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Community Screening for Nonischemic Cardiomyopathy in Asymptomatic Subjects ≥65 Years With Stage B Heart Failure

journal contribution
posted on 2023-05-18, 19:58 authored by Yang, H, Wang, Y, Nolan, M, Kazuaki Negishi, Okin, PM, Thomas MarwickThomas Marwick
A process to identify and target a selected population at risk of heart failure (HF) could facilitate screening and prevention. We sought to develop an effective screening process from clinical characteristics, functional capacity, and electrocardiogram (ECG). Asymptomatic subjects ≥65 years, with ≥1 HF risks were recruited from the community. Subjects with valvular disease, ejection fraction <40%, and atrial fibrillation were excluded. All underwent clinical evaluation including assessment of HF risk using Framingham HF score and Atherosclerosis Risk in Communities (ARIC) score, ECG, echocardiography, and 6-minute walk (6 MW) test. After 14 ± 4 months, new HF was assessed using Framingham criteria. A randomly selected derivation cohort was used to integrate ARIC score and 6 MW in a classification and regression tree (CART) analysis, with the remaining population used for validation. Of the 419 subjects (age 70 ± 5; 48% men), 52 developed HF. ARIC was more effective than the Framingham HF score (area under the curve 0.65 vs 0.53, p = 0.01). CART selected ARIC (>9.5%) and 6 MW (<501 m) as cutoffs to define low-, intermediate-, and high-risk groups. Abnormal ECG further divided the intermediate group into high and low risks. The 134 subjects identified as high risk by a combined clinical and electrocardiographic strategy showed more echocardiographic features of cardiac dysfunction including LV mass, mitral e', mitral E/e', and longitudinal strain (p <0.01). New HF was significantly more frequent than in the remaining patients (20% vs 10%, p = 0.003; hazard ratio 2.08, 95% confidence interval 1.21 to 3.57, p = 0.008). Thus, initial clinical risk and electrocardiographic assessment facilitate effective HF screening by identifying a high-risk group.

History

Publication title

The American Journal of Cardiology

Volume

117

Issue

12

Pagination

1959-1965

ISSN

0002-9149

Department/School

Menzies Institute for Medical Research

Publisher

Elsevier Inc.

Place of publication

United States

Rights statement

? 2016 Elsevier Inc. All rights reserved.

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

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