation including calculation of the Charlson co-morbidity score and a comprehensive echocardiography including global longitudinal strain (GLS). Functional capacity was assessed by 6 min walk test. New HF and cardiovascular death were assessed after a mean follow-up of 14 ± 4 months by three independent cardiologists using Framingham criteria. Of 410 subjects (median age 70 years; 48% men), the prevalence of stage B HF was 13% [by LV hypertrophy (LVH)], 12% (by abnormal E/e'), 33% (by impaired GLS), and 31% [by left atrial enlargement (LAE)]. New HF symptoms developed in 49, and 2 died of cardiovascular causes, giving an event rate of 104/1000 person-years. These patients were older (P = 0.012), had a higher Charlson co-morbidity score (P < 0.001), larger LV mass and left atrium, higher E/e', and lower GLS (P < 0.05). LAE, LVH, abnormal GLS, and E/e' were independent predictors of new HF. In sequential models, LV mass and GLS added incremental information to clinical parameters. GLS significantly reclassified individuals (P = 0.002), but no reclassification improvement was identified using LV mass index, E/e', and left atrial volume index. CONCLUSION:Echocardiographic assessment (especially GLS and LV mass) provides incremental value in predicting incident HF.

journal_name

Eur J Heart Fail

journal_title

European journal of heart failure

authors

Yang H,Negishi K,Wang Y,Nolan M,Saito M,Marwick TH

doi

10.1002/ejhf.643

subject

Has Abstract

pub_date

2016-11-01 00:00:00

pages

1331-1339

issue

eissn

1388-9842

issn

1879-0844

journal_volume

pub_type

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Echocardiographic screening for non-ischaemic stage B heart failure in the community.