AIMS: Incident heart failure (HF) continues to pose a common and serious problem. We sought to examine the value of echocardiographic predictors of new HF in a community-based elderly population at risk for HF, independent of and incremental to clinical evaluation.

METHODS AND RESULTS: Asymptomatic patients ≥65 years old, with ≥1 HF risk factor (hypertension, type 2 diabetes, or obesity) were recruited from the community; patients with valve disease, reduced ejection fraction (EF), and atrial fibrillation (AF) were excluded. Patients underwent standard clinical evaluation including calculation of the Charlson co-morbidity score and a comprehensive echocardiography including global longitudinal strain (GLS). Functional capacity was assessed by 6 min walk test. New HF and cardiovascular death were assessed after a mean follow-up of 14 ± 4 months by three independent cardiologists using Framingham criteria. Of 410 subjects (median age 70 years; 48% men), the prevalence of stage B HF was 13% [by LV hypertrophy (LVH)], 12% (by abnormal E/e'), 33% (by impaired GLS), and 31% [by left atrial enlargement (LAE)]. New HF symptoms developed in 49, and 2 died of cardiovascular causes, giving an event rate of 104/1000 person-years. These patients were older (P = 0.012), had a higher Charlson co-morbidity score (P < 0.001), larger LV mass and left atrium, higher E/e', and lower GLS (P < 0.05). LAE, LVH, abnormal GLS, and E/e' were independent predictors of new HF. In sequential models, LV mass and GLS added incremental information to clinical parameters. GLS significantly reclassified individuals (P = 0.002), but no reclassification improvement was identified using LV mass index, E/e', and left atrial volume index.

CONCLUSION: Echocardiographic assessment (especially GLS and LV mass) provides incremental value in predicting incident HF.

Item Type:	Refereed Article
Keywords:	Community, Echocardiography, Global longitudinal strain, Heart failure, Screening
Research Division:	Medical and Health Sciences
Research Group:	Cardiorespiratory Medicine and Haematology
Research Field:	Cardiology (incl. Cardiovascular Diseases)
Objective Division:	Health
Objective Group:	Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:	Cardiovascular System and Diseases
Author:	Yang, H (Ms Hong Yang)
Author:	Negishi, K (Dr Kazuaki Negishi)
Author:	Wang, Y (Ms Ying Wang)
Author:	Nolan, M (Mr Mark Nolan)
Author:	Saito, M (Dr Makoto Saito)
Author:	Marwick, TH (Professor Tom Marwick)
ID Code:	112523
Year Published:	2016
Web of Science® Times Cited:	8
Deposited By:	Menzies Institute for Medical Research
Deposited On:	2016-11-15
Last Modified:	2017-11-03
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