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Management and prognosis of asymptomatic left ventricular systolic dysfunction

Author
Wilson S Colucci, MD
Section Editor
Stephen S Gottlieb, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

Asymptomatic left ventricular systolic dysfunction (ALVSD) is defined as depressed LV systolic function in the absence of heart failure. Studies of asymptomatic LV systolic dysfunction have used heterogeneous criteria to identify this condition. For the discussion in this topic, ALVSD is defined as depressed LV systolic function with a subnormal LV ejection fraction, regional wall motion abnormality, or both. (See "Clinical manifestations and diagnosis of asymptomatic left ventricular systolic dysfunction", section on 'Definition'.)  

Population-based studies suggest that ALVSD is at least as common as heart failure with reduced ejection fraction (HFrEF). Asymptomatic LV dysfunction is a risk factor for progression to HF and death. Structural heart disease (including LV systolic dysfunction) without symptoms or signs of HF is defined as "stage B HF" in the American College of Cardiology Foundation/American Heart Association guidelines [1].

The evaluation and management of patients with asymptomatic LV systolic dysfunction will be reviewed here. Issues related to the management of HFrEF are presented separately. (See "Overview of the therapy of heart failure with reduced ejection fraction".)

PROGNOSIS

Individuals with asymptomatic left ventricular systolic dysfunction (ALVSD) with reduced LV ejection fraction (LVEF) have American College of Cardiology/American Heart Association stage B heart failure (HF), meaning they are at increased risk for clinical (ie, stage C or D) HF and death (figure 1). This risk was demonstrated by a meta-analysis including 10 reports with a total of 24,206 individuals with ASLVD followed for an average of approximately eight years [2]. The absolute risk of progression to HF was 8.4 per 100 person-years for those with ALVSD, as compared with 1 per 100 person-years in individuals without any ventricular dysfunction. The combined maximally adjusted relative risk of HF for ALVSD was 4.6. Based upon data from four studies that reported risk of HF per unit change in LVEF, the combined maximally adjusted relative risk of HF per 1 standard deviation lower EF was 1.4.

The following two studies were among those included in the meta-analysis:    

                              

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Literature review current through: Jul 2016. | This topic last updated: Jul 27, 2016.
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