Treatment of asymptomatic left ventricular dysfunction.
Patients with abnormalities of left ventricular (LV) systolic or diastolic function may have no symptoms, especially in the early stages. These patients are not uncommon in the community, and the prevalence of this condition increases in the presence of risk factors such as diabetes, hypertension, and coronary artery disease. Patients with asymptomatic LV dysfunction have a significantly increased risk of overt heart failure and mortality. Therefore, it is of prime importance to identify and treat these patients to prevent progression of the disease. Echocardiography is an excellent tool to characterize systolic and diastolic properties of the left ventricle. However, its cost and lack of widespread availability have limited its usefulness in screening the general population. Careful clinical assessment coupled with electrocardiography and natriuretic peptide level assessment can identify higher-risk patients who should be referred for detailed evaluation of LV function. The goal of therapy is to halt and even reverse LV remodeling. Neurohormonal blockade, now the cornerstone of heart failure therapy, has been shown to have salutatory effects in patients with asymptomatic LV systolic dysfunction, both in reversing remodeling and reducing adverse clinical outcomes. Except for risk factor control, there is no evidence to advocate any specific therapy for asymptomatic patients with LV diastolic dysfunction.
Moukarbel
George V
GV
Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Solomon
Scott D
SD