Patients with Left Ventricular Dysfunction Who Have Not Developed Symptoms (Stage B)

Patients without symptoms, but who have had an MI or have evidence of left ventricular dysfunction are at considerable risk of developing HF. In those cases, HF can be prevented by reducing the risk of additional injury and by retarding the evolution and progression of left ventricular dysfunction.¹

Prevention of Cardiovascular Events

• Patients with an Acute Myocardial Infarction— In patients who are experiencing an AMI, the infusion of a thrombolytic agent or the use of percutaneous coronary intervention can decrease the risk of developing HF, and those interventions can reduce death, especially in patients with a prior myocardial injury. Patients with an AMI can benefit from the administration of an ACE inhibitor and/or a beta-blocker, which can reduce the risk of reinfarction or death when initiated soon after the ischemic event, especially in patients whose course is complicated by HF.¹
  
• Patients with a History of MI, But Preserved Left Ventricular Function— Both hypertension and hyperlipidemia should be treated vigorously in patients with a history of MI, because the benefits of treating these coronary risk factors are particularly marked in patients with a prior ischemic event. Patients with a recent MI can benefit from the administration of an ACE inhibitor and/or a beta-blocker, which can reduce the risk of death when initiated days or weeks after an ischemic cardiac event.¹
  
• Patients with Chronic Left Ventricular Systolic Dysfunction, But No Symptoms— Long-term treatment with an ACE inhibitor has been shown to delay the onset of symptoms and decrease the combined risk of death and hospitalization for HF in asymptomatic patients with left ventricular systolic dysfunction, whether due to a remote ischemic injury or to a nonischemic cardiomyopathy. In addition, the use of beta-blockers in patients with a low ejection fraction and no symptoms, especially in those with coronary artery disease, is warranted.¹
  
• Patients with Severe Valvular Disease, But No Symptoms— Patients with severe aortic or mitral valve stenosis or regurgitation should be considered for valve replacement surgery, even when ventricular function is impaired. Those with severe aortic regurgitation who are deemed poor candidates for surgery may be considered for long-term treatment with a systemic vasodilator drug.¹

For more information on treating specific stages of heart failure, click on the following topics:

Patients at High Risk for Developing Left Ventricular Dysfunction (Stage A)
Patients with Left Ventricular Dysfunction Who Have Not Developed Symptoms (Stage B)
Patients With Left Ventricular Dysfunction With Current or Prior Symptoms (Stage C)
Patients with Refractory End-Stage HF (Stage D)

References