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Severe heart failure (NYHA Class IV) is associated with increased left ventricular mass index and short mitral deceleration time in severe aortic valve stenosis
Author(s) -
Kobayashi Sayuki,
Utsunomiya Hiroto,
Shiota Takahiro
Publication year - 2018
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13895
Subject(s) - medicine , cardiology , heart failure , stenosis , aortic valve replacement , ventricular pressure , hemodynamics
Background In aortic valve stenosis (AS), congestive heart failure (CHF) is a well‐established symptom that indicates the need for surgical aortic valve replacement (SAVR). However, it is difficult to judge whether CHF symptoms such as dyspnea are caused by severe AS or other conditions, especially in elderly persons with restricted mobility or other organ complications. It is important to identify objective and noninvasive parameters associated with severe CHF symptoms in severe AS. Methods One hundred ninety‐eight patients with severe AS without left ventricular (LV) dysfunction were retrospectively studied. CHF symptoms were classified by New York Heart Association (NYHA) functional class. Echo parameters were compared between NYHA I–III and NYHA IV. Results Patients with NYHA IV (n = 40; 20%) were older (86 ± 6 vs 82 ± 8 years; P = .001) and had a larger LV mass index (LVMI) (157 ± 43 vs 114 ± 34 g/m 2 , P < .001), a higher transmitral flow velocity ratio (E/A) (1.31 ± 0.62 vs 0.93 ± 0.42; P = .001), a shorter deceleration time (DT) (202 ± 72 vs 286 ± 98 ms; P < .001), and a higher systolic pulmonary arterial pressure (SPAP) (44 ± 13 vs 35 ± 13 mm Hg; P < .001) than patients with NYHA I–III. On multivariable analysis, LVMI and DT were independently associated with NYHA IV. Receiver operating characteristic curve analysis identified LVMI ≥ 142 g/m 2 and DT ≤ 194 ms as the cutoff values associated with NYHA IV in patients with severe AS. Conclusion Left ventricular mass index and DT were independently associated with severe heart failure (NYHA IV). These echo parameters could be helpful to judge whether CHF symptoms are caused by severe AS.