Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population

McDonagh, T.A., Morrison, C.E., Lawrence, A., Ford, I. , Tunstall-Pedoe, H., McMurray, J.J.V. and Dargie, H.J. (1997) Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population. Lancet, 350(9081), pp. 829-833. (doi:10.1016/S0140-6736(97)03033-X)

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Abstract

Background In most previous epidemiological studies on the prevalence of chronic heart failure (CHF) the disorder has been defined on clinical criteria. In a cross-sectional survey of 2000 men and women aged 25–74, randomly sampled from one geographical area, we assessed left- ventricular systolic function by echocardiography.

Methods 1640 (83%) of those invited took part. They completed a questionnaire on current medication, history, and symptoms of breathlessness. Blood pressure was measured and electrocardiography (ECG) and echocardiography were done. Left-ventricular ejection fraction was measurable in 1467 (89·5%) participants by the biplane Simpson's rate method.

Findings The mean left-ventricular ejection fraction was 47·3%. The prevalence of definite left-ventricular systolic dysfunction (defined as a left-ventricular ejection fraction ≤30%) was 2·9% overall (43 participants); it increased with age and was higher in men than in women (4·0 vs 2·0%). The left-ventricular systolic dysfunction was symptomatic in 1·5% of participants and asymptomatic in 1·4%. 83% of participants with left-ventricular systolic dysfunction had evidence of ischaemic heart disease (IHD) from history or ECG criteria compared with 21% of those without this abnormality (p>0·001). Hypertension was also more common in those with left-ventricular systolic dysfunction (72 vs 38%, p>0·001), but there was no difference between those with and without left-ventricular systolic dysfunction in the rate of hypertension without IHD.

Interpretation Left-ventricular systolic dysfunction was at least twice as common as symptomatic heart failure defined by clinical criteria. The main risk factors are IHD and hypertension in the presence of IHD; screening of such high-risk groups for left-ventricular systolic dysfunction should be considered.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McDonagh, Dr Theresa and McMurray, Professor John and Ford, Professor Ian and Dargie, Professor Henry and Morrison, Dr Caroline
Authors: McDonagh, T.A., Morrison, C.E., Lawrence, A., Ford, I., Tunstall-Pedoe, H., McMurray, J.J.V., and Dargie, H.J.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Lancet
Publisher:The Lancet Publishing Group
ISSN:0140-6736

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