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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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Left Ventricular Concentric Geometric Patterns Are Associated With Worse Prognosis Among Patients With Type-A Aortic

Walter E M Rocha1, Matheus F R A Oliveira1, Julia D Soares2

  • 1Department of Internal Medicine School of Medical Sciences State University of Campinas São Paulo Brazil.

Journal of the American Heart Association
|February 18, 2021
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Summary

Left ventricular remodeling patterns predict mortality in aortic dissection. Concentric patterns are linked to higher mortality in type A aortic dissection, but not in type B.

Keywords:
aortic dissectionconcentricityechocardiogramhypertrophyleft ventricular remodeling

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Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Thoracic Surgery

Background:

  • Aortic dissection (AD) involves different types (A and B) with varying prognoses.
  • Left ventricular (LV) remodeling, including hypertrophy and geometric patterns, may influence AD outcomes.
  • Predictive markers for mortality in AD are crucial for patient management.

Purpose of the Study:

  • To compare LV characteristics between type A and type B AD patients.
  • To assess the predictive ability of LV remodeling phenotypes for mortality in both AD types.
  • To identify specific LV geometric patterns associated with adverse prognosis.

Main Methods:

  • Retrospective analysis of 356 patients (236 type A, 120 type B AD) with echocardiograms near diagnosis.
  • Stratification of patients based on LV remodeling phenotypes (hypertrophy, concentricity, geometry).
  • Assessment of early (90-day) and late (1-year) mortality using multivariable Cox-regression and logistic regression analyses.

Main Results:

  • Type A AD patients showed higher odds of concentric hypertrophy and lower odds of eccentric hypertrophy compared to type B.
  • LV remodeling phenotypes did not predict mortality in type B AD.
  • LV concentricity was associated with increased early and late mortality in type A AD.
  • LV concentric remodeling and concentric hypertrophy predicted early mortality in type A AD.
  • LV concentric remodeling predicted late mortality in type A AD.
  • LV geometric patterns provided incremental prognostic value beyond clinical variables in type A AD.

Conclusions:

  • LV geometric patterns, particularly concentricity, are associated with increased mortality in type A AD.
  • LV remodeling phenotypes may serve as adverse prognostic markers in type A aortic dissection.
  • Further research is warranted to explore the clinical implications of these findings for type A AD management.