Echocardiographic screening for non‐ischaemic stage B heart failure in the community

Aims Incident heart failure ( HF ) continues to pose a common and serious problem. We sought to examine the value of echocardiographic predictors of new HF in a community‐based elderly population at risk for HF , independent of and incremental to clinical evaluation. Methods and results Asymptomatic patients ≥65 years old, with ≥1 HF risk factor (hypertension, type 2 diabetes, or obesity) were recruited from the community; patients with valve disease, reduced ejection fraction (EF), and atrial fibrillation (AF) were excluded. Patients underwent standard clinical evaluation including calculation of the Charlson co‐morbidity score and a comprehensive echocardiography including global longitudinal strain ( GLS ). Functional capacity was assessed by 6 min walk test. New HF and cardiovascular death were assessed after a mean follow‐up of 14 ± 4 months by three independent cardiologists using Framingham criteria. Of 410 subjects (median age 70 years; 48% men), the prevalence of stage B HF was 13% [by LV hypertrophy ( LVH )], 12% (by abnormal E/e'), 33% (by impaired GLS ), and 31% [by left atrial enlargement ( LAE )]. New HF symptoms developed in 49, and 2 died of cardiovascular causes, giving an event rate of 104/1000 person‐years. These patients were older ( P = 0.012), had a higher Charlson co‐morbidity score ( P < 0.001), larger LV mass and left atrium, higher E/e', and lower GLS ( P < 0.05). LAE , LVH , abnormal GLS , and E/e' were independent predictors of new HF . In sequential models, LV mass and GLS added incremental information to clinical parameters. GLS significantly reclassified individuals ( P = 0.002), but no reclassification improvement was identified using LV mass index, E/e', and left atrial volume index. Conclusion Echocardiographic assessment (especially GLS and LV mass) provides incremental value in predicting incident HF .