{
  "abstract": "Background Stage B heart failure (HF), defined by asymptomatic structural or functional cardiac abnormalities, encompasses a broad, clinically heterogeneous population. Within this group, some patients experience significant cardiac remodelling without progressing to symptomatic HF. The natural history and prognostic implications of this subgroup remain poorly understood.Objective To investigate echocardiographic and clinical differences in Stage B patients who demonstrated significant structural progression without transitioning to symptomatic HF, compared to those with stable echocardiographic profiles.Methods This retrospective study analysed data from 1,425 participants enrolled in the St Vincent’s Screening TO Prevent Heart Failure (STOP-HF) program. All participants underwent baseline classification into Stage A or B HF, with repeat assessment at a mean follow-up of 5.4 years. We identified a subgroup of Stage B patients (n = 81) with significant echocardiographic progression but no transition to Stage C, and compared them to their non-progressing counterparts within B (n = 253). Changes in echocardiographic parameters were assessed alongside BNP levels and clinical event rates (expressed per 1,000 patient-years).Results Patients with echocardiographic progression showed significantly greater increases in left ventricular mass index (117 vs 106 g/m 2, p = 0.002), left atrial volume index (34.5 vs 30.8 mL/m2, p = 0.012), and LV end-diastolic dimension (49.8 mm vs 48.1 mm, p = 0.043) compared to stable counterparts. However, event rates did not differ significantly between groups (127.1 vs 109.1, p = 0.3308). BNP levels were also similar (55.4 vs 66.5 pg/mL, p = 0.73), suggesting a disconnect between structural progression and biomarker or clinical event burden.Conclusions Echocardiographic progression within Stage B occurs but within our data set was not correlated with higher event rates or biomarker levels, suggesting a nuanced trajectory not reflected in clinical outcomes.",
  "authors": [
    {
      "affiliations": [
        "St Vincent’s University Hospital, Dublin, Ireland"
      ],
      "name": "A Moore"
    },
    {
      "affiliations": [
        "St Vincent’s University Hospital, Dublin, Ireland"
      ],
      "name": "M Barrett"
    },
    {
      "affiliations": [
        "St Vincent’s University Hospital, Dublin, Ireland"
      ],
      "name": "J Gallagher"
    },
    {
      "affiliations": [
        "St Vincent’s University Hospital, Dublin, Ireland"
      ],
      "name": "M Ledwidge"
    },
    {
      "affiliations": [
        "St Vincent’s University Hospital, Dublin, Ireland"
      ],
      "name": "K McDonald"
    }
  ],
  "title": "5 The quiet progressors: structural heart changes without symptoms in stage B heart failure",
  "uid": "1cfbca18-df40-5074-8b74-b091ace5560c"
}