Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
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
Uppsala University, Interfaculty Units, Centre for Clinical Research.
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. , p. 71
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 39
Keywords [en]
Medical sciences, Aged, Heart Failure, Ventricular Function, Prevalence, Echocardiography, Electrocardiography, Natriuretic Peptide, Mortality
Keywords [sv]
MEDICIN OCH VÅRD
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-5793ISBN: 91-554-6247-2 (print)OAI: oai:DiVA.org:uu-5793DiVA, id: diva2:166396
Public defence
2005-06-04, Aulan, Gamla vårdgymnasiet, Ingång 21, Centrallasarettet, Västerås, 13:15
Opponent
Supervisors
Available from: 2005-05-13 Created: 2005-05-13Bibliographically approved
List of papers
1. Left ventricular systolic dysfunction in 75-year-old men and women: A population-based study
Open this publication in new window or tab >>Left ventricular systolic dysfunction in 75-year-old men and women: A population-based study
Show others...
2001 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 22, no 8, p. 676-683Article 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.

Keywords
ventricular dysfunction, heart failure, prevalence, echocardiography, aged
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-93036 (URN)10.1053/euhj.2000.2284 (DOI)000168220200011 ()
Available from: 2005-05-13 Created: 2005-05-13 Last updated: 2017-12-14Bibliographically approved
2. Electrocardiogram and B-type natriuretic peptide as screening tools for left ventricular systolic dysfunction in a population-based sample of 75-year-old men and women
Open this publication in new window or tab >>Electrocardiogram and B-type natriuretic peptide as screening tools for left ventricular systolic dysfunction in a population-based sample of 75-year-old men and women
Show others...
2004 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 148, no 3, p. 524-529Article in journal (Refereed) Published
Abstract [en]

Background: Plasma concentration of B-type natriuretic peptide (BNP) has been suggested as a powerful screening tool for left ventricular systolic dysfunction. However, there are reports indicating that the 12-lead electrocardiogram (ECG) could be just as powerful. We aimed to evaluate the 12-lead ECG and BNP as screening tools for left ventricular systolic dysfunction in an elderly, unselected population.

Methods: In a randomly selected population-based sample of 75-year-old men and women (n = 407), diagnostic characteristics were evaluated for the ECG and plasma concentration of BNP to detect left ventricular systolic dysfunction.

Results: Sensitivity, specificity, and negative and positive predictive values for the ECG to detect left ventricular systolic dysfunction were 96%, 79%, 100%, and 26%, respectively. The corresponding values for the BNP (cut-off value 28 pg/mL) were 93%, 55%, 99%, and 13%. In participants without major abnormalities in the ECG, left ventricular systolic dysfunction was found in <1% (1/302), irrespective of BNP concentrations. In participants with abnormal ECGs, systolic dysfunction was more prevalent in persons with abnormal BNP concentrations than in those with normal concentrations (35% vs 3%, difference 32%, 95%CI for the difference 16%–44%)

Conclusions: In 75-year-old subjects both the ECG and the plasma concentration of BNP are highly efficient in excluding left ventricular systolic dysfunction. However, compared with the BNP, the ECG yields a lower number of false positive cases. In screening for left ventricular systolic dysfunction, the BNP has a diagnostic value in addition to the ECG, but only in individuals with abnormal ECGs.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-93037 (URN)10.1016/j.ahj.2004.03.034, (DOI)000224339600024 ()
Available from: 2005-05-13 Created: 2005-05-13 Last updated: 2017-12-14Bibliographically approved
3. Mitral annulus motion compared with wall motion scoring index in the assessment of left ventricular ejection fraction
Open this publication in new window or tab >>Mitral annulus motion compared with wall motion scoring index in the assessment of left ventricular ejection fraction
Show others...
2003 (English)In: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 16, no 6, p. 622-629Article in journal (Refereed) Published
Abstract [en]

The biplane disc summation method is the recommended echocardiographic procedure to determine left ventricular (LV) ejection fraction (EF). Assessment of mitral annulus motion (MAM) or wall motion scoring index (WMI) has been reported to be less dependent on image quality compared with the recommended method, and proposed as a surrogate to the disc summation method in calculation of LVEF. We aimed to compare MAM and WMI in the echocardiographic assessment of LVEF. In a randomly selected population-based sample of 75-year-old men and women in sinus rhythm (n = 409) MAM, as measured by M-mode, was compared with WMI, calculated as the mean value of wall motion scoring in 9 LV segments. LVEF, as measured by the biplane disc summation method was used as reference. The limits of agreement (mean difference ± 1.96 SD) between LVEF and corresponding MAM values were −18 to +13 LVEF%, and between LVEF and corresponding WMI values were −12 to +13 LVEF%. The areas under the receiver operating characteristic curves for MAM and WMI to predict a LVEF < 50% were 0.892 and 0.998, respectively (95% confidence interval of the difference 0.062-0.149). The corresponding areas for MAM and WMI to predict a LVEF < 40% were 0.955 and 0.998, respectively (95% confidence interval of the difference 0.017-0.069). In conclusion, the ability of WMI to estimate LVEF was more favorable than MAM in this population-based sample of 75-year-old participants. The findings suggest that the WMI is preferable to MAM in estimating LVEF.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-93038 (URN)10.1016/S0894-7317(03)00115-9 (DOI)000183510500004 ()
Available from: 2005-05-13 Created: 2005-05-13 Last updated: 2017-12-14Bibliographically approved
4. Mitral annulus motion as a predictor of mortality in a community-based sample of 75-year-old men and women
Open this publication in new window or tab >>Mitral annulus motion as a predictor of mortality in a community-based sample of 75-year-old men and women
Show others...
2006 (English)In: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 19, no 1, p. 88-94Article in journal (Refereed) Published
Abstract [en]

Mitral annulus motion (MAM) is a predictor of mortality in selected patient groups, but its prognostic value in less selected populations is not known. in a community-based random sample of 75-year-old men and women (n = 408), left ventricular function was measured as: (1) maximum amplitude of MAM; and (2) wall-motion index. During a median follow-up of 7.2 years, 83 persons died (26 from cardiac causes). Left ventricular function as measured by MAM predicted the risk of all-cause and cardiac mortality independently of other potential risk factors in this community-based sample. Regarding cardiac mortality, the predictive ability of MAM was also independent of left ventricular systolic function measured as wall-motion index. MAM may prove to be a valuable complement to other echocardiographic methods in the assessment of prognosis in less selected populations.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-93039 (URN)10.1016/j.echo.2005.05.005 (DOI)000244333900015 ()
Available from: 2005-05-13 Created: 2005-05-13 Last updated: 2017-12-14Bibliographically approved

Open Access in DiVA

fulltext(515 kB)931 downloads
File information
File name FULLTEXT01.pdfFile size 515 kBChecksum MD5
2a4c0973f1f43921c96c12358bba9b905f2b7e29b8986f6d7b60bb0e85491998928e34c3
Type fulltextMimetype application/pdf
Buy this publication >>

By organisation
Centre for Clinical Research
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 931 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 2837 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf