The Incremental Prognostic Value of Echocardiography in Asymptomatic Stage A Heart Failure

Should African–Americans with elevated blood pressure be routinely screened for hypertensive heart disease?

“…Conversely, data derived from predominantly white and mostly (though not exclusively) hypertensive individuals without established cardiovascular disease suggest a prevalence of subclinical diastolic dysfunction that is nearly threefold lower (25-35%) [9,10]. Moreover, when diastolic dysfunction is present, it appears to be tightly aligned with LV mass, exhibiting mathematical and biological collinearity with more limited potential for reclassification of risk [16].…”

“…Consequently, initial screening with ECG would lead to underdiagnosis of LV hypertrophy in many patients. Moreover, it would preclude the use of tissue Doppler, thereby limiting the ability to accurately identify diastolic dysfunction, a myocardial abnormality of evolving clinical and prognostic significance in asymptomatic hypertensive patients that can exist without an objectively defined increased LV mass [4,9,10].…”

Entendendo a disfunção diastólica assintomática na prática clínica

“…Although the echocardiographic parameters used to assess diastolic function and LVEF are influenced by changes in preload and afterload, these indexes are widely used for the assessment of systolic and diastolic function 43 .…”

Screening echocardiograms in a senior focused value based primary care improves systolic heart failure detection and clinical management

“…The second study, Carerj et al (5) performed a screening echocardiogram to 1,097 middle age asymptomatic subjects in Italy, classified them according to their cardiovascular risk factor burden and followed them for 2.5 years to determine cardiovascular outcomes. The study found a prevalence of systolic HF that ranged from 8%-15% with increasing risk factor burden and that this new systolic heart failure was predictive of cardiovascular outcomes.…”

“…Screening echocardiograms in a senior focused value based primary care improves systolic heart failure detection and clinical management for natriuretic peptides (3)(4)(5). Nevertheless, the Affordable Care Act emphasizes the provision of preventive patientcentered care, raising the question of the role that screening echocardiograms may have in risk-stratification and prevention of major adverse cardiovascular events among older adults receiving primary care.…”