title: Evaluation of different strategies for identifying asymptomatic left ventricular dysfunction and pre-clinical (stage B) heart failure in the elderly. Results from 'PREDICTOR', a population based-study in central Italy.
abstract: OBJECTIVE
  To evaluate the accuracy and cost-effectiveness of different screening strategies to identify systolic and/or diastolic asymptomatic LV dysfunction (ALVD), as well as pre-clinical (stage B) heart failure (HF), in a community of elderly subjects in Italy.
  
  
  RESULTS
  A sample of 1452 subjects aged 65-84 years were chosen from the original cohort of 2001 randomly selected residents of the Lazio Region (Italy), as a part of the PREDICTOR survey. All subjects underwent physical examination, biochemistry/NT-proBNP assessment, 12-lead ECG, and Doppler transthoracic echocardiography (TE). Five strategies were evaluated including ECG, NT-proBNP, TE, and their combinations. Subjects older than 75 years, and with at least two additional risk factors, were defined as being high-risk for HF (435), whereas the remaining 1017 were defined at low risk. Screening characteristics and cost-effectiveness (cost per case) of the five strategies to predict systolic (EF <50% ) or diastolic ALVD and pre-clinical HF (stage B) were compared. NT-proBNP was the most accurate and cost-effective screening strategy to identify systolic and moderate to severe diastolic LV dysfunction without a difference between the high-risk and low-risk groups. Adding ECG to the NT-proBNP assessment did not improve the detection of pre-clinical LV dysfunction. TE-based screening was the least cost-effective strategy. In fact, all screening strategies were inadequate to identify stage B HF.
  
  
  CONCLUSIONS
  In a community of elderly people, NT-proBNP is the most accurate and cost- effective pre-screening strategy to identify systolic and moderate to severe diastolic LV dysfunction.
authors.affiliation: Department of Cardiovascular Diseases, S. Giovanni-Addolorata Hospital, Via Amba Aradam 9, 00184, Roma, Italy.
authors.forename: Gian Francesco
authors.initials: GF
authors.lastname: Mureddu
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.forename: Nera
authors.initials: N
authors.lastname: Agabiti
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
authors.forename: Serge
authors.initials: S
authors.lastname: Masson
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
authors.forename: Giulia
authors.initials: G
authors.lastname: Cesaroni
authors.forename: Maria
authors.initials: M
authors.lastname: Miceli
authors.forename: Francesco
authors.initials: F
authors.lastname: Forastiere
authors.forename: Angela Beatrice
authors.initials: AB
authors.lastname: Scardovi
authors.forename: Massimo
authors.initials: M
authors.lastname: Uguccioni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Boccanelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D003362:Cost-Benefit Analysis; D003971:Diastole; D015150:Echocardiography, Doppler / Q000191:economics / Q000379:methods; D004562:Electrocardiography / Q000191:economics / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007558:Italy; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Asymptomatic left ventricular dysfunction; Elderly; Heart failure screening; Heart failure stage B; Prevention