Screening for left ventricular systolic dysfunction among patients with risk factors for heart failure.
BACKGROUND
The prevalence of left ventricular systolic dysfunction (LVSD) among individuals at risk for heart failure (HF) and the feasibility of screening have not been clearly defined. This study determined the prevalence of LVSD with the use of a limited screening echocardiogram among patients with risk factors for HF but no prior HF.


METHODS
General medicine patients > or =60 years of age with hypertension, diabetes, coronary artery disease, or previous myocardial infarction (MI) but no history of HF or reduced left ventricular ejection fraction (LVEF) were eligible. Medical history and symptoms of breathlessness were determined by interview and chart review; consenting patients underwent electrocardiography and echocardiography. The outcome was LVEF < or =45%, based on visual estimation from the echocardiogram.


RESULTS
Of the 482 patients who completed the study, only 1 patient could not have the LVEF visually estimated. A total of 7.9% of patients had LVEF < or =45%. The prevalence was 15.4% among those with a prior MI and 6.7% among those without prior MI. In multivariate analysis, prior MI (adjusted odds ratio, 2.75; 95% CI, 1.14 to 6.64) and probable or definite left ventricular hypertrophy by electrocardiography (adjusted odds ratio, 3.57; 95% CI, 1.22 to 10.48) were the strongest predictors of LVEF < or =45%.


CONCLUSIONS
Screening for LVSD among high-risk patients is feasible and has substantial yield, even among patients without prior MI. In light of the low cost of screening and the available therapies to prevent progression of LVSD to overt HF, controlled clinical trials of screening high-risk subgroups appear to be justified.
Baker
David W
DW
Department of Medicine and the Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill 60611, USA. dwbaker@northwestern.edu
Bahler
Robert C
RC
Finkelhor
Robert S
RS
Lauer
Michael S
MS
D000368:Aged; D018450:Disease Progression; D004452:Echocardiography; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control