Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: The Cardiovascular Health Study

OBJECTIVES We sought to assess the ability of echocardiographic indices of systolic and diastolic function to predict incident congestive heart failur e (CHF). BACKGROUND Noninvasive indices of subclinical systolic and/or diastolic dys function that can be used to identify patients in a transition phase betwee n normal cardiac function and clinical CI-IF would be valuable. Though midw all shortening and Doppler mitral inflow patterns are seemingly well suited to predict subsequent CHF, the predictive value of these indices has not b een investigated. METHODS We studied 2,671 participants in the Cardiovascular Health Study wh o were free of coronary heart disease, CHF or atrial fibrillation. Clinical and quantitative echocardiographic data were obtained in all participants. RESULTS At a mean follow-up of 5.2 years (range 0 to 6 years), 170 particip ants (6.4% of the cohort) del eloped CHF. Although 96%, of these participan ts had normal or borderline ejection fraction (EF) at baseline, only 57% ha d normal or borderline EF at the time of hospitalization. In multivariate m odeling, fractional shortening at the endocardium (relative risk [RR] 1.85 per 10-unit decrease, confidence interval [CI] 1.27 to 2.39), fractional sh ortening at the midwall (RR 1.29 per five-unit decrease, 95% CI 1.11-1.51) and peak Doppler peak E (RR 1.15 for each 0.1 M/s increment; CI 1.02 to 1.2 1) independently, predicted incident CHF. Both high and low Doppler E/A rat ios were predictive of incident CHF. CONCLUSIONS Roughly half the occurrences of CI-IF in this population are as sociated with normal or borderline EF. Echocardiographic findings suggestiv e of subclinical contractile dysfunction and diastolic filling abnormalitie s are both predictive of subsequent CI-IF. The standard (FSendo) and refine d (FSmw) parameters of systolic function performed similarly in this regard , though subjects with left ventricular hypertrophy and depressed FSmw are at particularly high risk for subsequent CHF. (J Am Coll Cardiol 2001;37:10 42-8) (C) 2001 by the American College of Cardiology.