Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.666156
Title: The prevalence, correlates, effects and detection of left ventricular systolic dysfunction in an urban population
Author: McDonagh, T. A.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1998
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Abstract:
The prevalence of chronic heart failure (CHF) in most epidemiological studies has been determined by using clinical criteria. In this thesis, in contrast, left ventricular systolic function was assessed objectively by echocardiography in a cross-sectional survey of 2000 men and women aged 25-74, randomly sampled from a geographical area. Left ventricular ejection fraction (LVEF) was measured using the Biplane Simpson's Rule Method. Its aims were to document the prevalence of both symptomatic and asymptomatic left ventricular systolic dysfunction; ascertain the correlates of left ventricular systolic dysfunction; assess its effects on effort capacity; determine the usefulness of the natriuretic peptides in detection systolic dysfunction and to explore the possibility of a genetic component to left ventricular systolic dysfunction by examining the relationship between left ventricular systolic dysfunction and the angiotensin-converting enzyme insertion/deletion polymorphism (ACE I/D). This work has shown that left ventricular systolic dysfunction is at least twice as common than previous studies based on clinical criteria of CHF would suggest: about half is asymptotic. Only 18% of subjects with definite left ventricular systolic dysfunction were taking an ACE inhibitor. Its main risk factors are IHD and hypertension in the presence of IHD. Screening such high risk groups for left ventricular systolic dysfunction is worthy of consideration. Using a test such as BNP and targeting its use to individuals at high risk would lead to the identification of many patients with left ventricular systolic dysfunction and, therefore, to the uptake of effective treatment. It would also lead to a more cost effective use of further investigation. This thesis also provides a mechanistic insight into the development of left ventricular systolic dysfucntion by suggesting that while the DD genotype confers a higher risk of MI, it is associated with better preservation of LV function post MI, possibly by enabling more adequate compensatory hypertrophy. The ACE gene I/D polymorphism may, therefore, have a bi-directional importance in determining both the risk of MI and post MI LV systolic dysfunction.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.666156  DOI: Not available
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