Severe heart failure (NYHA Class IV) is associated with increased left ventricular mass index and short mitral deceleration time in severe aortic valve stenosis

Background: Acceleration time (AT)/ejection time (ET) ratio is a marker of aortic valve stenosis (AS) severity and predicts outcome in moderate-severe AS. Methods: We explored the association of increased AT/ET ratio on prognosis in 1530 asymptomatic patients with presumably mild-moderate AS, normal ejection fraction, and without known diabetes or cardiovascular disease. Patients were part of the SEAS study (Simvastatin Ezetimibe Aortic Stenosis). Patients were grouped according to the optimal AT/ET ratio threshold to predict cardiovascular death and heart failure hospitalization. Low-gradient severe AS was identified as combined valve area ≤1.0 cm 2 and mean gradient <40 mm Hg. Outcome was assessed in Cox regression analyses, and results are reported as hazard ratio and 95% CI. Results: Higher AT/ET ratio was significantly associated with lower systolic blood pressure, lower left ventricular ejection fraction, lower stress-corrected midwall shortening, low flow, and with higher left ventricular mass and higher peak aortic jet velocity. AT/ET ratio ≥0.32 provided the optimal cutoff for predicting incident cardiovascular death and heart failure hospitalization in the total study sample. In patients with low-gradient severe AS, this threshold was >0.32. AT/ET ratio ≥0.32 had a 79% higher risk of cardiovascular death and heart failure hospitalization (hazard ratio, 1.79 [95% CI, 1.20–2.68]). In patients with low-gradient severe AS, AT/ET ratio >0.32 was associated with a 2-fold higher risk of cardiovascular death and heart failure hospitalization (hazard ratio, 2.15 [95% CI, 1.22–3.77]). Conclusions: In asymptomatic nonsevere AS and low-gradient severe AS, higher AT/ET ratio was associated with increased cardiovascular morbidity and mortality. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00092677.

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PROGNOSTIC IMPACT OF LEFT VENTRICULAR MASS INDEX REGRESSION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)32587-2 ◽

2019 ◽

Vol 73 (9) ◽

pp. 1981

Author(s):

Jin Kyung Oh ◽

Dae-Hee Kim ◽

Jong-Min Song ◽

Seung-Ah Lee ◽

Do-Yoon Kang ◽

...

Keyword(s):

Aortic Valve ◽

Left Ventricular Hypertrophy ◽

Aortic Valve Replacement ◽

Left Ventricular Mass ◽

Transcatheter Aortic Valve Replacement ◽

Ventricular Hypertrophy ◽

Left Ventricular Mass Index ◽

Left Ventricular ◽

Prognostic Impact ◽

Transcatheter Aortic Valve

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Prosthesis–patient mismatch after aortic valve replacement predominately affects patients with preexisting left ventricular dysfunction: Effect on survival, freedom from heart failure, and left ventricular mass regression

Yearbook of Cardiology ◽

10.1016/s0145-4145(08)70112-6 ◽

2007 ◽

Vol 2007 ◽

pp. 166-168

Author(s):

T.M. Sundt

Keyword(s):

Heart Failure ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Left Ventricular Mass ◽

Valve Replacement ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Ventricular Mass

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Relation of Left Ventricular Mass to Prognosis in Initially Asymptomatic Mild to Moderate Aortic Valve Stenosis

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.115.003644 ◽

2015 ◽

Vol 8 (11) ◽

Cited By ~ 55

Author(s):

Eva Gerdts ◽

Anne B. Rossebø ◽

Terje R. Pedersen ◽

Giovanni Cioffi ◽

Mai Tone Lønnebakken ◽

...

Keyword(s):

Aortic Valve ◽

Left Ventricular Mass ◽

Aortic Valve Stenosis ◽

Left Ventricular ◽

Ventricular Mass

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Early conversion of classic Fontan conversion may decrease term morbidity: single centre outcomes

Cardiology in the Young ◽

10.1017/s104795111900146x ◽

2019 ◽

Vol 29 (8) ◽

pp. 1045-1050

Author(s):

David Blitzer ◽

Asma S. Habib ◽

John W. Brown ◽

Adam C. Kean ◽

Jiuann-Huey I. Lin ◽

...

Keyword(s):

Heart Failure ◽

Heart Transplant ◽

Nyha Class ◽

Survival Rates ◽

Severe Heart Failure ◽

Retrospective Chart Review ◽

Left Ventricular ◽

Right Atrial ◽

Current Standard ◽

Fontan Conversion

AbstractBackground:The initial classic Fontan utilising a direct right atrial appendage to pulmonary artery anastomosis led to numerous complications. Adults with such complications may benefit from conversion to a total cavo-pulmonary connection, the current standard palliation for children with univentricular hearts.Methods:A single institution, retrospective chart review was conducted for all Fontan conversion procedures performed from July, 1999 through January, 2017. Variables analysed included age, sex, reason for Fontan conversion, age at Fontan conversion, and early mortality or heart transplant within 1 year after Fontan conversion.Results:A total of 41 Fontan conversion patients were identified. Average age at Fontan conversion was 24.5 ± 9.2 years. Dominant left ventricular physiology was present in 37/41 (90.2%) patients. Right-sided heart failure occurred in 39/41 (95.1%) patients and right atrial dilation was present in 33/41 (80.5%) patients. The most common causes for Fontan conversion included atrial arrhythmia in 37/41 (90.2%), NYHA class II HF or greater in 31/41 (75.6%), ventricular dysfunction in 23/41 (56.1%), and cirrhosis or fibrosis in 7/41 (17.1%) patients. Median post-surgical follow-up was 6.2 ± 4.9 years. Survival rates at 30 days, 1 year, and greater than 1-year post-Fontan conversion were 95.1, 92.7, and 87.8%, respectively. Two patients underwent heart transplant: the first within 1 year of Fontan conversion for heart failure and the second at 5.3 years for liver failure.Conclusions:Fontan conversion should be considered early when atrial arrhythmias become common rather than waiting for severe heart failure to ensue, and Fontan conversion can be accomplished with an acceptable risk profile.

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