Clinical and Echocardiographic Characterization of Stage B Heart Failure in Asymptomatic Adults With Cardiovascular Risk Factors

Background: Stage B heart failure (pre-HF) is characterized by objective cardiac abnormalities without HF symptoms.This study assessed the prevalence and clinical and echocardiographic characteristics of those who were asymptomatic yet had cardiovascular risk factors and Stage B HF.Methods: This cross-sectional study included 900 asymptomatic adults with cardiovascular risk factors, consecutively recruited from participating hospitals from October 2025 to July 2026.We performed clinical evaluation and a standardized transthoracic echocardiogram.Stage B/pre-HF was defined as the presence of objective cardiac structural or functional abnormalities in the absence of heart failure symptoms or signs.We evaluated independent factors associated with Stage B/pre-HF using multivariable logistic regression.Results: In this hospital-based cohort, Stage B/pre-HF was determined in 261 (29.0%) participants.Hypertension, diabetes mellitus, and obesity were more prevalent in the Stage B group, occurring in 154 (59.0%), 118 (45.2%), and 109 (41.8%), respectively.Stage B/pre-HF was characterized descriptively by lower left ventricular ejection fraction and higher left ventricular mass index, left atrial volume index, E/e′ ratio, and tricuspid regurgitation velocity, along with impaired diastolic function.Hypertension was the strongest independent association (OR = 5.930, 95% CI: 3.815-9.217),followed by diabetes (OR = 2.945, 95% CI: 1.913-4.532),age, sex, and BMI.The model showed good fit (Nagelkerke R² = 0.565; Hosmer-Lemeshow p = 0.449).Conclusion: Stage B/pre-HF was common among asymptomatic adults with cardiovascular risk factors and was characterized by structural and functional cardiac abnormalities.These findings support the potential value of early identification and management of modifiable cardiovascular risk factors in asymptomatic adults at risk for HF.