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Left ventricular systolic dysfunction in 75-year-old men and women: A population-based study
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2001 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 22, no 8, 676-683 p.Article in journal (Refereed) Published
Abstract [en]

Aims To determine the prevalence of left ventricular systolic dysfunction in 75-year-old men and women.

Methods and Results In a population-based random sample of 75-year-old subjects (n = 433; response rate 70.1%) the left ventricular systolic function was determined using two echocardiographic methods: (1) wall motion in nine left ventricular segments was visually scored and wall motion index was calculated as the mean value of the nine segments and (2) ejection fraction as measured by the disc summation method. Presence of heart failure was determined by a cardiologist's clinical evaluation. Wall motion index was achievable in 95% of the participants while ejection fraction was measurable in 65%. Normal values were obtained from a healthy subgroup (n = 108) and left ventricular systolic dysfunction was defined as the 0.5th percentile of the wall motion index (i.e. <1.7). In participants in whom both ejection fraction and wall motion index were achievable, wall motion index <1.7 predicted ejection fraction <43% with a sensitivity and specificity of 84.0% and 99.6%, respectively. The prevalence of left ventricular systolic dysfunction was 6.8% (95% CI, 5.6-8.0%) and was greater in men than in women (10.2% vs 3.4%, P = 0.006). Clinical evidence of heart failure was absent in 46% of the participants with left ventricular systolic dysfunction.

Conclusions Left ventricular systolic dysfunction is common among 75-year-olds with a prevalence of 6.8% in our estimate. The condition is more likely to affect men than women. In nearly half of 75-year-olds with left ventricular systolic dysfunction there is no clinical evidence of heart failure.

Place, publisher, year, edition, pages
2001. Vol. 22, no 8, 676-683 p.
Keyword [en]
ventricular dysfunction, heart failure, prevalence, echocardiography, aged
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-93036DOI: 10.1053/euhj.2000.2284ISI: 000168220200011OAI: oai:DiVA.org:uu-93036DiVA: diva2:166392
Available from: 2005-05-13 Created: 2005-05-13 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Left Ventricular Systolic Dysfunction in 75-year-old Men and Women: A Community-based Study of Prevalence, Screening and Mitral Annulus Motion for Diagnosis and Prognostics
Open this publication in new window or tab >>Left Ventricular Systolic Dysfunction in 75-year-old Men and Women: A Community-based Study of Prevalence, Screening and Mitral Annulus Motion for Diagnosis and Prognostics
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Reduced performance of the left ventricle to eject blood – left ventricular systolic dysfunction (LVSD) – is a common predecessor of the heart failure syndrome. With or without symptoms, LVSD is associated with a poor prognosis. However, with adequate treatment, the development or progression of symptoms, the need for hospitalisation and mortality can all be reduced. In the present work, the occurrence of LVSD was evaluated by echocardiography in a community-based sample of 75-year-old men and women (n = 433). LVSD was a common condition, with a prevalence rate of 6.8%. In nearly half the participants with LVSD, there was no clinical evidence of heart failure.

Community-based screening for asymptomatic LVSD has been proposed as a strategy to reduce the incidence of heart failure. Because of the high costs and low availability, echocardiography is not a suitable screening tool. The plasma concentration of B-type natriuretic peptide (BNP) has been the most advocated screening tool. Another alternative is the standard 12-lead electrocardiogram (ECG). Both the ECG and BNP were effective in excluding LVSD in our 75-year-old community-based sample. However, compared with BNP, the ECG had considerably better specificity. In screening for LVSD, BNP had a diagnostic value in addition to the ECG, but only in individuals with abnormal ECGs.

The left ventricular ejection fraction (LVEF) measured by echocardiography is a well-established index for describing left ventricular systolic function. The wall motion index (WMI) and the amplitude of mitral annulus motion (MAM) are suggested as alternative echocardiographic methods. Compared with MAM, the WMI had a more favourable agreement with the LVEF in our 75-year-old participants. Nonetheless, MAM was a strong predictor of mortality. MAM predicted the risk of all-cause and cardiac mortality independently of other risk factors. In addition, when it came to cardiac mortality, the predictive ability of MAM was independent of the LV function measured as the WMI.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 71 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 39
Keyword
Medical sciences, Aged, Heart Failure, Ventricular Function, Prevalence, Echocardiography, Electrocardiography, Natriuretic Peptide, Mortality, MEDICIN OCH VÅRD
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-5793 (URN)91-554-6247-2 (ISBN)
Public defence
2005-06-04, Aulan, Gamla vårdgymnasiet, Ingång 21, Centrallasarettet, Västerås, 13:15
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Available from: 2005-05-13 Created: 2005-05-13Bibliographically approved

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Hedberg, PärNilsson, Göran

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