Advanced Heart Disease Research Articles

Treating Children With Advanced Rheumatic Heart Disease in Sub-Saharan Africa: The NGO EMERGENCY's Project at the Salam Centre for Cardiac Surgery in Sudan

Rheumatic heart disease is endemic in Sub-Saharan Africa and while efforts are under way to boost prophylaxis and early diagnosis, access to cardiac surgery is rarely affordable. In this article, we report on a humanitarian project by the NGO EMERGENCY, to build and run the Salam Centre for Cardiac Surgery in Sudan. This hospital is a center of excellence offering free-of-charge, high-quality treatment to patients needing open-heart surgery for advanced rheumatic and congenital heart disease. Since it opened in 2007, more than 8,000 patients have undergone surgery there; most of them Sudanese, but ~20% were admitted from other countries, an example of inter-African cooperation. The program is not limited to surgical procedures. It guarantees long-term follow-up and anticoagulant treatment, where necessary. By way of example, we report clinical features and outcome data for the pediatric cohort: 1,318 children under the age of 15, operated on for advanced rheumatic heart disease between 2007 and 2019. The overall 5-year survival rate was 85.0% (95% CI 82.7–87.3). The outcomes for patients with mitral valves repaired and with mitral valves replaced are not statistically different. Nevertheless, observing the trend of patients undergoing valve repair, a better outcome for this category might be assumed. RHD in children is an indicator of poor socio-economic conditions and an inadequate health system, which clearly will not be cured by cardiac surgery alone. Nevertheless, the results achieved by EMERGENCY, with the crucial involvement and participation of the Sudanese government over the years, show that building a hospital, introducing free cardiac surgery, and offering long-term post-operative care may help spread belief in positive change in the future.

Patients requiring pediatric palliative care for advanced heart disease in France: A descriptive study

IntroductionPediatric palliative care (PPC) teams address unmet needs and improve the quality of life of patients with life-limiting conditions across pediatric subspecialties. However, little is known about the timing, reasons, and nature of PPC team interventions in advanced heart diseases (AHD). ObjectivesHere we describe how, when, and why PPC teams interact with referred teams of children suffering from AHD. MethodsWe conducted a retrospective nationwide survey among PPC teams in France. All patients referred to participating PPC teams for a cardiologic disease in 2019 were studied. ResultsAmong six PPC teams, 18 patients with AHD had a PPC consultation in 2019. Six of these patients had cardiomyopathy and 12 had congenital heart disease (CHD). The median age at referral was 0.9 months for CHD and 72 months for cardiomyopathy. An antenatal diagnosis had been made for six families with CHD, and two of them were referred to PPC before birth allowing for a prenatal palliative care plan. The main reason for referral was ethical considerations (50%) followed by organization for home-based palliative care (28%). PPC teams participated in ethical discussions when asked to but also provided family support (12/18), home-based PPC (9/18), coordination of care (5/18), support of the referred team (4/18), and symptoms management (3/18) ConclusionThe main reason for referral to PPC was ethical considerations, but PPC interventions followed a holistic model of care. Prospective outcomes measurement and partnerships should be further developed.

Pediatric Cardiology Teams interact with Pediatric Palliative Care (PPC) Teams for children's and family's best interest: Results from a multicentric study in France

Specialized Pediatric Palliative Care (PPC) teams address unmet needs and improve quality of life in patients with Life Limiting Conditions across pediatric subspecialties. However little is known about frequency, timing and trigger for PPC referral in non-malignant diseases. We hereby describe how, when and why french cardiologists interact with PPC teams. We conducted a retrospective nationwide survey among PPC teams in France. All patients referred to PPC team for a cardiologic disease in 2019 were studied. Among 6 respondent PPC teams, 18 patients and families met PPC teams in 2019 for an advanced heart disease. 12 had Congenital Heart Defect (CHD) and 6 had cardiomyopathy. No other diagnosis was represented. Median age at referral was 0.9 months for CHD and 72 months for cardiomyopathy. 61% of the patients were less than 1 years old. Antenatal diagnosis concerned 6 families with CHD and 2 of them were referred to PPC before birth allowing prenatal palliative care project. Main trigger for referral was ethical consideration (50%) followed by organization for home based palliative care (28%). PPC teams did participate to ethical discussion when asked to but also provided home-based PPC (9/18), family support (12/18), coordination of care (5/18), support of referring team (4/18) and symptoms management (3/18) Trigger for referral to PPC team is mainly for help in decision making in palliative care context and life threatening complications but PPC teams interventions tend to develop a holistic model of care. Pediatric cardiologist and PPC teams already interact in children's best interest in France, outcomes measurement and partnerships are ready to be developed.

The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Twenty-fourth pediatric lung transplantation report — 2021; Focus on recipient characteristics

In recent years, we have seen innovations in organ procurement and organ preservation, post-transplant management, and the use of non-transplant treatments for advanced heart and lung diseases. These developments continue to influence our decisions on recipient selection and transplantation. This focused report aims to document the changes that took place in the pediatric lung transplant recipient profile over the years and to identify important trends in recipient characteristics and their impact on post-transplant outcomes.

Effects of Enalapril on TLR2/NF-κB Signaling Pathway and Inflammatory Factors in Rabbits with Chronic Heart Failure.

Chronic heart failure (CHF) refers to the state of persistent heart failure, which is a complex clinical syndrome of various advanced heart diseases. The toll-like receptor 2 (TLR2)/nuclear transcription factor-κB (NF-κB) signal transduction pathway is one of the pathological mechanisms of CHF. Adriamycin can significantly induce the upregulation of TLR2 expression. Angiotensin-converting enzyme inhibitors (ACEI) are commonly used drugs for the treatment of CHF. In our study, the CHF model was established by injection of doxorubicin into the rabbit ear vein. The effect of enalapril on the TLR2/NF-κB signaling pathway in CHF rabbits has been analyzed and determined. Our research results showed that enalapril reduced the inflammatory response by inhibiting the activation of the TLR2/NF-κB signaling pathway, thereby improving cardiac structure, myocardial remodeling, and cardiac function.

Is it possible to expect left ventricular ejection fraction improvement in patients with known advanced heart diseases in the case of right atrial flutter treated by ablation?

Atrial flutter (AFL)-related tachycardia-induced cardiomyopathy (TICM) is a treatable cause of heart failure (HF). This study aims to explore the effect of AFL ablation on left ventricular (LV) function in right AFL patients with or without advanced heart diseases. Between January 2013 and December 2019, 149 patients underwent ablation for persistent AFL. Among them, 60 patients with persistent right atrial (RA) flutter had symptomatic HF and elevated natriuretic peptide levels. Group 1 consisted of 35 patients without advanced heart diseases, and group 2 consisted of 25 patients with prior history of ischemic cardiomyopathy (ICM), dilated cardiomyopathy (DCM) or surgery for valvular heart disease (VHD). Follow-up echocardiography was performed 6months later. Improvement of LV performance was defined as LV ejection fraction (EF) increase ≥50% of baseline EF without clinical HF symptoms or LVEF recovery to ≥60%. Group 2 had larger LV end-diastolic volume (LVEDV) and LV end-systolic volume than group 1. At follow-up, group 2 had larger LV end-systolic volume than group 1. Group 1 had more increase in LVEF than group 2 (21.7±15.2% vs 4.1±13.2%; P<.001). A receiver operating characteristic curve was constructed to determine the discrimination threshold of baseline LVEDV (137mL) in the overall study group for improvement of LV performance after ablation (P=.005). Successful ablation for right AFL could achieve more reversal of LV dysfunction in patients without advanced heart diseases. Pre-ablation LVEDV≥137mL was associated with no improvement of LV performance after ablation.

Parent-Reported Symptoms and Perceived Effectiveness of Treatment in Children Hospitalized with Advanced Heart Disease

To characterize parent-reported symptom burden and effectiveness of symptom management in children hospitalized with advanced heart disease. Prospective survey study of 161 parents whose child was admitted to a single institution with advanced heart disease between March 2018 and February 2019 using the Survey about Caring for Children with Heart Disease. Of the 161 patients, 54% were under 2years old with a diagnosis of single ventricle physiology (39%), pulmonary hypertension (12%), and other congenital heart disease (28%). Over one-half (56%) of parents reported that their child was experiencing a high degree ("a great deal"/"a lot") of symptoms. The most frequently reported symptoms were pain (68%), fatigue (63%), and breathing difficulties (60%). Of the symptoms that were treated, parents perceived successful treatment to be least likely for their child's sleep disturbance (24%), depression (29%), and fatigue (35%). Parents who reported their child's functional status as New York Heart Association class III/IV were more likely to report that their child was experiencing "a great deal" of symptoms, compared with those who reported class I/II (51% vs 19%, P<.001). Parents who reported their child was experiencing a high degree of suffering from fatigue were also more likely to report a high symptom burden (P<.001). Parents of children with advanced heart disease reported high symptom burden with a broad spectrum of symptoms. Parents reported fatigue and psychiatric symptoms frequently and rarely reported treatment as successful. Parents' view of their child's symptom burden was concordant with their perception of their child's functional status.

P017. Impact of Chronic Care Management on Heart Failure Readmissions

Heart Failure (HF) currently affects 6.2 million Americans, with an expected 8.5 million by 2030. There are 134, 000 annual HF readmissions (CMS) at an estimated cost of $4.5 billion. HF readmission significantly impacts Quality of Life (QOL) and mortality. Research suggests that Chronic Care Management (CCM) programs improve patient outcomes and reduce healthcare costs. Given the significant clinical and economic burdens associated with HF, we examined the effect of Nurse Practitioner led CCM program on hospitalization rate in HF patients. All patients enrolled in the CCM program between May 31, 2017 and January 4, 2019 at the Advanced Heart Disease Clinic were included in the analysis. Criteria for CCM participation included a diagnosis of HF plus another chronic condition. Number of hospitalizations, KCCQ scores, and LVEF scores were collected on each patient during the 18-month period, pre-enrollment and post-enrollment. A non-parametric Wilcox Signed-Rank Test was used to compare hospitalization rate; a Paired Sample T-test was used to compare QOL and LVEF. Twenty-nine patients were included in the analysis. Post CCM enrollment, there was a statistically significant reduction in HF hospitalization compared to pre-enrollment (p= 0.0007; 95% CL). Among the 14 (48%) patients with available KCCQ scores, no statistical difference was found pre to post-enrollment. Among the 25 (86.2%) patients with documented LVEF scores, 48% had improved EFs post enrollment (p=0.20). These results indicated that enrollment in a CCM program for HF may significantly reduce hospitalizations and in turn may have a positive impact on QOL with improvement in LVEF.

MO536CHINESE CHRONIC RENAL INSUFFICIENCY STUDY: BASED ON SMARTPHONE PLATFORM (C- CRISS): DESIGN AND METHOD

Abstract Background and Aims Abnormal mineral bone metabolism of chronic kidney disease (CKD-MBD) is the most common CKD complication. However, fewer data concerning the relationship between bone metabolic indexes, such as high serum phosphorus and cardiovascular diseases, bone mass reduction, and fracture, is available in Chinese adult patients. The Chinese Chronic Renal Insufficiency Study: Based on Smartphone Platform (C-CRISS) is established to explore the relationship between bone metabolic markers and other non-traditional risk factors with renal function progression, cardiovascular (CVD), and cerebrovascular diseases (BVD), and bone loss in CKD patients. Method/design The C-CRISS study is a multi-center prospective cohort study in China. It will recruit 3360 pre-dialysis patients aged 18 to 74 years and follow up for at least two years. The individuals with CKD G3b-5ND will account for over 70 percent of the study population. Active glomerulonephritis, rapidly progressing and advanced heart, liver, and tumor diseases will be excluded. The primary composite endpoints include the events of progression to ESRD, cardiovascular events, and death. The participants will undergo the clinical evaluation at baseline and clinic visits at six-monthly intervals in traditional consultation ways. The CVD, BVD, retinopathy, DXR, and other complications will be measured annually. Data on the questionnaire, diet, quality of life, and patients’ status during follow-up will be collected by the smartphone platform developed for this study. The sample size will enable us to have 80% power to detect a 2.0 risk ratio of CVD events in CKD G4 patients compared with CKD G3a patients. Conclusion The C-CRISS study would provide evidence of the potential risk of bone metabolic markers for progressive CKD and CVD/BVD. The study will also provide a new management and complication monitoring model through smartphone communication in chronic kidney disease patients. Trial registration ClinicalTrials.gov Identifier: NCT04229485

The significance of plasma collagen degradation products as biomarkers for advanced hypertensive heart disease.

The significance of plasma collagen degradation products as biomarkers for advanced hypertensive heart disease.

Prevalence and predictors of in-hospital mortality of patients hospitalized with COVID-19 infection

BackgroundThe severity and mortality from COVID-19 infection vary among populations. The aim of this study was to determine the prevalence and predictors of mortality among patients hospitalized with COVID-19 infection in a tertiary care hospital in Oman. MethodsWe conducted a retrospective study using database that included: demographic, clinical characteristics, laboratory parameters, medications and clinical outcomes of all patients hospitalized in Royal Hospital, Muscat, Oman, between March 12, 2020 and December 1st 2020. Univariate and multivariate logistic regression was performed to investigate the relationship between each variable and the risk of death of COVID-19 infected patients. ResultsIn total,1002 patients with COVID-19 infection with mean age of the cohort was 54±16 years (65% (n=650) male) were included, with an overall and intensive care unit (ICU) mortalities of 26% (n=257) and 42% (n=199/473), respectively. The prevalence of ICU admission was 47% (n=473) and the need for mechanical ventilation was 41% (n=413). The overall length of stay in the ICU was 13 (9–21) days. Adjusting for other factors in the model, the multivariable logistic regression demonstrated that in-hospital mortality in admitted COVID-19 patients was associated with old age (p<0.001), heart diseases (adjusted odds ratio (aOR), 1.84; 95% confidence interval (CI): 1.11–3.03; p=0.018), liver diseases (aOR, 4.48; 95% CI: 1.04–19.3; p=0.044), those with higher ferritin levels (aOR, 1.00; 95% CI: 1.00–1.00; p=0.006), acute respiratory distress syndrome (ARDS) (aOR, 3.20; 95% CI: 1.65–6.18; p=0.001), sepsis (aOR, 1.77; 95% CI: 1.12–2.80; p=0.022), and those that had ICU admission (aOR, 2.22; 95% CI: 1.12–4.38; p=0.022). ConclusionIn this cohort, mortality in hospitalized COVID-19 patients was high and was associated with advanced age, heart diseases, liver disease, high ferritin, ARDS, sepsis and ICU admission. These high-risk groups should be prioritized for COVID-19 vaccinations.

Depression Associated with Reduced Heart Rate Variability Predicts Outcome in Adult Congenital Heart Disease.

In adult congenital heart disease (ACHD), major depressive disorder (MDD) represents a frequent comorbidity. In non-CHD, adverse outcome is predicted by MDD and heart rate variability (HRV), whereas in ACHD their prognostic relevance is unknown. We prospectively evaluated 171 patients (age 35.6 ± 11.4 years; male 42.7%, mean observation time 54.7 ± 14.9 months). Binary regression analysis calculated the association between MDD and HRV. Cox proportional survival analysis estimated their impact on decompensated heart failure and all-cause mortality (HF/death), supraventricular and ventricular tachycardia (SVT/VT), and hospitalization due to unexpected cardiac causes. Exclusively MDD with moderate/severe symptoms showed significantly lower HRV as derived from frequency-domain analysis (Symindex) (p = 0.013). In multivariate Cox regression analysis, patients stratified according to the lower quartile of the Symindex comorbid with MDD (n = 16) exhibited poorer prognosis regarding HF/death (Hazard Ratio (HR): 7.04 (95%CI:(1.87–26.5)), SVT/VT (HR: 4.90 (95%CI:1.74–9.25)) and hospitalization (HR: 3.80 (95%CI:1.36–10.6)). An additional independent predictor was N-terminal pro-B-type natriuretic peptide elevation (p < 0.001), indicating advanced HF and heart disease complexity (p < 0.001). Autonomic nervous system dysfunction measured by altered HRV is considered to be one of the pathways linking MDD and adverse outcomes in cardiac diseases. Our results exceed the existing literature by demonstrating that MDD with decreased HRV is associated with poorer prognosis in ACHD.

Compound Danshen Dripping Pill inhibits doxorubicin or isoproterenol-induced cardiotoxicity

Heart failure (HF) is the advanced heart disease with high morbidity and mortality. Compound DanShen Dripping Pill (CDDP) is a widely used Traditional Chinese Medicine for cardiovascular disease treatment. Herein, we investigated if CDDP can protect mice against doxorubicin (DOX) or isoprenaline (ISO)-induced HF. After 3 days feeding of normal chow containing CDDP, mice were started DOX or ISO treatment for 4 weeks or 18 days. At the end of treatment, mice were conducted electrocardiogram and echocardiographic test. Blood and heart samples were determined biochemical parameters, myocardial structure and expression of the related molecules. CDDP normalized DOX/ISO-induced heart weight changes, HF parameters and fibrogenesis. The DOX/ISO-impaired left ventricular ejection fraction and fractional shortening were restored by CDDP. Mechanistically, CDDP blocked DOX/ISO-inhibited expression of antioxidant enzymes and DOX/ISO-induced expression of pro-fibrotic molecules, inflammation and cell apoptosis. Additional DOX/ISO-impaired targets in cardiac function but protected by CDDP were identified by RNAseq, qRT-PCR and Western blot. In addition, CDDP protected cardiomyocytes against oxygen-glucose deprivation-induced injuries. Taken together, our study shows that CDDP can protect against myocardial injuries in different models, suggesting its potential application for HF treatment.

In Hospital Frequency of Heart Failure in STEMI after Thrombolysis in Patient with Diabetes

Objective: To determine the frequency of heart failure after thrombolysis in STEMI patients with diabetes mellitus.&#x0D; Methodology: Through a prospective study we have enrolled all the diabetic patients who presented with acute ST-Segment Elevation Myocardial Infarction (STEMI) having age more than 35 years and less than 70 years who underwent pharmacological revascularization both males and females were included in this study. Patients with previous history of revascularization, end stage kidney, liver or heart disease, known advanced valvular heart disease, pregnant women, and those who develop serious complication related to streptokinase were excluded from our study. Echocardiography was done immediately after thrombolysis then after 3 days and then before discharge of the patients to determine the frequency of heart failure. Baseline and clinical data were entered and analysed using SPSS and a chi square test and p-value ≤0.05 was considered as significant.&#x0D; Results: A total of 175 patients were finally analysed and most of them were males as compared to females, 63.42% (N = 111) vs. 36.57% (N = 64), respectively. Mean age and SD of the patients was 55.90±10.49 years and mean duration of DM was 12.95±8.40 years. The overall frequency of heart failure in patients with post-STEMI was 56% (N = 98) and their mean ejection fraction was 38.46±8.20%. Frequency of heart failure in diabetic post-STEMI thrombolysed patients was significantly observed higher with increased age, increased duration of diabetes mellitus, hypertension, and smoking (p≤0.05).&#x0D; Conclusion: High prevalence of heart failure was observed in diabetic patients admitted with acute STEMI and underwent thrombolysis. The burden is even higher in males having age more than 55 years.

Palliative Care Referrals in Cardiac Disease.

With evidence of benefits of pediatric palliative care (PPC) integration, we sought to characterize subspecialty PPC referral patterns and end of life (EOL) care in pediatric advanced heart disease (AHD). In this retrospective cohort study, we compared inpatient pediatric (<21 years) deaths due to AHD in 2 separate 3-year epochs: 2007-2009 (early) and 2015-2018 (late). Demographics, disease burden, medical interventions, mode of death, and hospital charges were evaluated for temporal changes and PPC influence. Of 3409 early-epoch admissions, there were 110 deaths; the late epoch had 99 deaths in 4032 admissions. In the early epoch, 45 patients (1.3% admissions, 17% deaths) were referred for PPC, compared with 146 late-epoch patients (3.6% admissions, 58% deaths). Most deaths (186 [89%]) occurred in the cardiac ICU after discontinuation of life-sustaining therapy (138 [66%]). Medical therapies included ventilation (189 [90%]), inotropes (184 [88%]), cardiopulmonary resuscitation (68 [33%]), or mechanical circulatory support (67 [32%]), with no temporal difference observed. PPC involvement was associated with decreased mechanical circulatory support, ventilation, inotropes, or cardiopulmonary resuscitation at EOL, and children were more likely to be awake and be receiving enteral feeds. PPC involvement increased advance care planning, with lower hospital charges on day of death and 7 days before (respective differences $5058 [P = .02] and $25 634 [P = .02]). Pediatric AHD deaths are associated with high medical intensity; however, children with PPC consultation experienced substantially less invasive interventions at EOL. Further study is warranted to explore these findings and how palliative care principles can be better integrated into care.

Perception of Fathers of Hospitalized Children with Advanced Heart Disease

Perception of Fathers of Hospitalized Children with Advanced Heart Disease

Parent and Physician Understanding of Prognosis in Hospitalized Children With Advanced Heart Disease.

BackgroundThe unpredictable trajectory of pediatric advanced heart disease makes prognostication difficult for physicians and informed decision‐making challenging for families. This study evaluated parent and physician understanding of disease burden and prognosis in hospitalized children with advanced heart disease.Methods and ResultsA longitudinal survey study of parents and physicians caring for patients with advanced heart disease age 30 days to 19 years admitted for ≥7 days was performed over a 1‐year period (n=160 pairs). Percentage agreement and weighted kappa statistics were used to assess agreement. Median patient age was 1 year (interquartile range, 1–5), 39% had single‐ventricle lesions, and 37% were in the cardiac intensive care unit. Although 92% of parents reported understanding their child's prognosis “extremely well” or “well,” 28% of physicians thought parents understood the prognosis only “a little,” “somewhat,” or “not at all.” Better parent‐reported prognostic understanding was associated with greater preparedness for their child's medical problems (odds ratio, 4.7; 95% CI, 1.4–21.7, P=0.02). There was poor parent–physician agreement in assessing functional class, symptom burden, and likelihood of limitations in physical activity and learning/behavior; on average, parents were more optimistic. Many parents (47%) but few physicians (6%) expected the child to have normal life expectancy.ConclusionsParents and physicians caring for children with advanced heart disease differed in their perspectives regarding prognosis and disease burden. Physicians tended to underestimate the degree of parent‐reported symptom burden. Parents were less likely to expect limitations in physical activity, learning/behavior, and life expectancy. Combined interventions involving patient‐reported outcomes, parent education, and physician communication tools may be beneficial.

Update in carcinoid heart disease - the heart of the matter.

Carcinoid heart disease (CHD) is a paraneoplastic cardiac manifestation occurring in patients with carcinoid syndrome (CS) and advanced neuroendocrine malignancy. In about 20-40% of patients with CS, chronic exposure to tumor-released circulating vasoactive peptides typically results in right-sided valvular fibrosis leading to valve dysfunction and right heart failure. CHD remains a significant cause of morbidity and mortality. The management of patients with CHD is complex, as both the systemic malignant disease and the heart involvement have to be addressed. Early diagnosis and timely surgical intervention in selected patients are of utmost importance and offer a survival benefit. In patients with advanced carcinoid heart disease, valve replacement surgery is the most effective option to alleviate cardiac symptoms and contribute to survival outcomes. A collaboration of a multidisciplinary team in centers with experience is required to provide optimal patient management. Here, we review the current literature regarding CHD presentation, pathophysiology, diagnostic tools, and available treatment strategies.

Cardiac 1H MR spectroscopy: development of the past five decades and future perspectives.

Continued advances in laboratory medicine are required to realize the potential of individualized medicine to impact common cardiovascular diseases. Magnetic resonance imaging (MRI) and spectroscopy (MRS) techniques have advanced over recent years and offer unique, powerful insights into cardiac anatomic and metabolic changes, respectively, occurring in both nascent and advanced heart disease. Although numerous MRI-based in vivo diagnostics are already used in routine clinical practice and more are anticipated, MRS has been less incorporated into routine clinical practice. Given the ability of 1H MRS to identify and quantify specific molecules with high sensitivity and specificity, its potential utility should be successfully transition from "bench-to-bedside" is tantalizing. The present review will highlight the development of 1H MRS techniques for cardiac applications, observations in seminal studies with 1H MRS, and the prospects and challenges for widespread application in patients with cardiovascular disease.

Echocardiographic estimation of left ventricular-arterial coupling in dogs with myxomatous mitral valve disease.

BackgroundThe effective arterial elastance (Ea) to left ventricular (LV) end‐systolic elastance (Ees) ratio (Ea/Ees) is an index of the interaction between LV and systemic arterial systems, left ventricular‐arterial coupling (VAC). The Ea is an index of total arterial load of the LV, whereas Ees is an index of LV systolic function. In humans, inappropriate VAC based on increased Ea/Ees estimated using echocardiography is associated with more advanced heart disease severity.HypothesisLeft ventricular‐arterial coupling assessed by echocardiographic estimation of Ea/Ees is associated with disease severity in dogs with myxomatous mitral valve disease (MMVD).AnimalsNinety MMVD dogs and 61 healthy dogs.MethodsProspective cross‐sectional study. The MMVD dogs were classified into stages B1, B2, or C according to American College of Veterinary Internal Medicine guidelines. Effective arterial elastance was echocardiographically estimated using the formula: mean blood pressure/(forward stroke volume/body weight). End‐systolic elastance was echocardiographically estimated using the formula: mean blood pressure/(LV end‐systolic volume/body weight). The ratio Ea/Ees was calculated.ResultsThe ratio Ea/Ees was higher in stage B2 dogs than in healthy dogs and dogs stage B1 (both P < .0001), and higher in stage C dogs than in healthy dogs and dogs in the other 2 stages (healthy vs C and B1 vs C, P < .0001; B2 vs C, P = .0005). Multivariable logistic regression analysis showed that Ea/Ees and the peak velocity of early diastolic transmitral flow to isovolumic relaxation time ratio were independent predictors of stage C among echocardiographic indices in MMVD dogs.Conclusions and Clinical ImportanceInappropriate VAC assessed by echocardiographically estimated Ea/Ees is associated with advanced disease severity in dogs with MMVD.