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Gian Francesco Mureddu1*, Luigi Tarantini2, Nera Agabiti3, Pompilio Faggiano4, Serge Masson5, Roberto Latini5, Giulia Cesaroni3, Maria Miceli6, Francesco Forastiere3, Angela Beatrice Scardovi7, Massimo Uguccioni8 and Alessandro Boccanelli1
Heart failure (HF) is an issue of public health concern. Its overall prevalence continues to rise in developed countries, particularly in the elderly.1,2 It is a progressive disease with a pre-clinical phase
(stage B HF) characterized by the presence of structural and/or func- tional cardiac abnormalities that precede the development of the overt disease.1 – 3 Stage B HF includes asymptomatic subjects with previous acute myocardial infarction (AMI), LV post-AMI remodel- ling, hypertensive LV hypertrophy (LVH), pre-clinical (asymptomatic)
LV dysfunction (ALVD) (either systolic and/or diastolic), and valvular heart disease (VHD).1,3,4
The prevalence of both clinical and pre-clinical HF increases with age.4 – 11 In most community studies, the elderly showed a high preva- lence of systolic and diastolic AVLD,8 – 13 as well as of pre-clinical HF (stage B).10 Since early and appropriate pharmacological intervention has been shown to be effective in preventing or at least slowing the clinical course of the disease from pre-clinical to clinical HF,14,15 screening strategies have been advocated especially for high-risk subjects.16 – 24
Previous studies have reported the accuracy and cost-effectiveness of BNP, NT-proBNP, and/or 12-lead ECG over Doppler transthoracic echocardiography (TE) in screening people at high risk of HF both in the community and in clinical settings;18 – 22 however, no study has spe- cifically addressed the elderly. The present study aimed to assess the accuracy and cost-effectiveness ratio of ECG, NT-proBNP, and their combinations with Doppler TE, in screening for systolic and diastolic ALVD and stage B HF in randomly selected elderly subjects from an urban Italian community with different levels of risk.