Our goals are to objectively measure cardiac function in a community cohort, to define and characterize the natural history of left ventricular dysfunction (LVD), and to develop means for early detection of LVD. LVD is hypothesized to progress from asymptomatic LVD to severe LVD, ending ultimately in disability and death. Therefore, a foundational understanding of the occurrence and natural history of ventricular function in the community is of central significance for our understanding of congestive heart failure, a major form of cardiovascular disease that is increasing in prevalence. Our first objective was to perform a cross-sectional population-based study of objectively measured ventricular function parameters and clinical disease in the community. Our study of 2050 persons > 45 yrs of age, the Prevalence of Asymptomatic Left Ventricular Dysfunction (PAVD) in Olmsted County, MN (R01 HL55502), is providing estimates of the distribution of echocardiographic ventricular systolic and diastolic function parameters in the community, and of the association between ventricular function and prevalent cardiovascular symptoms and disease. In collaboration with the Strong Heart Study (SHS) preliminary analysis of the PAVD and SHS cohorts has shown that both systolic and diastolic LVD are associated with elevated plasma concentrations of brain natriuretic peptide (BNP), a peptide secreted by the heart in response to increased cardiac filling pressure, that may serve as a marker to aid in the early diagnosis of LVD. Longitudinal population-based studies of ventricular function and plasma BNP, and their association with incident cardiovascular events, are not available. Having now characterized cardiac structure and function in our population-based cross-sectional study, we propose to restudy this cohort employing the same ventricular function and BNP measurements. We will estimate the longitudinal change in ventricular structure and function and test the hypotheses that: 1) systolic/diastolic LVD are longitudinally progressive, 2) increasing plasma BNP is associated with progressive change in LV structure and function, and 3) abnormalities in LV structure, function, and BNP are associated with incident clinical events. We will thereby extend the value of this unique sentinel cohort for the population-based longitudinal study of LVD and CHF in the community.
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