Is mild asymptomatic left ventricular systolic dysfunction always predictive of adverse events in high‐risk populations? Insights from the DAVID‐Berg study

Gori, Mauro; Redfield, Margaret M.; Calabrese, Alice; Canova, Paolo; Cioffi, Giovanni; Maria, Renata De; Grosu, Aurelia; Fontana, Alessandra; Iacovoni, Attilio; Parati, Gianfranco; Gavazzi, Antonello; Senni, Michele

doi:10.1002/ejhf.1298

Cited by 14 publications

(9 citation statements)

References 48 publications

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“…Progression from HFmrEF to HFrEF is an ominous prognostic sign as well as having neurohormonal activation and/or multiple echocardiographic signs of LV systolic and diastolic dysfunction. 171,172,175,178,179 Retrospective analyses of clinical trials suggest that the response to treatment of the patients with HFmrEF is similar to that of those with HFrEF with favourable effects on outcomes of beta blockers, ARB, such as candesartan ( Figure 5), mineralocorticoid receptor antagonists, such as spironolactone, and even digoxin. 45,156,[180][181][182] More recently, these results were confirmed by the Prospective comparison of ARNI with angiotensin-receptor blockers Global Outcomes in HFpEF (PARADIGM-HF) with the patients' subgroup with a LVEF <57%, median value, having a decrease in major events with sacubitril/valsartan.…”

Section: Heart Failure With Mid-range Ejection Fractionmentioning

confidence: 99%

Highlights in heart failure

et al. 2019

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Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in studies in patients hospitalized for acute HF. More recently, DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 (SGLT2) inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HFpEF research are summarized and reviewed in this article.A multiparametric approach is often proposed for risk stratification of HF patients. The prognostic accuracy of the metabolic exercise test data combined with cardiac and kidney indexes risk score was found as superior to the HF Survival Score and Seattle HF model risk scores in a cohort of 6112 1106 D. Tomasoni et al.

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Section: Heart Failure With Mid-range Ejection Fractionmentioning

confidence: 99%

Highlights in heart failure

et al. 2019

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“…Mild asymptomatic LVSD (ALVSD) might be a predictor of adverse events mainly in subjects with combined DD [26]. Higher LVmass, wall thickness, and internal dimensions are associated with increased HF risk [39].…”

Section: H F P E Fmentioning

confidence: 99%

Unraveling diagnostic co-morbidity makeup of each HF category as characteristically derived by ECG- and ECHO-findings

Zaman

Calcagno

Zoccai

et al. 2021

Preprint

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Heart Failure (HF) relies mainly on measurements from Echocardiography, in particular Echo-Findings, to estimate Left Ventricle Ejection Fraction (LVEF) and evaluating structural heart disease criteria. As Echocardiography is not available in primary care, the key structural (heart chamber enlargements) and functional abnormality related measurements are not available precluding the ability to diagnose HF other than through mainly symptomatic means. The opportunity for earlier detection of HF is lost. In this work, we first explore each of the three HF categories, preserved EF, mild-reduced EF, and reduced EF, using various morphological and functional etiology-specific characteristics supported by a literature review and an extensive analysis of a large, dedicated database accumulated over 8 years. We then explore the typical signs and co-morbidities of HF using prevalence analysis to unravel the diagnostic makeup of each HF category as characteristically derived by ECG- and ECHO-findings. From this, we then conduct a principal component analysis (PCA) of the data to interpret patterns of comorbidities, showing groups of comorbidities frequently associated with each other. Lastly, we delve into the role of breakthrough methods for the analysis of bio-signals to replicate common ECHO-findings, as alternatives for detecting and diagnosing HF similarly to Echocardiography, thereby providing a simple device for the effective detection of HF for use in Primary Care.

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“…The characteristics of the Detection of Asymptomatic VentrIcular Dysfunction in Bergamo (DAVID-Berg) study have been previously published. [10][11][12][13] Briefly, the DAVID-Berg was a prospective cohort study carried out at three primary care group practices in Bergamo, Italy. In 2008, each primary care physician reviewed the clinical records of all subjects aged 55-80 years (n ¼ 4047).…”

Section: Study Populationmentioning

confidence: 99%

“…NT-proBNP was measured with a point of care competitive enzyme immunoassay (Cobas h232 Roche Diagnostic). According to the DAVID-Berg study and previous literature, 13,14 we considered abnormally high NT-proBNP values greater than age-/sex-specific 80th percentiles, as both sex and age significantly impact NT-proBNP plasma values (Supplementary Material Figure ). As a sensitivity analysis, we have also used a single cut-point of NT-proBNP equal to 180 ng/l.…”

Section: Np Assessmentmentioning

confidence: 99%

Integrating natriuretic peptides and diastolic dysfunction to predict adverse events in high-risk asymptomatic subjects

Gori

Lam

D’Elia

et al. 2020

European Journal of Preventive Cardiology

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Background Natriuretic peptides and diastolic dysfunction have prognostic value in asymptomatic subjects at risk for heart failure. Their integration might further refine the risk stratification process in this setting. Aim of this paper was to explore the possibility to predict heart failure and death combining diastolic dysfunction and natriuretic peptides in an asymptomatic population at risk for heart failure. Methods Among 4047 subjects aged ≥55/≤80 years followed by 10 general practitioners in Italy, the DAVID-Berg study prospectively enrolled 623 asymptomatic outpatients at increased risk for heart failure. Baseline evaluation included electrocardiogram, echocardiogram, and natriuretic peptides collection. Based on diastolic dysfunction and natriuretic peptides, subjects were classified in four groups: control group (no diastolic dysfunction/normal natriuretic peptides, 57%), no diastolic dysfunction/high natriuretic peptides (9%), diastolic dysfunction/normal natriuretic peptides (24%), and diastolic dysfunction/high natriuretic peptides (11%). We applied Cox multivariable and Classification and Regression Tree analyses. Results The mean age of the population was 69 ± 7 years, 44% were women, mean left ventricular ejection fraction was 61%, and 35% had diastolic dysfunction. During a median follow-up of 5.7 years, 95 heart failure/death events occurred. Overall, diastolic dysfunction and natriuretic peptides were predictive of adverse events (respectively, hazard ratio 1.91, confidence interval 1.19–3.05, padjusted = 0.007, and hazard ratio 2.25, confidence interval 1.35–3.74, padjusted = 0.002) with Cox analysis. However, considering the four study subgroups, only the group with diastolic dysfunction/high natriuretic peptides had a significantly worse prognosis compared to the control group (hazard ratio 4.48, confidence interval 2.31–8.70, padjusted < 0.001). At Classification and Regression Tree analysis, diastolic dysfunction/high natriuretic peptides was the strongest prognostic factor (risk range 24–58%). Conclusions The DAVID-Berg data suggest that we look for the quite common combination of diastolic dysfunction/high natriuretic peptides to correctly identify asymptomatic subjects at greater risk for incident heart failure/death, thus more suitable for preventive interventions.

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Is mild asymptomatic left ventricular systolic dysfunction always predictive of adverse events in high‐risk populations? Insights from the DAVID‐Berg study

Cited by 14 publications

References 48 publications

Highlights in heart failure

Highlights in heart failure

Unraveling diagnostic co-morbidity makeup of each HF category as characteristically derived by ECG- and ECHO-findings

Integrating natriuretic peptides and diastolic dysfunction to predict adverse events in high-risk asymptomatic subjects

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