Early Left Ventricular Longitudinal Systolic Dysfunction and Cardiovascular Risk Factors in 1,371 Asymptomatic Subjects with Normal Ejection Fraction: A Tissue Doppler Study

Background: Nowadays early diagnosis of left ventricular (LV) dysfunction represents a major challenge in asymptomatic subjects with cardiovascular (CV) risk factors. Tissue Doppler imaging (TDI) recently emerged as an important tool with clinical relevance in several cardiac diseases. Aim: To evaluate the ability of TDI in detecting early longitudinal ventricular dysfunction in asymptomatic subjects, with LV ejection fraction > 55%, normal diastolic function, and its relationship with CV risk factors. Methods: A total of 1,371 subjects (median age 60 years, 595 males) formed our study population: Controls, 265 healthy subjects; Group I, 434 subjects with one CV risk factor; Group II, 401 subjects with two CV risk factors; Group III, 271 subjects with >= 3 CV risk factors. All subjects underwent a comprehensive standard echo Doppler evaluation, including PW-TDI study. Results: Diastolic parameters such as (E backslash A, A-wave, Em backslash Am; E backslash Em) were able to discriminate the number of CV risk factors. The only systolic parameter that progressively reduced by increasing the number of CV risk factors was LV global longitudinal systolic function (Sm), (P < 0.0001). At multivariate analysis, the only functional parameter able to predict the increasing number of CV risk factors was Sm (P < 0.001). Conclusions: TDI is able to identify early longitudinal LV systolic abnormalities in presence of apparently normal systolic and diastolic function and progressively impairs with increasing CV risk factors. These findings could be clinically relevant in identifying asymptomatic subjects who need a early tailored preventive treatment. (Echocardiography 2011;28:268-275).