Echocardiographic screening for non-ischaemic stage B heart failure in the community.
Incident heart failure (HF) continues to pose a common and serious problem. We sought to examine the value of echocardiographic predictors of new HF in a community-based elderly population at risk for HF, independent of and incremental to clinical evaluation.



Asymptomatic patients ≥65 years old, with ≥1 HF risk factor (hypertension, type 2 diabetes, or obesity) were recruited from the community; patients with valve disease, reduced ejection fraction (EF), and atrial fibrillation (AF) were excluded. Patients underwent standard clinical evaluation including calculation of the Charlson co-morbidity score and a comprehensive echocardiography including global longitudinal strain (GLS). Functional capacity was assessed by 6 min walk test. New HF and cardiovascular death were assessed after a mean follow-up of 14 ± 4 months by three independent cardiologists using Framingham criteria. Of 410 subjects (median age 70 years; 48% men), the prevalence of stage B HF was 13% [by LV hypertrophy (LVH)], 12% (by abnormal E/e'), 33% (by impaired GLS), and 31% [by left atrial enlargement (LAE)]. New HF symptoms developed in 49, and 2 died of cardiovascular causes, giving an event rate of 104/1000 person-years. These patients were older (P = 0.012), had a higher Charlson co-morbidity score (P < 0.001), larger LV mass and left atrium, higher E/e', and lower GLS (P < 0.05). LAE, LVH, abnormal GLS, and E/e' were independent predictors of new HF. In sequential models, LV mass and GLS added incremental information to clinical parameters. GLS significantly reclassified individuals (P = 0.002), but no reclassification improvement was identified using LV mass index, E/e', and left atrial volume index.



Echocardiographic assessment (especially GLS and LV mass) provides incremental value in predicting incident HF.
Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
Hong
H
Yang
Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
Kazuaki
K
Negishi
Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
Ying
Y
Wang
Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
Mark
M
Nolan
Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
Makoto
M
Saito
Menzies Institute for Medical Research, Hobart, Tasmania, Australia. Tom.Marwick@bakeridi.edu.au.|Baker-IDI Heart and Diabetes Institute, Melbourne, Australia. Tom.Marwick@bakeridi.edu.au.
Thomas H
TH
Marwick
D000368:Aged; D001315:Australia / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology; D057187:Independent Living; D008297:Male; D008403:Mass Screening; D009765:Obesity / Q000453:epidemiology*; D009929:Organ Size; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D000070857:Walk Test
Community; Echocardiography; Global longitudinal strain; Heart failure; Screening