Prevalence of Asymptomatic Left Ventricular Systolic Dysfunction in At-risk Medical Inpatients

• Published in: The American journal of medicine Vol. 126; no. 1; pp. 68 - 73
• Main Authors: Martin, L. David, MD, Mathews, Simon, MD, Ziegelstein, Roy C., MD, Martire, Carol, RDCS, Howell, Eric E., MD, Hellmann, David B., MD, Hirsch, Glenn A., MD, MHS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2013; Elsevier Sequoia S.A
• Subjects: Age; Aged; Aged, 80 and over; Asymptomatic Diseases - epidemiology; Baltimore - epidemiology; Cardiology; Clinical outcomes; Echocardiography; Epidemiology; Female; Hand-carried ultrasound; Heart failure; Humans; Inpatients - statistics & numerical data; Internal Medicine; Male; Middle Aged; Portable ultrasound; Prevalence; Risk Factors; Systole; Systolic function; Ultrasonic imaging; Ventricular Dysfunction, Left - epidemiology; Baltimore; Heart failure; Hand-carried ultrasound; Echocardiography; Epidemiology; Systolic function; Portable ultrasound
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2012.06.020

Abstract Background Asymptomatic left ventricular systolic dysfunction is an important risk factor for heart failure and death. Given the availability of patients, trained personnel, and equipment, the hospital is an ideal setting to identify and initiate treatment for left ventricular systolic dysfunction. The purpose of this study was to determine the prevalence of asymptomatic left ventricular systolic dysfunction in patients 45 years of age or older with at least one clinical heart failure risk factor admitted to a general medical service. Methods Bedside, hand-carried echocardiography provided quantitative assessment of left ventricular systolic function in 217 medical inpatients 45 years of age or older who had at least one heart failure risk factor. Patients with known or suspected heart failure or with an assessment of left ventricular function in the past 5 years were excluded. We measured the prevalence of asymptomatic left ventricular systolic dysfunction, defined by left ventricular ejection fraction of 50% or lower, and its association with heart failure risk factors. Results Of 207 patients with interpretable images, 11 (5.3%) had a left ventricular ejection fraction of 50% or lower. Patients with left ventricular systolic dysfunction had more heart failure risk factors than those without left ventricular systolic dysfunction (3.09 ± 0.8 vs 2.5 ± 1.0, P = .04). The total number of heart failure risk factors trended towards an association with a greater prevalence of asymptomatic left ventricular systolic dysfunction, but this did not reach significance (odds ratio 1.74; 95% confidence interval, 0.97-3.12, P = .06). Conclusions Asymptomatic left ventricular systolic dysfunction is present in about 1 of every 20 general medical inpatients with at least one risk factor for heart failure. Because treatment of asymptomatic left ventricular systolic dysfunction may reduce morbidity, further studies examining the costs and benefits of using hand-carried ultrasound to identify this important condition in general medical inpatients are warranted.