Stage B Heart Failure Identified More than Expected in Indian Patients Undergoing Routine Echocardiography: IHJ, October 2025, Study Finds

Heart failure remains a major global health challenge, with five-year mortality rates of 30–50%. Its incidence continues to rise due to aging populations and increasing prevalence of hypertension, diabetes, obesity, and coronary artery disease. Stage B HF represents the pre-clinical phase, defined by structural or functional cardiac abnormalities—such as LVH or reduced ejection fraction—in otherwise asymptomatic individuals. Identifying these patients is essential, as early intervention can prevent or delay progression to symptomatic heart failure. However, data on the prevalence of stage B HF in the Indian population remain limited.

Study Overview

This study was designed as a clinic-based analysis at a referral center in North India, involving 227 consecutive patients (mean age 56.3± 12.1 years, 60% men) undergoing routine echocardiography for various indications. Rigorous exclusion criteria were applied, eliminating patients under 18 years of age, those with current or previous symptomatic HF, moderate or severe valve disease, Left Ventricular Ejection Fraction (LVEF) <50%, or major systemic diseases. The methodology mandated a comprehensive echocardiographic examination performed by a single experienced operator according to current recommendations, focusing on advanced metrics. Stage B HF was diagnosed if a patient presented with any one of three key abnormalities: Left Atrial Volume Index (LAVI) >34 mL/m², a Mitral E/E’ ratio >14, or a Left Ventricular Global Longitudinal Strain (LVGLS) less negative than −16%.

Study Findings

The study confirmed a high prevalence of Stage B HF, diagnosed in 52.4% of the subjects.

Analysis of the specific diagnostic criteria revealed that reduced LVGLS was the most prevalent abnormality, affecting 47% of the total patient cohort.

In contrast, 13% of patients exhibited increased LAVI and 7% showed an elevated mitral E/E’ ratio.

Comparing patients with Stage B HF to those without, the Stage B group showed significantly higher LAVI and Mitral E/E’ ratios, and a markedly lower LVGLS. Furthermore, Left Atrial Reservoir Strain (LARS) was found to be significantly lower in patients with Stage B HF.

Notably, no significant differences were observed between the two groups regarding mean age, male sex percentage, hypertension prevalence, diabetes status, LVEF, or routine right ventricular (RV) function parameters.

Clinical Importance for Early Intervention

The finding that over half of the patients undergoing routine echocardiography already meet the criteria for pre-clinical heart failure is a powerful signal for practicing cardiologists and physicians. This high prevalence rate aligns with or even exceeds rates reported in comparable studies of high-risk populations globally. Recognizing and diagnosing this silent phase is vital because numerous studies have confirmed that Stage B HF is associated with a significantly increased risk for both future symptomatic HF development and all-cause mortality.

Guidelines currently recommend lifestyle management and rigorous control of cardiovascular risk factors, such as hypertension and diabetes, to reduce the risk of progression. Additionally, pharmacological interventions, including Angiotensin-Converting Enzyme (ACE) inhibitors and beta-blockers, have demonstrated efficacy in preventing the progression of Stage B HF. This study reinforces the need for clinicians to integrate advanced echocardiographic parameters, particularly LVGLS and LARS, into routine assessment to proactively identify and treat these high-risk asymptomatic patients, shifting the focus toward aggressive primary prevention.

Reference: Gupta R, Das T, Suchak MK, Kudalkar SS, Pandey P, Shrivastava S, Bansal M, Das MK. Prevalence of stage B heart failure in patients undergoing echocardiography during regular Clinical practice. Indian Heart Journal. 2025 Jun 10.