What is the most cost-effective strategy to screen for left ventricular systolic dysfunction: natriuretic peptides, the electrocardiogram, hand-held echocardiography, traditional echocardiography, or their combination?
Open accessAbstract
AIMS: To assess the screening characteristics and cost-effectiveness of screening for left ventricular systolic dysfunction (LVSD) in community subjects. METHODS AND RESULTS: A total of 1392 members of the general public and 928 higher risk subjects were randomly selected from seven community practices. Attending subjects underwent an ECG, N-terminal pro-brain natriuretic peptide (NTproBNP) serum levels, and traditional echocardiography (TE). A total of 533 consecutive subjects underwent hand-held echocardiography (HE). The screening characteristics and cost-effectiveness (cost per case of LVSD diagnosed) of eight strategies to predict LVSD (LVSD <45% on TE) were compared. A total of 1205 subjects attended. Ninety six per cent of subjects with LVSD in the general population had identifiable risk factors. All screening strategies gave excellent negative predictive value. Screening high-risk subjects was most cost-effective, screening low-risk subjects least cost-effective. TE screening was the least cost-effective strategy. NTproBNP screening gave similar cost savings to ECG screening; HE screening greater cost-savings, and HE screening following NTproBNP or ECG pre-screening the greatest cost-savings, costing approximately 650 Euros per case of LVSD diagnosed in high-risk subjects (63% cost-savings vs.TE). CONCLUSION: Thus several different modalities allow cost-effective community-based screening for LVSD, especially in high-risk subjects. Such programmes would be cost-effective and miss few cases of LVSD in the community.
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Artificial intelligence can detect LVSD from ECGs.
“Artificial intelligence (AI) can detect left ventricular systolic dysfunction (LVSD) from electrocardiograms (ECGs)”
From Detection of left ventricular systolic dysfunction from single-lead electrocardiography adapted for portable and wearable devices (2023) · cites this paper as [9]
The Discussion (page unavailable) reports that ECG screening had high sensitivity for predicting LVSD in community subjects. The Electrocardiography section describes screening based on specified ECG abnormalities, but the paper does not report using artificial intelligence to detect LVSD. (LLM, conf=0.87)
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Detection of Left Ventricular Systolic Dysfunction From Electrocardiographic Images
Sangha, V., Nargesi, A. A., Dhingra, L. S., Khunte, A., Mortazavi, B. J., Ribeiro, A. H., Banina, E., Adeola, O., Garg, N., Brandt, C. A., et al. (2023) · Circulation · doi:10.1161/circulationaha.122.062646 · Cited by 150 · see citing works
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- Authors
- Galasko, G. I. W., Barnes, S. C., Collinson, P., Lahiri, A., & Senior, R.
- Affiliations
- Northwick Park Hospital (GB)
- St George's Hospital (GB)
- Corresponding author
- Galasko, Gavin I.W.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-11-02
- Volume
- 27
- Issue
- 2
- Pages
- 193-200
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2183065534
- Cited by
- 94
- References
- 1
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 5 · 2023: 6 · 2022: 2 · 2020: 2 · 2019: 6 · 2018: 4 · 2017: 2 · 2016: 2 · 2015: 5 · 2014: 4 · 2013: 9 · 2012: 10
- FWCI
- 3.88
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- European Heart Journal (publishedVersion, other-oa)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- left ventricular systolic dysfunction, cardiovascular screening, cost-effectiveness, natriuretic peptides, NT-proBNP, electrocardiogram, handheld echocardiography, vulnerable populations, community-based screening, risk stratification
- MeSH terms
- Adolescent, Adult, Aged, Ambulatory Care, Child, Cost-Benefit Analysis, Echocardiography, Electrocardiography, Female, Humans, Male, Mass Screening, Middle Aged, Systole, Ventricular Dysfunction, Left, Natriuretic Peptides
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