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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Management of patients with asymptomatic left ventricular (LV) dysfunction or hypertrophy (heart failure stage B) Class I - There is evidence and/or general agreement that the following approaches are effective for the management of asymptomatic LV dysfunction •  Beta blockers and angiotensin converting enzyme (ACE) inhibitors if there is a recent or remote history of myocardial infarction (MI), regardless of left ventricular ejection fraction (LVEF). •  An angiotensin II receptor blocker (ARB) to post-MI patients who do not tolerate an ACE inhibitor and have a low LVEF. •  Beta blockers and ACE inhibitors in patients without a history of MI who have a reduced LVEF. •  Treatment of an acute MI according to current guidelines. •  Coronary revascularization according to current guidelines. •  Valve replacement or repair for hemodynamically significant valvular stenosis or regurgitation according to current guidelines Class IIa - The weight of evidence or opinion is in favor of the usefulness of the following approaches for the management of asymptomatic LV dysfunction •  ACE inhibitors or ARBs in patients with hypertension and LV hypertrophy. •  ARBs in patients with a low LVEF who are intolerant of ACE inhibitors. •  Placement of an ICD in patients with ischemic cardiomyopathy who are at least 40 days post-MI, have an LVEF of ≤30 percent, are NYHA functional class I on chronic optimal medical therapy, and have a reasonable expectation of survival with a good functional status for more than one year. Class IIb - The weight of evidence or opinion is less well established for the usefulness of the following approach for the management of asymptomatic LV dysfunction •  Placement of an ICD in patients with nonischemic cardiomyopathy who have an LVEF, are in New York Heart Association functional class I with chronic optimal medical therapy, and have a reasonable expectation of survival with good functional status for more than one year. Class III - There is evidence and/or general agreement that the following approaches are not useful or may be harmful for the management of asymptomatic LV dysfunction •  Digitalis in patients with a low LVEF and sinus rhythm, since the risk of harm is not balanced by any known benefit. •  Use of nutritional supplements to treat structural heart disease or prevent symptomatic heart failure

Class III - There is evidence and/or general agreement that the following approaches are not useful or may be harmful for the management of asymptomatic LV dysfunction •  Digitalis in patients with a low LVEF and sinus rhythm, since the risk of harm is not balanced by any known benefit. •  Use of nutritional supplements to treat structural heart disease or prevent symptomatic heart failure •  Calcium channel blockers with negative inotropic activity may be harmful in post-MI patients who have a low LVEF. Data from Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005; 112:e154.