Evaluation and management of asymptomatic left ventricular systolic dysfunction
- Wilson S Colucci, MD
Wilson S Colucci, MD
- Section Editor — Heart Failure
- Professor of Medicine
- Boston University School of Medicine
Left ventricular (LV) systolic dysfunction with symptoms of heart failure (HF) is a common clinical problem. Population-based studies suggest that asymptomatic LV dysfunction is at least as prevalent as symptomatic HF in the general population. Structural heart disease without signs of symptoms of HF is defined as “stage B HF” in the American College of Cardiology Foundation/American Heart Association guidelines .
Patients with asymptomatic LV systolic dysfunction progress to overt HF over time. In the placebo arm of the SOLVD trial, patients with asymptomatic LV dysfunction not treated with an angiotensin converting enzyme inhibitor progressed to symptomatic HF at a rate of 9.7 percent per year . In addition, the mortality rate in patients with asymptomatic LV dysfunction is increased, although to a lesser degree than in symptomatic HF (figure 1). In the placebo arm of the SOLVD trial, the three-year mortality rate was 16 percent . (See 'Chronic LV systolic dysfunction' below.)
The management of patients with asymptomatic LV systolic dysfunction will be reviewed here. Issues related to the prevalence of and possible screening for asymptomatic LV systolic dysfunction and the management of symptomatic systolic HF are presented separately. (See "Screening for asymptomatic left ventricular dysfunction" and "Overview of the therapy of heart failure with reduced ejection fraction".)
Asymptomatic LV diastolic dysfunction is also common and associated with an adverse prognosis . However, there are no data on the efficacy of treating diastolic dysfunction before the onset of symptoms. (See "Treatment and prognosis of heart failure with preserved ejection fraction", section on 'Asymptomatic diastolic dysfunction'.)
By definition, patients with asymptomatic left ventricular (LV) dysfunction have no symptoms. The diagnosis is usually made by echocardiography performed because the patient might have underlying heart disease or cardiomegaly is detected on chest radiograph.
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- CLINICAL FEATURES
- Neurohumoral activation
- Familial disease
- - ACE inhibitors
- - Acute anterior MI
- - Beta blockers
- - Elderly
- - Other medications
- Chronic LV systolic dysfunction
- - ACE inhibitors
- - Beta blockers
- Influence of gender
- Influence of race
- ARRHYTHMIA MANAGEMENT
- Threshold for therapy
- Post-MI or revascularization
- - ACE inhibitors
- - Beta blockers
- Chronic LV systolic dysfunction
- Risk factor modification
- Other therapies