Abstract 44: Symptoms Associated with Early Adverse Echocardiographic Changes in Community-based Cohort in Tobago

Abstract

Introduction: Transthoracic echocardiography (TTE) is often part of the cardiac evaluation of patient-reported symptoms. Guidelines for obtaining TTE assume its ready availability, which may not be the case in resource-limited settings. Identifying symptoms associated with abnormalities of cardiac structure and function may help future selection of patients for TTE, particularly in low resource settings. Hypothesis: Individuals with symptoms associated with heart disease will be more likely to have echocardiographic evidence of cardiac dysfunction. Methods: The Tobago Health Study (THS) is a longitudinal community-based cohort study in adults on the Caribbean island of Tobago. Starting in 2021, an ancillary study conducted standard 2-D, M-mode, Doppler TTE at a local cardiology office in 905 THS participants without a history of heart failure, COPD, or coronary heart disease. Participants also completed clinical exams and health history questionnaires, including the Rose Angina Questionnaire. Associations between self-reported cardiac-related symptoms with TTE-determined cardiac structure and function were examined in regression models adjusted for age, sex, BMI, hypertension, smoking, and asthma. Sensitivity and specificity of symptoms for features of cardiac structure and function were calculated. Results: Participants were aged 41-88 (mean 63 years) and 38% female. Mean BMI was 30 kg/m2, 59% were hypertensive, 11% were current or former smokers, and 5.9% had asthma. In total, 60% of participants reported at least one symptom on the Rose Questionnaire, lower extremity edema and chest pain being the most common (Table 1). Echocardiography-defined clinical outcomes present in the THS included reduced (<50%) left ventricular ejection fraction (LVEF) in 2.3% (mean LVEF 64%), diastolic dysfunction in 12.8%, aortic stenosis (aortic valve peak velocity >2m/s) in 2.1% and left ventricular hypertrophy (LVH) in 7.6%. Table 2 displays multivariable-adjusted associations between symptoms and these features on TTE. Overall, symptoms provided low sensitivity, but higher specificity for reduced LVEF or aortic stenosis (Table 3). Sleeping with 2 or more pillows to help breathing yielded >93% specificity for reduced LVEF or aortic stenosis. Conclusions: In persons without a history of cardiovascular disease in resource limited settings, the presence of symptoms, particularly severe chest pain or orthopnea, is associated with presence of reduced LVEF and/or aortic stenosis.