Screening for left ventricular dysfunction: a step too far?

Much has been written and said about the burden of heart failure in the community, and the need for its accurate and rapid diagnosis to facilitate access to the disease modifying therapies which can alleviate both the morbidity and mortality which accompany the syndrome. At this time, however, it might seem that we are overwhelmed with the problem of dealing with the manifest phase of this condition, never mind trying to address the question posed in the title of this article. Nevertheless, it is my remit to step back further in the natural history of heart failure to try and answer the question of whether we should be screening for an asymptomatic precursor of heart failure. Before embarking on this, it is worth reminding ourselves of the criteria which should be fulfilled before we screen for a disease. Namely, the disease we are seeking to detect should be common, it should be serious (that is, represent a significant public health problem), it should have a recognisable latent phase, it must be treatable, and lastly there should be a cost effective and acceptable test with which to detect it.1 So lets apply these criteria to heart failure. Firstly, is there a recognisable latent phase? The most common antecedent of chronic heart failure (CHF) and the one we understand best is left ventricular systolic dysfunction (LVSD) although a proportion of heart failure cases arise in the presence of normal systolic function. As we have only recently begun to unravel how to treat heart failure caused by systolic dysfunction and know very little about how to treat the latter condition effectively, it would be wise to contain this argument for now to the scenario of heart failure arising from systolic dysfunction. Pertaining to this, we are now becoming increasingly aware that many …