Stage B: What is the Evidence for Treatment of Asymptomatic Left Ventricular Dysfunction?
Brent N. Reed and Carla A. Sueta
Affiliation: Center for Heart & Vascular Care, University of North Carolina, 160 Dental Circle, CB 7075, Chapel Hill, NC 27599-7075, USA.
Keywords: ACE inhibitors, asymptomatic left ventricular dysfunction, beta blockers, device therapy, heart failure, stage B.
Although patients with American College of Cardiology / American Heart Association (ACC/AHA) Stage B
heart failure, or asymptomatic left ventricular dysfunction (ALVD) are at high risk for developing symptomatic heart failure,
few management strategies have been shown to slow disease state progression or improve long-term morbidity and
mortality. Of the pharmacologic therapies utilized in patients with symptomatic disease, only angiotensin converting enzyme
(ACE) inhibitors (and to a lesser extent, angiotensin receptor blockers, or ARBs) have been shown to improve clinical
outcomes among patients with ALVD. Although evidence to support the use of beta blockers in this setting has been
primarily derived from retrospective studies or subgroup analyses, they are generally recommended in most patients with
ALVD, especially those with ischemic etiology. Statins are associated with improvements in both major adverse cardiovascular
events and heart failure events among patients with a history of acute myocardial infarction. Finally, in eligible
patients, placement of an automatic implantable cardioverter defibrillator (ICD) has been associated with reduced mortality
rates among those with ALVD due to ischemic cardiomyopathy, and some subgroups may derive benefit from cardiac
resynchronization therapy or biventricular pacing.
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