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Severe heart failure (NYHA Class IV) is associated with increased left ventricular mass index and short mitral

Sayuki Kobayashi1,2, Hiroto Utsunomiya3, Takahiro Shiota4,5

  • 1Center of Medical Ultrasonics, Saitama Medical Center, Dokkyo Medical University, Saitama, Japan.

Echocardiography (Mount Kisco, N.Y.)
|April 21, 2018
PubMed

Insights

In severe aortic stenosis (AS), elevated left ventricular mass index (LVMI) and short deceleration time (DT) are linked to severe heart failure (NYHA IV). These echocardiographic measures can help differentiate AS-related symptoms.

Area of Science:

  • Cardiology
  • Echocardiography
  • Heart Failure Research

Background:

  • Congestive heart failure (CHF) is a key symptom indicating the need for surgical aortic valve replacement (SAVR) in severe aortic stenosis (AS).
  • Distinguishing CHF symptoms like dyspnea caused by severe AS from other conditions is challenging, especially in elderly patients with comorbidities.
  • Identifying objective, noninvasive parameters to assess severe CHF in severe AS is crucial for clinical decision-making.

Purpose of the Study:

  • To identify objective, noninvasive echocardiographic parameters associated with severe congestive heart failure (CHF) symptoms in patients with severe aortic stenosis (AS).
  • To determine if left ventricular mass index (LVMI) and deceleration time (DT) can predict severe CHF (NYHA IV) in severe AS patients without left ventricular dysfunction.

Main Methods:

  • Retrospective study of 198 patients with severe AS and no left ventricular dysfunction.
  • Classification of CHF symptoms using the New York Heart Association (NYHA) functional classification.
  • Comparison of echocardiographic parameters between patients in NYHA functional class IV and those in NYHA classes I-III.

Main Results:

  • Patients with NYHA IV (20%) were older and exhibited significantly higher LVMI, E/A ratio, and systolic pulmonary arterial pressure (SPAP).
  • A shorter deceleration time (DT) was observed in NYHA IV patients compared to NYHA I-III patients.
  • Multivariable analysis revealed LVMI and DT as independent predictors of NYHA IV. Optimal cutoff values were identified as LVMI ≥ 142 g/m² and DT ≤ 194 ms.

Conclusions:

  • Left ventricular mass index (LVMI) and deceleration time (DT) are independently associated with severe heart failure (NYHA IV) in severe aortic stenosis (AS).
  • These echocardiographic parameters may aid clinicians in determining if CHF symptoms are primarily caused by severe AS.
Abstract

Keywords:
NYHA functional classaortic valve stenosisechocardiographysevere heart failure

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