Author + information
- Received November 28, 2016
- Revision received October 25, 2017
- Accepted November 1, 2017
- Published online December 4, 2017.
- aDepartment of Medicine, University of Melbourne, St. Vincent’s Hospital Melbourne, Fitzroy, Australia
- bSt. Vincent’s Institute of Medical Research, Fitzroy, Australia
- cDepartment of Cardiology, St. Vincent’s Hospital Melbourne, Fitzroy Australia
- ↵∗Address for correspondence:
A/Prof David L. Prior, Department of Cardiology, St. Vincent’s Hospital, P.O. Box 2900, Fitzroy, Victoria 3065, Australia.
Heart failure (HF) continues to grow as a cause of morbidity and mortality in our community and presents a significant public health problem, predominantly in individuals ≥65 years of age. Early intervention in asymptomatic HF subjects (Stage A/B) at risk of progression to symptomatic HF (Stage C/D) may provide an opportunity to halt this epidemic. The ability of cardiac imaging to assess cardiac structure and function permits early identification of those at increased risk of developing symptomatic HF. Systolic, diastolic, and structural left ventricular parameters each predict symptomatic HF, but no single parameter has sufficient sensitivity for screening to identify individuals with Stage A/B HF who are at increased risk of disease progression. Transthoracic echocardiography (TTE) has the advantage over other imaging modalities in being able to measure systolic, diastolic, and structural left ventricular parameters, and it identified at least 1 abnormal parameter in >50% of individuals with Stage A/B HF ≥65 years of age. Moreover, identification of at least 1 abnormality according to TTE in individuals with Stage A/B HF ≥65 years of age had 72% to 82% sensitivity for detection of those who subsequently developed symptomatic HF. Therefore, a case can be made for cardiac imaging by using TTE for community-dwelling populations with Stage A/B HF ≥65 years of age to identify those with increased risk of symptomatic HF who can be offered preventative therapies. Further studies are required to determine the best strategy for identifying the risk of symptomatic HF in younger individuals.
St. Vincent's Institute of Medical Research is supported in part by the Victorian Government’s Operational Infrastructure Support Program. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 28, 2016.
- Revision received October 25, 2017.
- Accepted November 1, 2017.
- 2017 American College of Cardiology Foundation
- Central Illustration
- Mechanisms of Systolic and Diastolic Dysfunction and Structural Abnormalities
- Parameters of Systolic Function That Predict Progression of Stage A/B HF
- Parameters of Diastolic Function That Predict Progression of Stage A/B HF
- Structural Parameters That Predict Progression of Stage A/B HF
- Prediction of HF by Multiple Imaging Parameters
- Pre-screening Strategies to Select Individuals for Noninvasive Imaging
- Other Cardiac Imaging Modalities
- Application of Imaging to the Prediction of HF
- Future Directions