Risk of Progression for Asymptomatic LV Dysfunction to Overt Heart Failure
What is the risk of progression for systolic or diastolic asymptomatic left ventricular dysfunction (ALVD) to overt heart failure (HF)?
The study authors included cohort studies reporting on the progression from asymptomatic LV (ALVSD) or diastolic dysfunction (ALVDD) to overt HF following a systematic search of MEDLINE and EMBASE databases. Using a random-effects model meta-analysis, they pooled effect estimates (prevalence, incidence, and relative risk [RR]), separately for systolic and diastolic dysfunction. They assessed heterogeneity with the I2 statistic (in general, I2 values of 25% or less, 50%, and 75% or more represent low, moderate, and high level of heterogeneity, respectively).
The study authors included 13 reports in this meta-analysis, based on 11 distinct studies of progression of ALVSD assessing a total of 25,369 participants followed for 7.9 years on average. They found that absolute risks (95% confidence interval [CI]) of progression to HF were 8.4 per 100 person-years (95% CI, 4.0-12.8) for those with ALVSD, 2.8 per 100 person-years (95% CI, 1.9-3.7) for those with ALVDD, and 1.04 per 100 person-years (95% CI, 0.0-2.2) without any ventricular dysfunction evident). The combined maximally adjusted RR of HF for ALVSD was 4.6 (95% CI, 2.2-9.8), and that of ALVDD was 1.7 (95% CI, 1.3-2.2). These results suggest that risk of progression to overt HF (stage C) is increased by 70-500%.
The authors concluded that ALVSD and ALVDD are each associated with a substantial risk for incident HF, indicating an imperative to develop effective intervention at these stages.
This is an important study because it reiterates the fact that asymptomatic LVD is not benign. Clinical trials are required to determine how best to identify and treat such patients, given the high absolute and relative risk of progression from ALVD to overt HF.
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