Age‐specific diastolic dysfunction improves prediction of symptomatic heart failure by Stage B heart failure

Abstract

Aims We investigated whether addition of diastolic dysfunction (DD) and longitudinal strain (LS) to Stage B heart failure (SBHF) criteria (structural or systolic abnormality) improves prediction of symptomatic HF in participants of the SCReening Evaluation of the Evolution of New Heart Failure study, a self‐selected population at increased cardiovascular disease risk recruited from members of a health insurance fund in Melbourne and Shepparton, Australia. Both American Society of Echocardiography and European Association of Cardiovascular Imaging (ASE/EACVI) criteria and age‐specific Atherosclerosis Risk in Communities (ARIC) study criteria, for SBHF and DD, and ARIC criteria for abnormal LS, were examined. Methods and results Inclusion criteria were age ≥60 years with one or more of self‐reported ischaemic or other heart disease, irregular or rapid heart rhythm, cerebrovascular disease, renal impairment, or treatment for hypertension or diabetes for ≥2 years. Exclusion criteria were known HF, or ejection fraction <50% or >mild valve abnormality detected on previous echocardiography or other imaging. Echocardiography was performed in 3190 participants who were followed for a median of 3.9 (interquartile range: 3.4, 4.5) years after echocardiography. Symptomatic HF was diagnosed in 139 participants at a median of 3.1 (interquartile range: 2.1, 3.9) years after echocardiography. ARIC structural, systolic, and diastolic abnormalities predicted HF in univariate and multivariable proportional hazards analyses, whereas ASE/EACVI structural and systolic, but not diastolic, abnormalities predicted HF. ARIC and ASE/EACVI SBHF criteria predicted HF with sensitivities of 81% and 55%, specificities of 39% and 76%, and C statistics of 0.60 (95% confidence interval: 0.57, 0.64) and 0.66 (0.61, 0.71), respectively. Adding ARIC DD to SBHF increased sensitivity to 94% with specificity of 24% and C statistic of 0.59 (0.57, 0.61), whereas addition of ASE/EACVI DD to SBHF increased sensitivity to 97% but reduced specificity to 9% and the C statistic to 0.52 (0.50, 0.54, P < 0.0001). Addition of LS to ARIC or ASE/EACVI SBHF criteria had minimal impact on prediction of HF. Conclusions Age‐specific ARIC DD criteria, but not ASE/EACVI DD criteria, predicted symptomatic HF, and addition of age‐specific ARIC DD criteria to ARIC SBHF criteria improved prediction of symptomatic HF in asymptomatic individuals with cardiovascular disease risk factors. Addition of LS to ASE/EACVI or ARIC SBHF criteria did not improve prediction of symptomatic HF.

Age‐related longitudinal change in cardiac structure and function in adults at increased cardiovascular risk

“…The SCREEN-HF study is a community-based evaluation of the use of plasma amino-terminal-pro-B-type natriuretic peptide (NT-proBNP) to identify individuals with cardiac dysfunction (as assessed by echocardiography) and increased risk of HF and other cardiovascular events. [23][24][25][26] A flow chart for participant recruitment and follow-up is shown in Figure S1. In summary, 44 000 members of private health fund Bupa and residents of Melbourne or Shepparton, Victoria, Australia, were invited to participate.…”

“…We previously reported comparison of participants who came for the baseline echocardiographic examination and those who did not. 25 Participants were invited to return for a second echocardiographic examination (Visit 3) at a median of 3.8 (IQR 3.5, 4.2) years after the baseline echocardiographic examination. 25 Participants who were diagnosed with HF and/or MI between Visit 2 and Visit 3 (n = 125) were excluded, and the number of participants with baseline echocardiography for this study was 3065, of which 2358 returned for a second echocardiographic examination.…”

“…25 Participants were invited to return for a second echocardiographic examination (Visit 3) at a median of 3.8 (IQR 3.5, 4.2) years after the baseline echocardiographic examination. 25 Participants who were diagnosed with HF and/or MI between Visit 2 and Visit 3 (n = 125) were excluded, and the number of participants with baseline echocardiography for this study was 3065, of which 2358 returned for a second echocardiographic examination. The SCREEN-HF study was approved by the Alfred Human Research Ethics Committee and conformed to the ethical standards of the Declaration of Helsinki, and written informed consent was obtained from all participants.…”

“…Cardiac structure and function were assessed using transthoracic echocardiography with either a Vivid 7 (n = 2834) or Vivid i (n = 231) instrument (GE Healthcare, Chicago, Illinois, USA). 25 Echocardiography was performed according to American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. 11,[30][31][32] Data were stored in raw data format and analysed offline by two experienced cardiologists.…”

“…8,13 In addition to uncertainty about age-associated change in cardiac structure and function, there is limited information about the contribution of age and CVD risk factors to these changes. 15,16,[18][19][20]22 To define the effect of age on cardiac structure and function, and the relationship of CVD risk factors with age-associated change in cardiac structure and function, we performed serial echocardiographic examinations in the participants of the SCReening Evaluation of the Evolution of New HF (SCREEN-HF) study, [23][24][25][26] a prospective community-based cohort study of men and women ≥60 years of age without HF but with risk factors for HF.…”