Asymptomatic Left Ventricular Dysfunction Research Articles

Abstract 328: Left Ventricular Diastolic Dysfunction, Regardless of Classification is Associated with increased Muscle Sympathetic Nerve Activity in Hypertensive Patients.

Background: The presence of asymptomatic left ventricular diastolic dysfunction (LVDD) in hypertensive patients can be associated with the development of cardiac events. The increase in the sympathetic activity is considered one of the mechanisms that predisposes to this outcome. The aim of this study was to investigate whether there is an increase of MSNA in the presence of LVDD in hypertensive patients under therapy, and whether it influences or not the different classes of diastolic dysfunction in the MSNA. Method: After analyzing left ventricular function by echoDopplercardiography exam, 45 hypertensive patients were allocated into 3 groups: normal function (H, n=15); impaired relaxation (H-IR, n=15) and pseudonormal or restrictive (H-P/R, n=15). An age, sex and body mass index- matched control group of normotensive volunteers (N, n=14) was included. In all groups, muscle nerve sympathetic activity (MNSA) by microneuragraphy, and blood pressure by FINOMETER® were evaluated in supine rest position. Evaluation statistics: ANOVA and Fisher’s Exact. Results: Blood pressure and antihypertensive drugs were similar among hypertensive groups. Both H-IR and H-P/R had a similar MSNA (33±1 and 32±1 bursts/min respectively) which was significantly higher compared to H and N groups (26±3 and15±2 bursts/min respectively). Conclusions: 1. Increased MSNA in treated hypertensive patients exhibiting LVDD can be detected. 2. The increased MSNA is not influenced by different classes of LVDD. 3.The clinical implication of this finding should be further evaluated, considering the worse prognosis already established when LVDD is present.

OC12.01: Maternal cardiovascular impairment in preterm fetal growth restricted pregnancies

Fetal growth restriction and pre-eclampsia are both conditions of placental etiology and associated to increased risk for the long term development of cardiovascular disease in the mother. At presentation, pre-eclampsia is associated with maternal global diastolic dysfunction which is determined, at least in part, by increased afterload and myocardial stiffness. The aim of this study is to test the hypothesis that women with normotensive fetal growth restricted pregnancies also exhibit global diastolic dysfunction. This was a prospective case-control study conducted over a three year period involving 29 preterm fetal growth restricted, 25 preeclamptic with fetal growth restriction pregnancies and 58 matched control pregnancies. Women were assessed by conventional echocardiography and tissue Doppler imaging at diagnosis of the complication and followed-up at 12 weeks postpartum. Fetal growth restricted pregnancies are characterized by a lower cardiac index and higher total vascular resistance index than expected for gestation. Compared to controls, fetal growth restricted pregnancy was associated with significantly increased prevalence (P = 0.0001) of asymptomatic left ventricular diastolic dysfunction (28% versus 4%) and widespread impaired myocardial relaxation (59% versus 21%). Unlike pre-eclampsia, cardiac geometry and intrinsic myocardial contractility were preserved in fetal growth restricted pregnancy. Fetal growth restricted pregnancies are characterized by a low output, high resistance circulatory state as well as a higher prevalence of asymptomatic global diastolic dysfunction and poor cardiac reserve. These findings may explain the increased long-term cardiovascular risk in these women who have had fetal growth restricted pregnancies. Further studies are needed to clarify the postnatal natural history of cardiac dysfunction in these women.

Heart failure, ventricular dysfunction and risk factor prevalence in Australian Aboriginal peoples: the Heart of the Heart Study

BackgroundLimited strategies have been developed to evaluate and address the alarming discrepancy in early mortality between Indigenous and non-Indigenous populations.ObjectiveTo assess heart failure (HF), HF risk factors and document cardiac...

Arterial Stiffness and Wave Reflection

Increased arterial stiffness and wave reflection have been reported in heart failure with normal ejection fraction (HFNEF) and in asymptomatic left ventricular (LV) diastolic dysfunction, a precursor of HFNEF. It is unclear whether women, who have higher frequency of HFNEF, are more vulnerable than men to the deleterious effects of arterial stiffness on LV diastolic function. We investigated, in a large community-based cohort, whether sex differences exist in the relationship among arterial stiffness, wave reflection, and LV diastolic function. Arterial stiffness and wave reflection were assessed in 983 participants from the Cardiovascular Abnormalities and Brain Lesions study using applanation tonometry. The central pulse pressure/stroke volume index, total arterial compliance, pulse pressure amplification, and augmentation index were used as parameters of arterial stiffness and wave reflection. LV diastolic function was evaluated by 2-dimensional echocardiography and tissue-Doppler imaging. Arterial stiffness and wave reflection were greater in women compared with men, independent of body size and heart rate (all P <0.01), and showed inverse relationships with parameters of diastolic function in both sexes. Further adjustment for cardiovascular risk factors attenuated these relationships; however, a higher central pulse pressure/stroke volume index predicted LV diastolic dysfunction in women (odds ratio, 1.54; 95% confidence intervals, 1.03 to 2.30) and men (odds ratio, 2.09; 95% confidence interval, 1.30 to 3.39), independent of other risk factors. In conclusion, in our community-based cohort study, higher arterial stiffness was associated with worse LV diastolic function in men and women. Women's higher arterial stiffness, independent of body size, may contribute to their greater susceptibility to develop HFNEF.

Urinary proteome analysis in hypertensive patients with left ventricular diastolic dysfunction.

Despite the significant heart failure (HF) burden on society, easily applicable screening techniques, particularly for the early detection of asymptomatic left ventricular (LV) dysfunction, are lacking. The present study aimed to identify and test a set of urinary polypeptides that may indicate early LV diastolic dysfunction as defined by echocardiography in hypertensive patients in a cross-sectional case-control study nested within the FLEMish study on ENvironment, Genes and Health Outcome (FLEMENGHO). To identify potentially discriminating urinary biomarkers for LV diastolic dysfunction, we applied capillary electrophoresis coupled to mass spectrometry. In the discovery set, we compared 19 hypertensive patients with asymptomatic LV diastolic dysfunction with 19 healthy controls. In the absence of adjustment for multiple testing, 85 urinary peptides were different between cases and controls at a P-value of <0.033. With adjustment for multiple testing, three potential biomarkers remained significantly different between cases and controls (P ≤ 0.02). We combined the 85 potential biomarkers in a high-dimensional model (classifier), which we applied in a blinded manner to an independent test set of 16 hypertensive patients with symptomatic HF and 16 healthy controls. Upon unblinding, the area under the receiver operating characteristic curve (AUC) of the HF classification was 0.84 (95% CI: 0.70-0.98; P= 0.001). In asymptomatic hypertensive patients with LV diastolic dysfunction, we identified a set of urinary polypeptides specific for essential hypertension with LV diastolic dysfunction that subsequently distinguished hypertensive patients with overt HF from healthy controls.

Prevalence of preclinical and clinical heart failure in the elderly. A population‐based study in Central Italy

We conducted a population-based cross-sectional study to assess the prevalence of both preclinical and clinical heart failure (HF) in the elderly. A sample of 2001 subjects, 65- to 84-year-old residents in the Lazio Region (Italy), underwent physical examination, biochemistry/N-terminal pro brain natriuretic peptide (NT-proBNP) assessment, electrocardiography, and echocardiography. Systolic left ventricular dysfunction (LVD) was defined as left ventricular ejection fraction (LVEF) <50%. Diastolic LVD was defined by a Doppler-derived multiparametric algorithm. The overall prevalence of HF was 6.7% [95% confidence interval (CI) 5.6-7.9], mainly due to HF with preserved LVEF (HFpEF) (4.9%; 95% CI 4.0-5.9), and did not differ by gender. A systolic asymptomatic LVD (ALVD) was detected more frequently in men (1.8%; 95% CI 1.0-2.7) than in women (0.5%; 95% CI 0.1-1.0; P = 0.005), whereas the prevalence of diastolic ALVD was comparable between genders (men: 35.8%; 95% CI = 32.7-38.9; women: 35.0%; 95% CI = 31.9-38.2). The NT-proBNP levels and severity of LVD increased with age. Overall, 1623 subjects (81.1% of the entire studied population) had preclinical HF (Stage A: 22.2% and stage B: 59.1% respectively). A large number of subjects in stage B of HF showed risk factor levels not at target. In a population-based study, the prevalence of preclinical HF in the elderly is high. The prevalence of clinical HF is mainly due to HFpEF and is similar between genders.

Association Between Radiotherapy vs No Radiotherapy Based on Early Response to VAMP Chemotherapy and Survival Among Children With Favorable-Risk Hodgkin Lymphoma

More than 90% of children with favorable-risk Hodgkin lymphoma can achieve long-term survival, yet many will experience toxic effects from radiation therapy. Pediatric oncologists strive for maintaining excellent cure rates while minimizing toxic effects. To evaluate the efficacy of 4 cycles of vinblastine, Adriamycin (doxorubicin), methotrexate, and prednisone (VAMP) in patients with favorable-risk Hodgkin lymphoma who achieve a complete response after 2 cycles and do not receive radiotherapy. Multi-institutional, unblinded, nonrandomized single group phase 2 clinical trial to assess the need for radiotherapy based on early response to chemotherapy. Eighty-eight eligible patients with Hodgkin lymphoma stage I and II (<3 nodal sites, no B symptoms, mediastinal bulk, or extranodal extension) enrolled between March 3, 2000, and December 9, 2008. Follow-up data are current to March 12, 2012. The 47 patients who achieved a complete response after 2 cycles received no radiotherapy, and the 41 with less than a complete response were given 25.5 Gy-involved-field radiotherapy. Two-year event-free survival was the primary outcome measure. A 2-year event-free survival of greater than 90% was desired, and 80% was considered to be unacceptably low. Two-year event-free survival was 90.8% (95% CI, 84.7%-96.9%). For patients who did not require radiotherapy, it was 89.4% (95% CI, 80.8%-98.0%) compared with 92.5% (95% CI, 84.5%-100%) for those who did (P = .61). Most common acute adverse effects were neuropathic pain (2% of patients), nausea or vomiting (3% of patients), neutropenia (32% of cycles), and febrile neutropenia (2% of patients). Nine patients (10%) were hospitalized 11 times (3% of cycles) for febrile neutropenia or nonneutropenic infection. Long-term adverse effects after radiotherapy were asymptomatic compensated hypothyroidism in 9 patients (10%), osteonecrosis and moderate osteopenia in 2 patients each (2%), subclinical pulmonary dysfunction in 12 patients (14%), and asymptomatic left ventricular dysfunction in 4 patients (5%). No second malignant neoplasms were observed. Among patients with favorable-risk Hodgkin lymphoma and a complete early response to chemotherapy, the use of limited radiotherapy resulted in a high rate of 2-year event-free survival. clinicaltrials.gov Identifier: NCT00145600.

Maternal Cardiovascular Impairment in Pregnancies Complicated by Severe Fetal Growth Restriction

Fetal growth restriction and preeclampsia are both conditions of placental etiology and associated to increased risk for the long-term development of cardiovascular disease in the mother. At presentation, preeclampsia is associated with maternal global diastolic dysfunction, which is determined, at least in part, by increased afterload and myocardial stiffness. The aim of this study is to test the hypothesis that women with normotensive fetal growth-restricted pregnancies also exhibit global diastolic dysfunction. This was a prospective case-control study conducted over a 3-year period involving 29 preterm fetal growth-restricted pregnancies, 25 preeclamptic with fetal growth restriction pregnancies, and 58 matched control pregnancies. Women were assessed by conventional echocardiography and tissue Doppler imaging at diagnosis of the complication and followed-up at 12 weeks postpartum. Fetal growth-restricted pregnancies are characterized by a lower cardiac index and higher total vascular resistance index than expected for gestation. Compared with controls, fetal growth-restricted pregnancy was associated with significantly increased prevalence (P<0.001) of asymptomatic left ventricular diastolic dysfunction (28% versus 4%) and widespread impaired myocardial relaxation (59% versus 21%). Unlike preeclampsia, cardiac geometry and intrinsic myocardial contractility were preserved in fetal growth-restricted pregnancy. Fetal growth-restricted pregnancies are characterized by a low output, high resistance circulatory state, as well as a higher prevalence of asymptomatic global diastolic dysfunction and poor cardiac reserve. These findings may explain the increased long-term cardiovascular risk in these women who have had fetal growth-restricted pregnancies. Further studies are needed to clarify the postnatal natural history of cardiac dysfunction in these women.

English

Early detection of asymptomatic left ventricular systolic dysfunction (LVSD) or diastolic dysfunction (DD) in Type II Diabetes Melli- tus patients may prevent complication such as Myocardial infarction. Present study is aimed to study the prediction chances of myocardial infarction in type II Diabetes mellitus patients using co-relation of plasma BNP level with 2-D-ECHO findings. A total of 100 diabetes mellitus type II patients were studied of which 50 DM had evidence of MI and remaining 50 were without any evidence of MI for more than 5 yrs. BNP values were inversely proportional to left ventricular systolic ejection fraction. This correlation was significant (p<0.001). Elevated BNP levels were significantly correlated with presence of Diastolic Dysfunction (p<0.001).In our study the BNP cutoff value of 100pg/ml had a sensitivity of 90%, specificity of 70 %. In patients with only Diabetes, of the 14 patients with elevated BNP levels and normal Ejection Frac- tion, 10 revealed diastolic dysfunction. Of the remaining 4, further follow-up of two patients showed presence of Coronary Artery Disease, indicates that BNP is good investigation for detecting underlying coronary artery disease in high risk population such as Type II Diabetes Mellitus.

A novel global strain diastolic index correlates with plasma NT-proBNP levels in asymptomatic hypertensive patients with preserved left ventricular ejection fraction.

The strain imaging diastolic index (SI-DI) was reported to be a sensitive marker of regional left ventricular (LV) delayed relaxation induced by ischemia. However, the clinical usefulness of the global SI-DI has not been evaluated. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a sensitive biomarker for the detection of asymptomatic diastolic LV dysfunction. This study investigated the ability of a novel parameter, the global SI-DI, obtained using 2D speckle tracking imaging (2DSI) to correlate with the plasma NT-proBNP levels in asymptomatic hypertensive patients with preserved LV ejection fraction. We performed 2D echocardiography and 2DSI in 83 asymptomatic hypertensive patients with preserved ejection fraction (>45%) and in 37 control subjects. In 2DSI, the LV longitudinal peak strain and the SI-DI of 18 LV segments were measured. NT-proBNP was measured in all subjects. The data were compared between hypertensive patients and normal controls. The average peak strain and global SI-DI of 18 LV segments were significantly reduced in hypertensive patients compared with control subjects (P<0.05); however, only the global SI-DI was significantly correlated with log10 NT-proBNP (r=-0.469, P=0.001). In Pearson's correlation analyses, log10 NT-proBNP was significantly correlated with E/e', E/A ratio, early diastolic mitral annular velocity (e'), global peak strain, deceleration time of the E-wave, and LV ejection fraction. In the multiple stepwise regression analysis, the global SI-DI was the strongest independent determinant of log10 NT-proBNP (β=-0.386, P=0.008). The global SI-DI derived from 2DSI correlates well with plasma NT-proBNP levels and may have prognostic value in asymptomatic hypertensive patients with preserved ejection fraction.

Radionuclide Imaging in Stage B Heart Failure

This article discusses currently available radionuclide techniques in the diagnostic and prognostic evaluation of patients with chronic heart failure, with a focus on stage B/asymptomatic left ventricular dysfunction. Radionuclide imaging is promising for such patients because it can simultaneously determine left ventricular function, evaluate for the presence of obstructive coronary disease, determine the extent of viable myocardium, and evaluate dyssynchronous left ventricular contraction. Radionuclide imaging can thus provide important noninvasive insights into the pathophysiology, prognosis, and management of patients with asymptomatic left ventricular dysfunction as well as more advanced heat failure.

Clinical Monitoring of Stage B Heart Failure: Echocardiography

Estimates of the prevalence of asymptomatic left ventricular systolic dysfunction (LVSD) vary widely depending on the study sample and definition of LVSD. Subtle reductions in LV systolic or diastolic function are now detectable with newer echocardiographic measures, which can influence estimates of the burden of stage B heart failure (HF). If the definition is broadened to include diastolic filling abnormalities, the estimated prevalence of stage B HF increases dramatically. This article reviews the rationale for echocardiographic screening for stage B HF, describes currently available measures of cardiac structure and function, and assesses the potential role of echocardiography in selected subgroups.

β-Blockers in Stage B: A Precursor of Heart Failure

β-blockers are an important treatment of heart failure (HF) and are useful in reducing the progression of the syndrome. They should be considered for patients with asymptomatic left ventricular (LV) dysfunction. Evidence-based β-blocker therapy (bisoprolol, carvedilol, or metoprolol succinate) in combination with standard therapy is a mainstay of treatment of all symptomatic patients with LV systolic dysfunction. Patients in stage B also benefit from the early introduction of β-blockers, but there are no large randomized clinical trials to support this strategy. Whether there is a role for ivabradine in the treatment of HF is not clear.

Stage B Heart Failure: Rationale for Screening

To adequately address the burden imposed by heart failure, a combined approach to prevention, early detection, and management is required. Failure to adequately consider the presymptomatic pool of subjects largely accounts for the continuing burden of incident cases of symptomatic heart failure. This article reviews the rationale for the early detection and management of stage B heart failure with specific reference to asymptomatic left ventricular systolic dysfunction as a potentially modifiable heart failure antecedent. Provided one can safely and reliably detect these individuals, a strong case can be made for screening given the evidence from treatment efficacy studies that clinicians can improve patient outcomes.

Biomarkers

Epidemiologic, clinical, and basic research has identified several antecedent conditions that predispose individuals to heart failure and its predecessor, asymptomatic left ventricular remodeling and dysfunction (stage B heart failure). Many biochemical markers have been described that characterize the remodeling process and the development of cardiac dysfunction. Although natriuretic peptides and cardiac troponin are currently used in the context of diagnosis, risk stratification, and management of stage C and D heart failure, many other biomarkers provide insights into the underlying pathophysiology of left ventricular dysfunction, suggesting new directions for fundamental research or the development of new therapies.

Reduced lung diffusion capacity in type 2 diabetes is independent of heart failure

In a case–control analysis comparing 303 patients with diabetes and 303 without (matched on age, race, sex and height), diabetics had reduced lung diffusion (DLCO) independent of smoking, obesity, clinical heart failure, asymptomatic left ventricular systolic and diastolic dysfunction: DLCO (mean±SE: 15.5±0.9 vs. 16.4 ±0.9, p=0.01).

Pooled analysis of cardiac safety in patients with cancer treated with pertuzumab

Pertuzumab, a human epidermal growth factor receptor (HER) 2 dimerization inhibitor, has demonstrated promising efficacy in combination with trastuzumab in patients with metastatic breast cancer. As HER signaling pathways are not only involved in oncogenesis, but also in myocardial homeostasis, an analysis of cardiac safety data was undertaken in a large group of patients treated with pertuzumab. A complete database of patients treated with full-dose pertuzumab was used to describe the incidence of asymptomatic left ventricular systolic dysfunction (LVSD) and symptomatic heart failure (HF). Information for 598 unique patients was available for the current analysis. Of the patients treated with pertuzumab alone (n = 331) or pertuzumab in combination with a non-anthracycline-containing cytotoxic (n = 175) or trastuzumab (n = 93), 23 (6.9%), 6 (3.4%), and 6 (6.5%), respectively, developed asymptomatic LVSD and 1 (0.3%), 2 (1.1%), and 1 (1.1%), respectively, displayed symptomatic HF. None of the 15 patients receiving both pertuzumab and erlotinib demonstrated LVSD. Patients treated with pertuzumab experienced relatively low levels of asymptomatic LVSD or symptomatic HF. There was no notable increase in cardiac side-effects when pertuzumab was given in combination with other anticancer agents.

Asymptomatic systolic and diastolic dysfunction in patients with risk factors referred for echocardiography. The DAVES study by the Italian Society of Cardiovascular Echography

This study aims to determine the prevalence of left ventricular dysfunction in subjects without signs and symptoms of heart failure referred for echocardiography essentially for the presence of one or more cardiovascular risk factors. The DAVES study (Disfunzione Asintomatica del Ventricolo Sinistro, left ventricular asymptomatic dysfunction) is a multicenter cross-sectional observational study based on echocardiography. Among 16,099 screened subjects from 75 Centers, we enrolled 3,537 subjects without signs or symptoms of heart failure. The prevalence of depressed left ventricular systolic (left ventricular ejection fraction ≤ 50%) and diastolic function was analyzed. The overall prevalence of asymptomatic left ventricular systolic dysfunction was 9.4%, while diastolic dysfunction was detected in 39.1% of subjects. The rate of systolic and diastolic dysfunction increased proportionally to the number of cardiovascular risk factors (1 or ≥ 5 risk factors), ranging from 8.1% to 27.1% and from 37.5% to 45.0%, respectively. At multivariate analysis, independent variables predictive for systolic dysfunction were male gender (p < 0.001), family history of cardiovascular disease (p = 0.002) and diabetes (p = 0.027); while for diastolic dysfunction they were age (p < 0.001), hypertension (p < 0.001) and diabetes (p < 0.05). In a large sample of subjects without symptoms of heart failure referred to echocardiography, we found a significant prevalence of left ventricular systolic and diastolic dysfunction, both related to the number of cardiovascular risk factors. Valutare la prevalenza della disfunzione del ventricolo sinistro in soggetti senza segni o sintomi di scompenso cardiaco sottoposti a ecocardiografia in relazione alla presenza di uno o più fattori di rischio cardiovascolare. Lo studio DAVES (Disfunzione Asintomatica del Ventricolo Sinistro) è uno studio osservazionale multicentrico. Sono stati valutati 16.099 pazienti provenienti da 75 Centri e arruolati 3.537 soggetti senza segni o sintomi di scompenso cardiaco. È stata valutata la funzione sistolica e diastolica del ventricolo sinistro, osservando una prevalenza di disfunzione sistolica (frazione di eiezione ≥ 50%) del 9,4% e diastolica del 39,1%. La presenza di disfunzione sistolica e diastolica aumentava proporzionalmente al numero dei fattori di rischio cardiovascolare, rispettivamente, dall’8,1% al 27,1% e dal 37,5% al 45,0%. All’analisi multivariata, variabili predittive indipendenti per la disfunzione sistolica erano il sesso maschile (p < 0,001), una familiarità nota per malattie cardiovascolari (p = 0,002) e il diabete mellito (p = 0,027), mentre per la disfunzione diastolica erano l’età (p < 0,001), l’ipertensione arteriosa (p < 0,001) e il diabete mellito (p < 0,05). In un ampio campione di soggetti asintomatici per scompenso cardiaco sottoposti a ecocardiogramma abbiamo riscontrato una significativa prevalenza di disfunzione sistolica e diastolica, correlata al numero di fattori cardiovascolari.

Heart fAilure Prevalence and Predictors in TurkeY (HAPPY) Çalışması

The aim of this study was to determine the prevalence of heart failure (HF) in adult residents of Turkey based on echocardiography and N-terminal B type natriuretic factor. 4650 randomly selected residents aged ≥ 35 years were enrolled. Height, weight, waist and hip circumference, and blood pressure measurements were taken, and a 12-lead ECG was performed. Advanced age, hypertension (HT), diabetes mellitus (DM), obesity, and chronic renal failure (CRF) were assessed. History of any heart disease, any abnormal ECG, or an NT-proBNP ≥ 120 pg/mL was accepted as echocardiography indication. Patients with systolic and/or diastolic dysfunction, or NT-proBNP ≥ 2000 pg/mL were classified as having HF if their functional capacity was NYHA ≥ Class II, and were classified as having asymptomatic left ventricular dysfunction (ASVD) if their functional capacity was NYHA <Class I. The absolute and estimated prevalences were 2.9% and 6.9% for HF, and 4.8% and 7.9% for ASVD, respectively. Advanced age, male gender, history of heart disease, HT and CRF were independent predictors of HF. In patients with ejection fraction (EF) <50%, HF prevalence was higher in men, while HF prevalences were higher in women when EF ≥ 50%. In global sum, HF and ALVD prevalence were similar in male and females. The prevalences of HF and ASVD are higher in Turkey when compared with western countries, despite a younger Turkish population. The established predictors of HF are valid for Turkey as well. There is a significant ASVD population in Turkey with similar characteristics and risk factors to HF. Focusing on the early detection and treatment of ASVD may prevent the progression to HF, and therefore would decrease the prevalence of HF in Turkey.

P1-10-01: Utility of Routine Cardiac Ejection Fraction (CEF) Measurement Prior to Anthracycline-Based Chemotherapy (ABC): A Study of 466 Patients with Early-Stage Her2-Negative Invasive Breast Cancer.

Abstract Background: Despite the lack of evidence to support its utility, routine CEF measurement prior to ABC is a common practice in the community, required in most US clinical trials, endorsed by the American Heart Association and American College of Cardiology, and appears on Food Drug Administration-approved labeling guidelines. Objectives: We determined the frequency of the following events in newly diagnosed invasive breast cancer patients: a) CEF measurement prior to ABC; b) asymptomatic left ventricular dysfunction; c) modification in initial treatment strategy as a result of CEF measurement; d) development of congestive heart failure (CHF) after ABC. Methods: From our cancer registry, we obtained a list of all female patients with newly diagnosed stage I-III breast cancer who were treated with chemotherapy as part of initial therapy at our institution in 2000–2010 (N=562). We excluded those with prior CHF, ABC, and those who had Her2-positive disease (n=66). CEF &amp;lt;50% was considered low. CHF risk factors including coronary heart disease, cigarette smoking, hypertension, obesity, and diabetes mellitus were collected. Results: We included 496 patients with the following stage distribution: I (22%), II (54%), and III (24%). The mean age was 53 years (SD±11; range 25–88). In 30 (7%) patients, ABC was considered inappropriate by the physician provider due to poor performance status, co-morbidities, and physician or patient preference. Of the 466 patients considered for ABC, CEF was measured in 241 (52%) patients before chemotherapy. In the latter group, only 1 (0.4%) patient was found to have asymptomatic left ventricular dysfunction with CEF of 48%. Among patients considered for ABC, 10 (2%) did not receive ABC for the following reasons: low or borderline CEF (2), patient preference (3), co-morbidities (2), and randomization to non-ABC in clinical trials (3). After a mean follow up 57 months (SD±34), only 3 of 456 (0.7%) patients who received ABC developed CHF. Two had normal CEF prior to treatment while the other did not have CEF measured. The practice of CEF measurement prior to ABC varied among physician providers, ranging from 23% to 67% (mean/SD 47%±15%). Those who had CEF measured before chemotherapy were older (55 vs. 50 years; P &amp;lt;0.001) and had more CHF risk factors (1.3 vs. 0.9; P &amp;lt;0.001). Conclusions: At our institution, routine CEF measurement prior to ABC as initial therapy for early-stage Her2-negative invasive breast cancer patients is a common though not uniform practice. Asymptomatic left ventricular dysfunction is rarely detected and generally mild. Our findings do not support the utility of routine CEF measurement in this population and challenge current practice and guidelines. Potential cost implications to our health care system can be substantial. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-10-01.