ASYMPTOMATIC LEFT VENTRICULAR DYSFUNCTION: THE SILENT RISK WE SHOULD NOT IGNORE.

Abstract

Background: Asymptomatic left ventricular dysfunction (ALVD), characterized by a reduced left ventricular ejection fraction (LVEF <40%) without heart failure symptoms, is classified as stage B in the ACC/AHA guidelines. Increased echocardiography use has led to more frequent ALVD detection. This high-risk condition can progress to symptomatic heart failure, ventricular arrhythmias, hospitalization, and sudden death. Methods: This review, conducted in Medellín, Colombia, between April and June 2025, proposes a practical, evidence-based clinical decision-making approach for ALVD patients to prevent major cardiovascular complications. Our analysis incorporated key clinical trials (SOLVD Prevention, DAPA-HF, and PARADIGM-HF) and international clinical practice guidelines from leading cardiology societies, focusing on the effectiveness of early pharmacological interventions and diagnostic/clinical follow-up strategies. Results: The available evidence supports early intervention in ADI through the use of ACE inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 (SGLT2) inhibitors, drugs that reduce progression to symptomatic heart failure and improve survival. A five-step diagnostic-therapeutic algorithm was designed that includes: Diagnostic confirmation of LVHF, Etiological identification (ischemic, cardiomyopathies, toxic, infiltrative, or inflammatory), Initiation of evidence-based pharmacological treatment, Arrhythmic risk assessment and sudden death stratification, Periodic clinical and echocardiographic follow-up. In conclusion, AFVD represents a high-risk entity that requires an active approach even in the absence of symptoms. The implementation of early diagnostic and therapeutic strategies improves prognosis, prevents major cardiovascular events, and optimizes healthcare resources. In this context, proactive management of DVIA is not only a cost-effective cardiovascular prevention strategy but also an ethically responsible measure, as it anticipates the unfavorable progression of the disease.