Managment of Subclinical Disease
Patients often have subclinical (asymptomatic disease). The long term consequences of this are unknown.
Community-based observational studies show that asymptomatic left-ventricular systolic dysfunction (LVSD) in adults is associated with increased:
- Cardiovascular mortality
- All causes of mortality and nonfatal cardiovascular events, such as myocardial infarctions and stroke.
Little is known about the rate of progression of asymptomatic LVSD to overt congestive failure. One study in adults reported an annual incidence of CHF at 3% in elderly individuals with LVSD without coronary artery disease.
Long term survivors can have hemodynamically important LV dysfunction along with mild LV systolic dysfunction. They may have significant pulmonary and cardiac symptoms. Thus heart failure can occur despite that fact that systolic function is preserved.26
Heart failure with preserved LVEF has no proven therapy and needs further research into how to treat in the future26
Angiotensin-converting enzyme inhibitors have been shown to reduce the incidence of CHF in adult patients with LVSD.
In the absence of longitudinal studies of cardiovascular and other outcomes in childhood cancer survivors with subclinical cardiac dysfunction, it is difficult to make firm treatment recommendations.