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Risk stratifying asymptomatic left ventricular systolic dysfunction in the community: beyond left ventricular ejection fraction.

Abstract

AIMS

Midwall fractional shortening (MWFS) is a measure of left ventricular (LV) systolic function that is more reliable in case of concentric LV geometry compared to LV ejection fraction (LVEF). We hypothesized that MWFS might predict heart failure (HF) and death in a high-risk asymptomatic population, beyond other echocardiographic parameters.

METHODS AND RESULTS

Among 4047 subjects aged ≥55/≤80 years followed by 10 general practitioners in northern Italy, the DAVID-Berg study prospectively enrolled 623 asymptomatic outpatients at increased risk for HF. Baseline evaluation included clinical visit, electrocardiogram, N-terminal pro-brain natriuretic peptide (NT-proBNP), and echocardiogram. Mean age of the population was 69 ± 7 years, 56% were men, 88% had hypertension, mean LVEF was 61 ± 9%, and mean MWFS 16.2 ± 3.3. During a median follow-up of 5.7 years, 95 subjects experienced HF/death events. At Cox analysis, lower MWFS was the only echocardiographic parameter, among structural/functional ones, associated with higher risk of HF/death [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.84-0.95, Padjusted < 0.001]. The risk of HF/death related to clinical data and NT-proBNP (baseline model) was reclassified by echocardiography only when MWFS was included into the model (baseline C-statistics 0.761; adding conventional structural/functional echocardiographic data 0.776, P = 0.09; adding MWFS 0.791, P = 0.007). Compared to subjects with normal LVEF and MWFS, only subjects with combined systolic dysfunction (11% of the population) were at higher risk (P = 0.001 for both abnormal; P > 0.24 for either LVEF or MWFS abnormal).

CONCLUSION 

DAVID-Berg data suggest to include MWFS assessment in clinical practice, a simple and reliable echocardiographic parameter able to improve risk stratification in subjects at high risk for HF.

Authors+Show Affiliations

CardioVascular Department, ASST Papa Giovanni XXIII Hospital, Piazza OMS, 1, Bergamo, Italy. Division of Cardiology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital University of Rome Sapienza, Via di Grottarossa, 00189 Roma, Italy.CardioVascular Department, ASST Papa Giovanni XXIII Hospital, Piazza OMS, 1, Bergamo, Italy.Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale Aristide Stefani, 1, Verona, Italy.CardioVascular Department, ASST Papa Giovanni XXIII Hospital, Piazza OMS, 1, Bergamo, Italy.CardioVascular Department, ASST Papa Giovanni XXIII Hospital, Piazza OMS, 1, Bergamo, Italy.CNR Institute of Clinical Physiology, CardioThoracic and Vascular Department, Niguarda Ca' Granda Hospital, Piazza dell'Ospedale Maggiore, 3, Milano, Italy.CardioVascular Department, ASST Papa Giovanni XXIII Hospital, Piazza OMS, 1, Bergamo, Italy.CardioVascular Department, ASST Papa Giovanni XXIII Hospital, Piazza OMS, 1, Bergamo, Italy.CardioVascular Department, ASST Papa Giovanni XXIII Hospital, Piazza OMS, 1, Bergamo, Italy.CardioVascular Department, ASST Papa Giovanni XXIII Hospital, Piazza OMS, 1, Bergamo, Italy.Division of Cardiology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital University of Rome Sapienza, Via di Grottarossa, 00189 Roma, Italy. IRCCS Neuromed, Loc. Camerelle, Pozzilli IS, Italy.Division of Cardiology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital University of Rome Sapienza, Via di Grottarossa, 00189 Roma, Italy.Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan, Italy, Department of Medicine and Surgery, University of Milano-Bicocca, Piazzale Brescia, 20, Milano, Italy.Research Foundation, ASST Papa Giovanni XXIII Hospital, Piazza OMS, 1 - 24127 Bergamo, Italy.CardioVascular Department, ASST Papa Giovanni XXIII Hospital, Piazza OMS, 1, Bergamo, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31808506

Citation

Burocchi, Simone, et al. "Risk Stratifying Asymptomatic Left Ventricular Systolic Dysfunction in the Community: Beyond Left Ventricular Ejection Fraction." European Heart Journal Cardiovascular Imaging, 2019.
Burocchi S, Gori M, Cioffi G, et al. Risk stratifying asymptomatic left ventricular systolic dysfunction in the community: beyond left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging. 2019.
Burocchi, S., Gori, M., Cioffi, G., Calabrese, A., Canova, P., De Maria, R., ... Senni, M. (2019). Risk stratifying asymptomatic left ventricular systolic dysfunction in the community: beyond left ventricular ejection fraction. European Heart Journal Cardiovascular Imaging, doi:10.1093/ehjci/jez298.
Burocchi S, et al. Risk Stratifying Asymptomatic Left Ventricular Systolic Dysfunction in the Community: Beyond Left Ventricular Ejection Fraction. Eur Heart J Cardiovasc Imaging. 2019 Dec 6; PubMed PMID: 31808506.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk stratifying asymptomatic left ventricular systolic dysfunction in the community: beyond left ventricular ejection fraction. AU - Burocchi,Simone, AU - Gori,Mauro, AU - Cioffi,Giovanni, AU - Calabrese,Alice, AU - Canova,Paolo, AU - De Maria,Renata, AU - Grosu,Aurelia, AU - Fontana,Alessandra, AU - Iacovoni,Attilio, AU - Ferrari,Paola, AU - Volpe,Massimo, AU - De Biase,Luciano, AU - Parati,Gianfranco, AU - Gavazzi,Antonello, AU - Senni,Michele, Y1 - 2019/12/06/ PY - 2019/08/01/received PY - 2019/11/26/accepted PY - 2019/12/7/entrez PY - 2019/12/7/pubmed PY - 2019/12/7/medline KW - community KW - echocardiography KW - heart failure KW - midwall fractional shortening JF - European heart journal cardiovascular Imaging JO - Eur Heart J Cardiovasc Imaging N2 - AIMS: Midwall fractional shortening (MWFS) is a measure of left ventricular (LV) systolic function that is more reliable in case of concentric LV geometry compared to LV ejection fraction (LVEF). We hypothesized that MWFS might predict heart failure (HF) and death in a high-risk asymptomatic population, beyond other echocardiographic parameters. METHODS AND RESULTS: Among 4047 subjects aged ≥55/≤80 years followed by 10 general practitioners in northern Italy, the DAVID-Berg study prospectively enrolled 623 asymptomatic outpatients at increased risk for HF. Baseline evaluation included clinical visit, electrocardiogram, N-terminal pro-brain natriuretic peptide (NT-proBNP), and echocardiogram. Mean age of the population was 69 ± 7 years, 56% were men, 88% had hypertension, mean LVEF was 61 ± 9%, and mean MWFS 16.2 ± 3.3. During a median follow-up of 5.7 years, 95 subjects experienced HF/death events. At Cox analysis, lower MWFS was the only echocardiographic parameter, among structural/functional ones, associated with higher risk of HF/death [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.84-0.95, Padjusted < 0.001]. The risk of HF/death related to clinical data and NT-proBNP (baseline model) was reclassified by echocardiography only when MWFS was included into the model (baseline C-statistics 0.761; adding conventional structural/functional echocardiographic data 0.776, P = 0.09; adding MWFS 0.791, P = 0.007). Compared to subjects with normal LVEF and MWFS, only subjects with combined systolic dysfunction (11% of the population) were at higher risk (P = 0.001 for both abnormal; P > 0.24 for either LVEF or MWFS abnormal). CONCLUSION : DAVID-Berg data suggest to include MWFS assessment in clinical practice, a simple and reliable echocardiographic parameter able to improve risk stratification in subjects at high risk for HF. SN - 2047-2412 UR - https://www.unboundmedicine.com/medline/citation/31808506/Risk_stratifying_asymptomatic_left_ventricular_systolic_dysfunction_in_the_community:_beyond_left_ventricular_ejection_fraction L2 - https://academic.oup.com/ehjcimaging/article-lookup/doi/10.1093/ehjci/jez298 DB - PRIME DP - Unbound Medicine ER -