Risk of supranormal left ventricular ejection fraction in patients with aortic stenosis.

BACKGROUND: Cardiovascular events are increasing in patients with supranormal left ventricular ejection fraction (snLVEF). However, the effect of snLVEF in patients with aortic stenosis (AS) remains unclear, especially in patients with moderate AS. HYPOTHESIS: This study aimed to evaluate the prognosis of mortality and heart failure (HF) in patients with LVEF ≥ 50% and moderate or severe AS. METHODS: This retrospective study targeted patients with moderate or severe AS and LVEF > 50%. LVEF of 50%-65% was classified as normal LVEF (nLVEF, nEF group) and >65% as snLVEF (snEF group). AS severity was stratified based on the aortic valve area into moderate (1.0-1.5 cm²) and severe (<1.0 cm²). Primary outcomes included all-cause mortality and HF hospitalization. RESULTS: A total of 226 participants were included in this study. There were 67 and 65 participants with moderate AS in snEF (m-snEF) and nEF groups (m-nEF), respectively, and 41 and 53 participants with severe AS in the snEF (s-snEF) and nEF groups (s-nEF), respectively. During the observation period (median: 554 days), the primary composite outcome occurred in 108 individuals. Cox hazard analysis revealed no significant differences among the four groups in primary composite outcomes. With respect to HF hospitalization, the adjusted hazard ratios (95% confidence intervals) with m-snEF as the reference were as follows: m-nEF, 0.41 (0.19-0.89); s-nEF, 1.43 (0.76-2.67); and s-snEF, 1.83 (1.00-3.35). CONCLUSIONS: The risk of HF hospitalization for m-snLVEF was higher than m-nLVEF and not significantly different from s-nLVEF.

Investigation of effective invasive blood pressure control methods to prevent acute exacerbation of acute aortic dissection.

BACKGROUND: Acute aortic dissection is associated with high mortality and increased risk of complications. Acute exacerbations have a relatively high frequency; however, the contributing factors are unclear. Blood pressure (BP) and heart rate control are important factors, but the ideal BP control strategy to prevent acute exacerbations under invasive arterial pressure monitoring remains unclear. Therefore, in this study, we aimed to determine the relationship between invasive arterial BP and the effects of acute exacerbation of aortic dissection. METHODS AND RESULTS: This single-centre, retrospective, case-control study included 104 patients with a partial diagnosis of acute aortic dissection (Stanford type A or B) who were treated conservatively between September 2013 and September 2022. The patients were divided into exacerbation (acute exacerbation; n  = 26) and stable (no acute deterioration) groups. The SBP trend (122.5 ±â€…13.1 vs. 116.6 ±â€…10.6 mmHg, respectively; P  = 0.024) and mean BP trend (77.8 ±â€…5.8 vs. 74.4 ±â€…7.5 mmHg, respectively; P  = 0.038) significantly differed between the two groups. The time to target BP was significantly longer in the exacerbation group ( P  = 0.036). CONCLUSION: The exacerbation group did not achieve a mean SBP < 120 mmHg. Moreover, the importance of early BP reduction was demonstrated in the present study.