The Epidemiology of Asymptomatic Left Ventricular Systolic Dysfunction: Implications for Screening

Wang, Thomas J.; Levy, Daniel; Benjamin, Emelia J.; Vasan, Ramachandran S.

doi:10.7326/0003-4819-138-11-200306030-00012

Cited by 229Heart Failure Treatment and ManagementCardiovascular Function and Risk FactorsCardiac Imaging and Diagnostics

The Epidemiology of Asymptomatic Left Ventricular Systolic Dysfunction: Implications for Screening

Wang, Thomas J., Levy, Daniel, Benjamin, Emelia J., Vasan, Ramachandran S.·2003·Annals of Internal Medicine

DOI 10.7326/0003-4819-138-11-200306030-00012

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Abstract

Congestive heart failure is a progressive disorder that is frequently preceded by asymptomatic left ventricular systolic dysfunction. We reviewed the epidemiology, diagnosis, and natural history of asymptomatic left ventricular systolic dysfunction and evaluated community-wide screening for this condition as a potential strategy to reduce the incidence of heart failure. Asymptomatic left ventricular systolic dysfunction has an estimated prevalence of 3% to 6%, and is at least as common in the community as systolic heart failure. Because it often occurs in the absence of known cardiovascular disease, this condition may go unrecognized and undertreated. In randomized trials, individuals with asymptomatic left ventricular systolic dysfunction have high rates of incident heart failure and death. However, little is known about the prognosis of individuals with this condition in the community, who have a substantially lower prevalence of myocardial infarction, have milder degrees of systolic dysfunction, and are older than patients enrolled in clinical trials. Current evidence is inadequate to support community-wide screening for asymptomatic left ventricular systolic dysfunction, either with echocardiography or with assays for natriuretic peptides. Given the increasing prevalence of heart failure, additional studies are needed to develop effective strategies to detect and optimally manage individuals with asymptomatic left ventricular dysfunction in the community.

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Asymptomatic left ventricular systolic dysfunction is estimated to affect approximately 3-6% of the general population and is associated with a substantially increased risk of progression to overt heart failure.
“Asymptomatic left ventricular systolic dysfunction is estimated to affect approximately 3–6% of the general population and is associated with a substantially increased risk of progression to overt heart failure.4”
From AI-ECG for Echocardiography Triage in Structural Heart Disease: Evidence, Implementation, and Future Directions (2026) · cites this paper as [4]
Early diagnosis of low EF, particularly in asymptomatic patients, is critical in reducing lifetime risk of morbidity and mortality.
“Early diagnosis of low EF, particularly in asymptomatic patients, is critical in reducing lifetime risk of mobility and mortality.[15][16][17]”
From Clinician Adoption of an Artificial Intelligence Algorithm to Detect Left Ventricular Systolic Dysfunction in Primary Care. (2022) · cites this paper as [17]
LVSD is frequently diagnosed only after patients develop symptomatic disease due to the lack of effective screening strategies.
“but LVSD is frequently diagnosed only after patients develop symptomatic disease due to the lack of effective screening strategies5–7.”
From Detection of left ventricular systolic dysfunction from single-lead electrocardiography adapted for portable and wearable devices (2023) · cites this paper as [5]

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Plasma Natriuretic Peptide Levels and the Risk of Cardiovascular Events and Death
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Predicting Heart Failure With Preserved and Reduced Ejection Fraction
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Subclinical Late Cardiomyopathy After Doxorubicin Therapy for Lymphoma in Adults
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Assessment of Conventional Cardiovascular Risk Factors and Multiple Biomarkers for the Prediction of Incident Heart Failure and Atrial Fibrillation
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Self care in patients with chronic heart failure
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Monitoring for Cardiovascular Disease in Survivors of Childhood Cancer: Report From the Cardiovascular Disease Task Force of the Children's Oncology Group
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Plasma Brain Natriuretic Peptide to Detect Preclinical Ventricular Systolic or Diastolic Dysfunction
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Effect of kidney transplantation on left ventricular systolic dysfunction and congestive heart failure in patients with end-stage renal disease
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Epidemiology of the inherited cardiomyopathies
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Prognostic Value of Echocardiographic Indicators of Left Ventricular Systolic Function in Asymptomatic Dialysis Patients
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10-Year Risk Equations for Incident Heart Failure in the General Population
Khan, S. S., Ning, H., Shah, S. J., Yancy, C. W., Carnethon, M. R., Berry, J. D., Mentz, R. J., O'Brien, E. C., Correa, A., Suthahar, N., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.02.057 · Cited by 199 · see citing works
Left Ventricular Systolic Dysfunction and the Risk of Ischemic Stroke in a Multiethnic Population
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Evidence based diagnostics
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Assessing the Risk of Progression From Asymptomatic Left Ventricular Dysfunction to Overt Heart Failure
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Detection of Left Ventricular Systolic Dysfunction From Electrocardiographic Images
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Systolic and Diastolic Heart Failure: Differences and Similarities
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Hand-carried Ultrasound Performed by Hospitalists: Does It Improve the Cardiac Physical Examination?
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Mechanisms of Diastolic Dysfunction in Heart Failure
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Precision wearable accelerometer contact microphones for longitudinal monitoring of mechano-acoustic cardiopulmonary signals
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Mendelian Randomization Study of B-Type Natriuretic Peptide and Type 2 Diabetes: Evidence of Causal Association from Population Studies
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Anti-Remodelling Effect of Canrenone in Patients with Mild Chronic Heart Failure (AREA IN-CHF study): Final Results
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Prognosis of Individuals With Asymptomatic Left Ventricular Systolic Dysfunction in the Multi-Ethnic Study of Atherosclerosis (MESA)
Yeboah, J., Rodríguez, C. J., Stacey, B. R., Lima, J. A. C., Liu, S., Carr, J. J., Hundley, W. G., & Herrington, D. M. (2012) · Circulation · doi:10.1161/circulationaha.112.112201 · Cited by 113 · see citing works
The Role of N-terminal PRO-Brain Natriuretic Peptide and Echocardiography for Screening Asymptomatic Left Ventricular Dysfunction in a Population at High Risk for Heart Failure. The PROBE-HF Study
Betti, I., Castelli, G., Barchielli, A., Beligni, C., Boscherini, V., Luca, L. D., Messeri, G., Gheorghiade, M., Maisel, A., & Zuppiroli, A. (2009) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2008.12.002 · Cited by 109 · see citing works
Diagnosis of Nonischemic Stage B Heart Failure in Type 2 Diabetes Mellitus
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Personalised cancer follow-up: risk stratification, needs assessment or both?
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“However, incidence is low and there is no evidence yet that presymptomatic treatment affects outcome (Wang et al, 2003) so this condition does not fulfil our criteria for risk assessment at present.”
Background
Long-Term Outcome of Patients with Acromegaly and Congestive Heart Failure
Bihan, H., Espinosa, C., Valdés-Socin, H., Salenave, S., Young, J., Levasseur, S., Assayag, P., Beckers, A. M., & Chanson, P. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-0821 · Cited by 106 · see citing works
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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Multicenter Evaluation of Plasma N-Terminal Probrain Natriuretic Peptide (NT-pro BNP) as a Biochemical Screening Test for Asymptomatic (occult) Cardiomyopathy in Cats
Fox, P. R., Rush, J. E., Reynolds, C., DeFrancesco, T. C., Keene, B. W., Atkins, C. E., Gordon, S. G., Schober, K. E., Bonagura, J. D., Stepien, R. L., et al. (2011) · Journal of Veterinary Internal Medicine · doi:10.1111/j.1939-1676.2011.00776.x · Cited by 101 · see citing works
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 · see citing works
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Echocardiographic Screening for Non-Ischaemic Stage B Heart Failure in the Community
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Obesity cardiomyopathy: diagnosis and therapeutic implications
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Cardiovascular Considerations Before Cancer Therapy
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The Effect of Right Ventricular Apical and Nonapical Pacing on the Short‐ and Long‐Term Changes in Left Ventricular Ejection Fraction: A Systematic Review and Meta‐Analysis of Randomized‐Controlled Trials
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Association of Novel Biomarkers of Cardiovascular Stress With Left Ventricular Hypertrophy and Dysfunction: Implications for Screening
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Myocardial dysfunction in rheumatoid arthritis: epidemiology and pathogenesis.
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Cost-effectiveness of cardiac resynchronization therapy in patients with asymptomatic to mild heart failure: insights from the European cohort of the REVERSE (Resynchronization Reverses remodeling in Systolic Left Ventricular Dysfunction)
Linde, C. M., Mealing, S., Hawkins, N., Eaton, J., Brown, B., Daubert, C., & on behalf of the REVERSE study group (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq408 · Cited by 69 · see citing works
Amino-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity C-Reactive Protein as Predictors of Sudden Cardiac Death Among Women
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Effects of diabetes mellitus and ischemic heart disease on the progression from asymptomatic left ventricular dysfunction to symptomatic heart failure: a retrospective analysis from the Studies of Left Ventricular Dysfunction (SOLVD) Prevention trial
Das, S. R., Drazner, M. H., Yancy, C. W., Stevenson, L. W., Gersh, B. J., & Dries, D. L. (2004) · American Heart Journal · doi:10.1016/j.ahj.2004.04.019 · Cited by 68 · see citing works
Asymptomatic Left Ventricular Systolic Dysfunction in Essential Hypertension
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Prognostic Cardiovascular Markers in Chronic Kidney Disease
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Biventricular Versus Right Ventricular Pacing in Patients with AV Block (BLOCK HF): Clinical Study Design and Rationale
Curtis, A. B., Adamson, P. B., Chung, E. S., Sutton, M. S. J., Tang, F. R., & WORLEY, S. J. (2007) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2007.00907.x · Cited by 59 · see citing works
Left Ventricular Dilation and Incident Congestive Heart Failure in Asymptomatic Adults Without Cardiovascular Disease: Multi-Ethnic Study of Atherosclerosis (MESA)
Yeboah, J., Bluemke, D. A., Hundley, W. G., Rodríguez, C. J., Lima, J. A. C., & Herrington, D. M. (2014) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2014.09.002 · Cited by 59 · see citing works
Epidemiology of Heart Failure
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Burden of Systolic and Diastolic Left Ventricular Dysfunction Among Hispanics in the United States
Mehta, H., Armstrong, A. D. C., Swett, K. R., Shah, S. J., Allison, M., Hurwitz, B. E., Bangdiwala, S. I., Dadhania, R., Kitzman, D. W., Argüelles, W., et al. (2016) · Circulation Heart Failure · doi:10.1161/circheartfailure.115.002733 · Cited by 56 · see citing works
Left Ventricular Systolic Function Monitoring in Asymptomatic Dialysis Patients
Zoccali, C., Benedetto, F. A., Tripepi, G. L., Mallamaci, F., Rapisarda, F., Seminara, G., Bonanno, G., & Malatino, L. (2006) · Journal of the American Society of Nephrology · doi:10.1681/asn.2005111240 · Cited by 56 · see citing works
The Dutch Childhood Oncology Group guideline for follow-up of asymptomatic cardiac dysfunction in childhood cancer survivors
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Left ventricular ejection fraction: are the revised cut-off points for defining systolic dysfunction sufficiently evidence based?
Mahadevan, G., Davis, R., Frenneaux, M. P., Hobbs, R. F., Lip, G. Y. H., Sanderson, J. E., & Davies, M. K. (2007) · Heart · doi:10.1136/hrt.2007.123877 · Cited by 56 · see citing works
Echocardiography, Natriuretic Peptides, and Risk for Incident Heart Failure in Older Adults
Kalogeropoulos, A. P., Georgiopoulou, V. V., deFilippi, C. R., Gottdiener, J. S., & Butler, J. (2012) · JACC. Cardiovascular imaging · doi:10.1016/j.jcmg.2011.11.011 · Cited by 55 · see citing works
Left Ventricular Systolic Dysfunction in Rheumatoid Disease
Bhatia, G. S., Sosin, M. D., Patel, J. V., Grindulis, K. A., Khattak, F., Hughes, E. A., Lip, G. Y. H., & Davis, R. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.10.059 · Cited by 47 · see citing works
Automated detection of low ejection fraction from a one-lead electrocardiogram: application of an AI algorithm to an electrocardiogram-enabled Digital Stethoscope
Attia, Z. I., Dugan, J., Rideout, A., Maidens, J. N., Venkatraman, S., Guo, L., Noseworthy, P. A., Pellikka, P. A., Pham, S. L., Kapa, S., et al. (2022) · European Heart Journal - Digital Health · doi:10.1093/ehjdh/ztac030 · Cited by 46 · see citing works
Natural history of dilated cardiomyopathy: from asymptomatic left ventricular dysfunction to heart failure – a subgroup analysis from the Trieste Cardiomyopathy Registry
Aleksova, A., Sabbadini, G., Merlo, M., Pinamonti, B., Barbati, G., Zecchin, M., Bussani, R., Silvestri, F., Iorio, A. M., Stolfo, D., et al. (2009) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0b013e32832bba35 · Cited by 46 · see citing works
Cost Effectiveness of an Electrocardiographic Deep Learning Algorithm to Detect Asymptomatic Left Ventricular Dysfunction
Tseng, A. S., Thao, V., Borah, B. J., Attia, I. Z., Medina‐Inojosa, J. R., Kapa, S., Carter, R. E., Friedman, P. A., López-Jiménez, F. A., Yao, X., et al. (2021) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2020.11.032 · Cited by 43 · see citing works
Prognostic efficacy of cardiac biomarkers for mortality in dialysis patients
Hickman, P. E., McGill, D. A., Talaulikar, G. S., Hiremagalur, B., Bromley, J., Rahman, A., Koerbin, G., Southcott, E., & Potter, J. M. (2009) · Internal Medicine Journal · doi:10.1111/j.1445-5994.2009.01846.x · Cited by 41 · see citing works
Heart failure is associated with reduced patency after endovascular intervention for symptomatic peripheral arterial disease
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Authors: Wang, T. J., Levy, D., Benjamin, E. J., & Vasan, R. S.
Affiliations: Boston University (US)
ORCID: Wang, Thomas J.
Levy, Daniel
Benjamin, Emelia J.
Vasan, Ramachandran S.
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2003-06-03
Volume: 138
Issue: 11
Pages: 907-916
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-138-11-200306030-00012
OpenAlex: W1489075861
Cited by: 229
References: 85
Citations by year: 2026: 6 · 2025: 7 · 2024: 6 · 2023: 6 · 2022: 9 · 2021: 8 · 2020: 6 · 2019: 10 · 2018: 4 · 2017: 7 · 2016: 7 · 2015: 10 · 2014: 9 · 2013: 12 · 2012: 11
FWCI: 2.29
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (n01hc25195-41-0-1)
National Heart, Lung, and Blood Institute (K24-HL-04334-01A1, N01‐HC25195, 1U01 HL 66582, U01HL066582, K24HL004334)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords: congestive heart failure, heart failure screening, prevalence, natural history (disease), prognosis, echocardiography, natriuretic peptides, heart failure incidence, mortality
MeSH terms: Angiotensin-Converting Enzyme Inhibitors, Female, Heart Failure, Humans, Male, Mass Screening, Research, Risk Factors, Comorbidity, Prevalence, Ventricular Dysfunction, Left

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The Epidemiology of Asymptomatic Left Ventricular Systolic Dysfunction: Implications for Screening

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