Circulation. 2003;108:977-982
Published online before print August 11, 2003, doi: 10.1161/01.CIR.0000085166.44904.79
Published online before print August 11, 2003, doi: 10.1161/01.CIR.0000085166.44904.79
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2003;108:977.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Natural History of Asymptomatic Left Ventricular Systolic Dysfunction in the Community
From the Framingham Heart Study (T.J.W., J.C.E., E.J.B., D.L., E.C.L., R.S.V.), Framingham, Mass; Cardiology Division (T.J.W.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; National Heart, Lung & Blood Institute (D.L.), Bethesda, Md; Cardiology Section (E.J.B., R.S.V.), Preventive Medicine and Epidemiology (D.L., E.J.B., R.S.V.), Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Mass.
Correspondence to Ramachandran S. Vasan, MD, Framingham Heart Study, 73 Mt Wayte Ave, Suite No. 2, Framingham, MA 01702-5827. E-mail vasan{at}fram.nhlbi.nih.gov
Received March 18, 2003; revision received May 30, 2003; accepted June 4, 2003.
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% without a history of CHF) was 6.0% in men and 0.8% in women. During up to 12 years of follow-up, rates of CHF among subjects with normal left ventricular systolic function (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.
Conclusion— 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.
Key Words: heart failure • ventricular dysfunction • echocardiography
This article has been cited by other articles:
 |
|
 |
|
  H.-C. Huang, L.-Y. Lin, H.-Y. Yu, and Y.-L. Ho Risk stratification by T-wave morphology for cardiovascular mortality in patients with systolic heart failure Europace, November 1, 2009; 11(11): 1522 - 1528. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Jessup MADIT-CRT -- Breathtaking or Time to Catch Our Breath? N. Engl. J. Med., October 1, 2009; 361(14): 1394 - 1396. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Klapholz {beta}-Blocker Use for the Stages of Heart Failure Mayo Clin. Proc., August 1, 2009; 84(8): 718 - 729. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. Vasan, N. L. Glazer, J. F. Felix, W. Lieb, P. S. Wild, S. B Felix, N. Watzinger, M. G. Larson, N. L. Smith, A. Dehghan, et al. Genetic Variants Associated With Cardiac Structure and Function: A Meta-analysis and Replication of Genome-wide Association Data JAMA, July 8, 2009; 302(2): 168 - 178. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J Y S Chan, A M Li, C-T Au, A F C Lo, S-K Ng, V J Abdullah, C Ho, C-M Yu, T-F Fok, and Y-K Wing Cardiac remodelling and dysfunction in children with obstructive sleep apnoea: a community based study Thorax, March 1, 2009; 64(3): 233 - 239. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Stewart, D. Wilkinson, C. Hansen, V. Vaghela, R. Mvungi, J. McMurray, and K. Sliwa Predominance of Heart Failure in the Heart of Soweto Study Cohort: Emerging Challenges for Urban African Communities Circulation, December 2, 2008; 118(23): 2360 - 2367. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) Eur. Heart J., October 1, 2008; 29(19): 2388 - 2442. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, A. W. Hoes, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) Eur J Heart Fail, October 1, 2008; 10(10): 933 - 989. [Full Text] [PDF]
|
|
|
|
|
|
E Crisafulli, S Costi, F Luppi, G Cirelli, C Cilione, O Coletti, L M Fabbri, and E M Clini Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation Thorax, June 1, 2008; 63(6): 487 - 492. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. D. Schocken, E. J. Benjamin, G. C. Fonarow, H. M. Krumholz, D. Levy, G. A. Mensah, J. Narula, E. S. Shor, J. B. Young, and Y. Hong Prevention of Heart Failure: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group Circulation, May 13, 2008; 117(19): 2544 - 2565. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. M. Albert and C. Lewis Recognizing and Managing Asymptomatic Left Ventricular Dysfunction: After Myocardial Infarction Crit. Care Nurse, April 1, 2008; 28(2): 20 - 37. [Full Text] [PDF]
|
|
|
|
|
|
A. Dzudie, A. P. Kengne, S. Mbahe, A. Menanga, M. Kenfack, and S. Kingue Chronic heart failure, selected risk factors and co-morbidities among adults treated for hypertension in a cardiac referral hospital in Cameroon Eur J Heart Fail, April 1, 2008; 10(4): 367 - 372. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J L Hare, C Jenkins, S Nakatani, A Ogawa, C-M Yu, and T H Marwick Feasibility and clinical decision-making with 3D echocardiography in routine practice Heart, April 1, 2008; 94(4): 440 - 445. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Pfister, H. Diedrichs, A. Schiedermair, S. Rosenkranz, M. Hellmich, E. Erdmann, and C. A. Schneider Prognostic impact of NT-proBNP and renal function in comparison to contemporary multi-marker risk scores in heart failure patients Eur J Heart Fail, March 1, 2008; 10(3): 315 - 320. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. R. S. Fernandes, J. F. Polak, S. Cheng, B. D. Rosen, B. Carvalho, K. Nasir, R. McClelland, G. Hundley, G. Pearson, D. H. O'Leary, et al. Arterial Stiffness Is Associated With Regional Ventricular Systolic and Diastolic Dysfunction: The Multi-Ethnic Study of Atherosclerosis Arterioscler Thromb Vasc Biol, January 1, 2008; 28(1): 194 - 201. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. P.Y. Koonen, M. Febbraio, S. Bonnet, J. Nagendran, M. E. Young, E. D. Michelakis, and J. R.B. Dyck CD36 Expression Contributes to Age-Induced Cardiomyopathy in Mice Circulation, November 6, 2007; 116(19): 2139 - 2147. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Banerjee, J. Z. Ma, A. J. Collins, and C. A. Herzog Long-Term Survival of Incident Hemodialysis Patients Who Are Hospitalized for Congestive Heart Failure, Pulmonary Edema, or Fluid Overload Clin. J. Am. Soc. Nephrol., November 1, 2007; 2(6): 1186 - 1190. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Mosterd and A. W Hoes Clinical epidemiology of heart failure Heart, September 1, 2007; 93(9): 1137 - 1146. [Full Text] [PDF]
|
|
|
|
 |
|
 L. C. Costello-Boerrigter, G. Boerrigter, G. J. Harty, A. Cataliotti, M. M. Redfield, and J. C. Burnett Jr Mineralocorticoid Escape by the Kidney But Not the Heart in Experimental Asymptomatic Left Ventricular Dysfunction Hypertension, September 1, 2007; 50(3): 481 - 488. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. S. Colucci, T. J. Kolias, K. F. Adams, W. F. Armstrong, J. K. Ghali, S. S. Gottlieb, B. Greenberg, M. I. Klibaner, M. L. Kukin, J. E. Sugg, et al. Metoprolol Reverses Left Ventricular Remodeling in Patients With Asymptomatic Systolic Dysfunction: The REversal of VEntricular Remodeling with Toprol-XL (REVERT) Trial Circulation, July 3, 2007; 116(1): 49 - 56. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. A. Ammar, S. J. Jacobsen, D. W. Mahoney, J. A. Kors, M. M. Redfield, J. C. Burnett Jr, and R. J. Rodeheffer Prevalence and Prognostic Significance of Heart Failure Stages: Application of the American College of Cardiology/American Heart Association Heart Failure Staging Criteria in the Community Circulation, March 27, 2007; 115(12): 1563 - 1570. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Nasir, M. Tsai, B. D. Rosen, V. Fernandes, D. A. Bluemke, A. R. Folsom, and J. A.C. Lima Elevated Homocysteine Is Associated With Reduced Regional Left Ventricular Function: The Multi-Ethnic Study of Atherosclerosis Circulation, January 16, 2007; 115(2): 180 - 187. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. G. Neilan, D. S. Jassal, T. M. Perez-Sanz, M. J. Raher, A. D. Pradhan, E. S. Buys, F. Ichinose, D. B. Bayne, E. F. Halpern, A. E. Weyman, et al. Tissue Doppler imaging predicts left ventricular dysfunction and mortality in a murine model of cardiac injury Eur. Heart J., August 1, 2006; 27(15): 1868 - 1875. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. G. Hays, R. L. Sacco, T. Rundek, R. R. Sciacca, Z. Jin, R. Liu, S. Homma, and M. R. Di Tullio Left Ventricular Systolic Dysfunction and the Risk of Ischemic Stroke in a Multiethnic Population Stroke, July 1, 2006; 37(7): 1715 - 1719. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. R.S. Fernandes, J. F. Polak, T. Edvardsen, B. Carvalho, A. Gomes, D. A. Bluemke, K. Nasir, D. H. O'Leary, and J. A.C. Lima Subclinical Atherosclerosis and Incipient Regional Myocardial Dysfunction in Asymptomatic Individuals: The Multi-Ethnic Study of Atherosclerosis (MESA) J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2420 - 2428. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. R. Goldberg and M. Jessup Stage B Heart Failure: Management of Asymptomatic Left Ventricular Systolic Dysfunction Circulation, June 20, 2006; 113(24): 2851 - 2860. [Full Text] [PDF]
|
|
|
|
|
|
D. Feldman The Timing for Transplantation: Superior Genetics or Social Prejudice? J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2243 - 2244. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Zoccali, F. A. Benedetto, G. Tripepi, F. Mallamaci, F. Rapisarda, G. Seminara, G. Bonanno, and L. S. Malatino Left Ventricular Systolic Function Monitoring in Asymptomatic Dialysis Patients: A Prospective Cohort Study J. Am. Soc. Nephrol., May 1, 2006; 17(5): 1460 - 1465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Hirashiki, H. Izawa, F. Somura, K. Obata, T. Kato, T. Nishizawa, A. Yamada, H. Asano, S. Ohshima, A. Noda, et al. Prognostic Value of Pacing-Induced Mechanical Alternans in Patients With Mild-to-Moderate Idiopathic Dilated Cardiomyopathy in Sinus Rhythm J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1382 - 1389. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Chung, S. R. Das, D. Leonard, R. M. Peshock, F. Kazi, S. M. Abdullah, R. M. Canham, B. D. Levine, and M. H. Drazner Women Have Higher Left Ventricular Ejection Fractions Than Men Independent of Differences in Left Ventricular Volume: The Dallas Heart Study Circulation, March 28, 2006; 113(12): 1597 - 1604. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. S. Bhatia, M. D. Sosin, J. V. Patel, K. A. Grindulis, F. H. Khattak, E. A. Hughes, G. Y.H. Lip, and R. C. Davis Left Ventricular Systolic Dysfunction in Rheumatoid Disease: An Unrecognized Burden? J. Am. Coll. Cardiol., March 21, 2006; 47(6): 1169 - 1174. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Hoffmann, S. von Bardeleben, J. D. Kasprzak, A. C. Borges, F. ten Cate, C. Firschke, S. Lafitte, N. Al-Saadi, S. Kuntz-Hehner, G. Horstick, et al. Analysis of Regional Left Ventricular Function by Cineventriculography, Cardiac Magnetic Resonance Imaging, and Unenhanced and Contrast-Enhanced Echocardiography: A Multicenter Comparison of Methods J. Am. Coll. Cardiol., January 3, 2006; 47(1): 121 - 128. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. I.W. Galasko, S. C. Barnes, P. Collinson, A. Lahiri, and R. Senior What is the most cost-effective strategy to screen for left ventricular systolic dysfunction: natriuretic peptides, the electrocardiogram, hand-held echocardiography, traditional echocardiography, or their combination? Eur. Heart J., January 2, 2006; 27(2): 193 - 200. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, K. Swedberg, Writing Committee:, J. Cleland, H. Dargie, H. Drexler, F. Follath, M. Komajda, L. Tavazzi, O. A. Smiseth, et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology Eur. Heart J., June 1, 2005; 26(11): 1115 - 1140. [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia, F. Angeli, R. Gattobigio, M. Sardone, and C. Porcellati Asymptomatic Left Ventricular Systolic Dysfunction in Essential Hypertension: Prevalence, Determinants, and Prognostic Value Hypertension, March 1, 2005; 45(3): 412 - 418. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Jenkins, K. Bricknell, L. Hanekom, and T. H. Marwick Reproducibility and accuracy of echocardiographic measurements of left ventricular parameters using real-time three-dimensional echocardiography J. Am. Coll. Cardiol., August 18, 2004; 44(4): 878 - 886. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. M. Redfield, R. J. Rodeheffer, S. J. Jacobsen, D. W. Mahoney, K. R. Bailey, and J. C. Burnett Jr Plasma Brain Natriuretic Peptide to Detect Preclinical Ventricular Systolic or Diastolic Dysfunction: A Community-Based Study Circulation, June 29, 2004; 109(25): 3176 - 3181. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Sundstrom, L. Sullivan, J. Selhub, E. J Benjamin, R. B D'Agostino, P. F Jacques, I. H Rosenberg, D. Levy, P. W.F Wilson, and R. S Vasan Relations of plasma homocysteine to left ventricular structure and function: the Framingham Heart Study Eur. Heart J., March 2, 2004; 25(6): 523 - 530. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. SoRelle Cardiovascular News Circulation, August 26, 2003; 108 (8): e9014 - e9015. [Full Text]
|
|