Cited by 633Cardiovascular Function and Risk FactorsHeart Failure Treatment and ManagementCardiomyopathy and Myosin Studies

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Natural History of Asymptomatic Left Ventricular Systolic Dysfunction in the Community

Wang, Thomas J., Evans, Jane C., Benjamin, Emelia J., Levy, Daniel, LeRoy, Elizabeth C., Vasan, Ramachandran S.·2003·Circulation

DOI 10.1161/01.cir.0000085166.44904.79

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Abstract

Background— Information is limited regarding the rates of progression to congestive heart failure (CHF) and death in individuals with asymptomatic left ventricular systolic dysfunction (ALVD). We sought to characterize the natural history of ALVD, by studying unselected individuals with this condition in the community. Methods and Results— We studied 4257 participants (1860 men) from the Framingham Study who underwent routine echocardiography. The prevalence of ALVD (visually estimated ejection fraction [EF]≤50% without a history of CHF) was 6.0% in men and 0.8% in women. During up to 12 years of follow-up, rates of CHF among subjects with normal left ventricular systolic function (EF >50%, n=4128) and ALVD (n=129) were 0.7 and 5.8 per 100 person-years, respectively. After adjustment for cardiovascular disease risk factors, ALVD was associated with a hazards ratio (HR) for CHF of 4.7 (95% CI 2.7 to 8.1), compared with individuals without ALVD. An elevated risk of CHF after ALVD was observed even in individuals without prior myocardial infarction or valvular disease, with an adjusted HR of 6.5 (CI 3.1 to 13.5). Mild ALVD (EF 40% to 50%, n=78) and moderate-to-severe ALVD (EF <40%, n=51) were associated with adjusted HRs for CHF of 3.3 (CI 1.7 to 6.6) and 7.8 (CI 3.9 to 15.6), respectively. ALVD was also associated with an increased mortality risk (adjusted HR 1.6, CI 1.1 to 2.4). The median survival of ALVD subjects was 7.1 years. Conclusion— Individuals with ALVD in the community are at high risk of CHF and death, even when only mild impairment of EF is present. Additional studies are needed to define optimal therapy for mild ALVD.

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The natriuretic peptides in cardiovascular medicine
Munagala, V. K., BURNETTJR, J., & Redfield, M. M. (2004) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2004.07.002 · Cited by 151
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
“Further sensitivity analyses demonstrated consistent model performance on ECGs: (1) without a prolonged PR interval (AUROC, 0.”
Method
Type 2 diabetes mellitus and heart failure, a scientific statement from the American Heart Association and Heart Failure Society of America
Dunlay, S. M., Givertz, M. M., Aguilar, D., Allen, L. A., Chan, M., Desai, A. S., Deswal, A., Dickson, V. V., Kosiborod, M. N., Lekavich, C. L., et al. (2019) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2019.05.007 · Cited by 145
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Advances in Multimodality Imaging in Cardio-Oncology
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Predictors and Outcomes of Heart Failure with Mid-Range Ejection Fraction
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Self-citation
Risk factors for heart failure
Kenchaiah, S., Narula, J., & Vasan, R. S. (2004) · Medical Clinics of North America · doi:10.1016/j.mcna.2004.04.016 · Cited by 136
“Natriuretic peptides also are correlated with increased LV mass and systolic dysfunction [213–215], known precursors of HF [139,140].”
BackgroundSelf-citation
CD36 Expression Contributes to Age-Induced Cardiomyopathy in Mice
Koonen, D. P. Y., Febbraio, M., Bonnet, S., Nagendran, J., Young, M. E., Michelakis, E. D., & Dyck, J. R. B. (2007) · Circulation · doi:10.1161/circulationaha.107.712901 · Cited by 137
Both aerobic exercise and resveratrol supplementation attenuate doxorubicin-induced cardiac injury in mice
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Left Ventricular Dysfunction in Patients Receiving Cardiotoxic Cancer Therapies
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Biomarkers for heart failure: small molecules with high clinical relevance
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Functional measurements based on feature tracking of cine magnetic resonance images identify left ventricular segments with myocardial scar
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“Unless compensated for by hyperkinetic wall motion in remote areas, the physiological effect of a WMA is a reduction in the left ventricular ejection fraction (LVEF) which is closely related to prognosis in chronic coronary artery disease [7-11].”
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Meta-Analysis of the Prognostic Role of Late Gadolinium Enhancement and Global Systolic Impairment in Left Ventricular Noncompaction
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Left Ventricular Ejection Fraction
Fonarow, G. C., & Hsu, J. J. (2016) · JACC Heart Failure · doi:10.1016/j.jchf.2016.03.021 · Cited by 117
The Influence of Rheumatoid Arthritis Disease Characteristics on Heart Failure
Myasoedova, E., Crowson, C. S., Nicola, P., Kremers, H. M., Davis, J. M., Roger, V. L., Therneau, T. M., & Gabriel, S. E. (2011) · The Journal of Rheumatology · doi:10.3899/jrheum.100979 · Cited by 116
“Medications were modeled 2 ways: (1) as use at any time where the time-dependent covariates reflected medication start dates only; and (2) as current use where the time-dependent covariates represented the time each patient was taking each medication, beginning at start date and ending at stop date for each medication.”
Method
Prevalence of Preclinical and Clinical Heart Failure in the Elderly. A Population-Based Study in Central Italy
Mureddu, G. F., Agabiti, N., Rizzello, V., Forastiere, F., Latini, R., Cesaroni, G., Masson, S., Cacciatore, G., Colivicchi, F., Uguccioni, M., et al. (2012) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfs052 · Cited by 118
Incremental Prognostic Value of Myocardial Fibrosis in Patients With Non–Ischemic Cardiomyopathy Without Congestive Heart Failure
Masci, P. G., Doulaptsis, C., Bertella, E., Torto, A. D., Symons, R., Pontone, G., Barison, A., Droogné, W., Andreini, D., Lorenzoni, V., et al. (2014) · Circulation Heart Failure · doi:10.1161/circheartfailure.113.000996 · Cited by 116
Prognosis of Individuals With Asymptomatic Left Ventricular Systolic Dysfunction in the Multi-Ethnic Study of Atherosclerosis (MESA)
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Guías de Práctica Clínica sobre el diagnóstico y tratamiento de la insuficiencia cardíaca crónica. Versión resumida (actualización 2005)
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“Congestive heart failure (CHF) remains to be one of the major cardiovascular disorders in the world”
Background
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Self-citation
Trastuzumab-induced cardiotoxicity in early breast cancer patients: a retrospective study of possible risk and protective factors
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Left Ventricular Function Assessed by Two-Dimensional Speckle Tracking Echocardiography in Long-Term Survivors of Hodgkin's Lymphoma Treated by Mediastinal Radiotherapy With or Without Anthracycline Therapy
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Arterial Stiffness Is Associated With Regional Ventricular Systolic and Diastolic Dysfunction
Fernandes, V., Polak, J. F., Cheng, S. C., Rosen, B. D., Carvalho, B. S., Nasir, K., McClelland, R. L., Hundley, G. W., Pearson, G., O’Leary, D. H., et al. (2007) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.107.156950 · Cited by 107
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“Yet, a notable 62% of patients with asymptomatic LVEF decline who developed CHF had a history of baseline or interval myocardial infarction.(14) However, in the oncology setting, the association between asymptomatic LVEF decline and CHF is”
Background
Screening the population for left ventricular hypertrophy and left ventricular systolic dysfunction using natriuretic peptides: Results from the Dallas Heart Study
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“0 25 (3-65) 94 (91-96) 7 (1-24) 98 (97-99) Black 688 8.”
Influential
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Association of Cardiorespiratory Fitness With Left Ventricular Remodeling and Diastolic Function
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Subclinical Atherosclerosis and Incipient Regional Myocardial Dysfunction in Asymptomatic Individuals
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“Because asymptomatic global LV dysfunction is considered to be a subclinical marker of heart failure because of its frequent progression to symptomatic CHF ( 25 ,26), the IMT-related alterations of regional LV function reported in this study could represent the earliest signs of myocardial functional impairment in the…”
Background
Phosphinic peptides as zinc metalloproteinase inhibitors
Dive, V., Georgiadis, D., Matziari, M., Makaritis, A., Beau, F., Cuniasse, P., & Yiotakis, A. (2004) · Cellular and Molecular Life Sciences · doi:10.1007/s00018-004-4050-y · Cited by 103
Long-Term Survival of Incident Hemodialysis Patients Who Are Hospitalized for Congestive Heart Failure, Pulmonary Edema, or Fluid Overload
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A Comparison between QLAB and TomTec Full Volume Reconstruction for Real Time Three‐Dimensional Echocardiographic Quantification of Left Ventricular Volumes
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“The original intention of the analysis was to develop a risk score using the available clinical variables.”
Method
ECG AI-Guided Screening for Low Ejection Fraction (EAGLE): Rationale and design of a pragmatic cluster randomized trial
Yao, X., McCoy, R. G., Friedman, P. A., Shah, N. D., Barry, B. A., Behnken, E. M., Inselman, J. W., Attia, Z. I., & Noseworthy, P. A. (2020) · American Heart Journal · doi:10.1016/j.ahj.2019.10.007 · Cited by 98
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Wong, C. M., Hawkins, N. M., Petrie, M. C., Jhund, P. S., Gardner, R. S., Ariti, C. A., Poppe, K., Earle, N. J., WHALLEY, G. A., Squire, I. B., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu216 · Cited by 98
Dabigatran Compared with Warfarin in Patients with Atrial Fibrillation and Symptomatic Heart Failure: A Subgroup Analysis of the RE-LY Trial
Ferreira, J., Ezekowitz, M. D., Connolly, S. J., Brueckmann, M., Fraessdorf, M., Reilly, P. A., Yusuf, S., & Wallentin, L. C. (2013) · European Journal of Heart Failure · doi:10.1093/eurjhf/hft111 · Cited by 96
Left Ventricular Assist Devices Are Underutilized
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Authors: Wang, T. J., Evans, J. C., Benjamin, E. J., Levy, D., LeRoy, E. C., & Vasan, R. S.
Affiliations: Boston University (US)
ORCID: Wang, Thomas J.
Benjamin, Emelia J.
Levy, Daniel
Vasan, Ramachandran S.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2003-08-26
Volume: 108
Issue: 8
Pages: 977-982
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.0000085166.44904.79
OpenAlex: W2095689312
Semantic Scholar: c0b4cca1f7420447dfabc94c7398e07a3c8a6163
Cited by: 633
References: 24
Citations by year: 2026: 21 · 2025: 21 · 2024: 28 · 2023: 22 · 2022: 20 · 2021: 45 · 2020: 31 · 2019: 36 · 2018: 29 · 2017: 39 · 2016: 32 · 2015: 21 · 2014: 28 · 2013: 37 · 2012: 36
FWCI: 11.05
Type: journal article
Language: en
Open access: closed
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5k23hl074077-03, 5k24hl004334-08, n01hc25195-41-0-1, 5r01ns017950-40)
National Heart, Lung, and Blood Institute (K23 HL074077-01, K24-HL-04334-01A1, N01‐HC25195)
National Institute of Neurological Disorders and Stroke (5-R01-NS-17950)
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
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
Keywords: natural history (disease), congestive heart failure, mortality risk, ejection fraction, Framingham Heart Study, community-based cohort, disease progression
MeSH terms: Adult, Aged, Aged, 80 and over, Echocardiography, Female, Follow-Up Studies, Heart Failure, Humans, Male, Massachusetts, Middle Aged, Risk Factors, Stroke Volume, Systole, Cohort Studies, Comorbidity, Incidence, Prevalence, Survival Rate, Proportional Hazards Models, Age of Onset, Age Distribution, Disease Progression, Ventricular Dysfunction, Left, Risk Assessment, Disease-Free Survival

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Natural History of Asymptomatic Left Ventricular Systolic Dysfunction in the Community

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