Omnes Viae Romam Ducunt

Abstract

Despite significant progress in the treatment of heart failure, its incidence and prevalence are rising in the United States. In order to further heart failure prevention efforts, the American Heart Association and the American College of Cardiology proposed a classification scheme for heart failure to include stage A patients (those who do not have structural heart disease but are at risk for heart failure) and stage B patients (those with asymptomatic cardiac structural or functional abnormalities).1 Measures implemented to prevent progression of patients at risk for heart failure rely on our ability to predict accurately who will most likely benefit from early interventions. Because heart failure eventually leads to multiorgan involvement, even mild dysfunction of a noncardiac organ may trigger clinical manifestations of heart failure. In addition, preexisting asymptomatic ventricular dysfunction may interact with a dysfunctional noncardiac organ and accelerate the progression to overt heart failure. To date, there is little information available to describe the contribution of asymptomatic systolic and diastolic dysfunction or that of noncardiac organ dysfunction to the occurrence of heart failure, and the article by Lam et al2 in the present issue of Circulation is bringing forth important data in that regard. Article see p 24 One thousand thirty eight participants from the Framingham Heart Study who were free of heart failure or overt renal failure at enrollment (1987–1990) were followed up for an average of 11 years. Detailed echocardiographic assessment was performed at baseline, and participants with an ejection fraction ≤45% were considered to have asymptomatic systolic dysfunction, whereas those with an ejection fraction >45% and with abnormal relaxation or pseudonormal or restrictive filling were considered to have asymptomatic diastolic dysfunction. In line with their hypothesis that major noncardiac organ dysfunction may accelerate the progression to heart …