The DOI matches its Crossref record; 24 of the 24 references it cites were found in a registry or an index.
Natural History of Asymptomatic Left Ventricular Systolic Dysfunction in the Community
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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“Moreover, there are no strategies to identify individuals at risk of developing SHDs, despite the presence of evidence-based interventions that can alter the course of patients.6-8”
From Ensemble Deep Learning Algorithm for Structural Heart Disease Screening Using Electrocardiographic Images (2025) · cites this paper as [8]
In the citing paper
“Recent guidelines have a notable emphasis on the detection of asymptomatic ventricular dysfunction (“stage B heart failure”) as part of efforts to understand and prevent overt heart failure.61”
From The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective (2014) · cites this paper as [61]
Citations
Cites
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Burden of Systolic and Diastolic Ventricular Dysfunction in the Community
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Levy, D., Kenchaiah, S., Larson, M. G., Benjamin, E. J., Kupka, M. J., Ho, K. K. L., Murabito, J. M., & Vasan, R. S. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa020265 · Cited by 2,152
Self-citationEpidemiological approaches to heart disease: the Framingham study
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McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O. D., et al. (2021) · PubMed · doi:10.1093/eurheartj/ehab670 · Cited by 20,604
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., Falk, V., González-Juanatey, J. R., Harjola, V.-P., Jankowska, E. A., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw128 · Cited by 11,429
2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., Falk, V., González-Juanatey, J. R., Harjola, V.-P., Jankowska, E. A., et al. (2016) · European Journal of Heart Failure · doi:10.1002/ejhf.592 · Cited by 5,866
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001063 · Cited by 4,922
ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008
Dickstein, K., Authors Task Force Members, Solal, A. C., Filippatos, G. S., McMurray, J. J. V., Ponikowski, P. P., Poole-Wilson, P. A., Strömberg, A., van Veldhuisen, D. J., Atar, D., et al. (2008) · European Journal of Heart Failure · doi:10.1016/j.ejheart.2008.08.005 · Cited by 3,535
Metadata
- Authors
- Wang, T. J., Evans, J. C., Benjamin, E. J., Levy, D., LeRoy, E. C., & Vasan, R. S.
- Affiliations
- Boston University (US)
- Venue
- Circulation
- Published
- 2003-08-26
- Volume
- 108
- Issue
- 8
- Pages
- 977-982
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- 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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