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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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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