Varicella is a highly contagious disease that represents an escalating public health concern. This study aimed to assess the influence of meteorological factors on varicella incidence, identify vulnerable populations, and estimate the disease burden associated with meteorological exposure. Data were collected from Chongqing Municipality (2010-2019), including varicella case counts and seven meteorological variables. We employed a method combining a quasi-Poisson generalized additive model with a distributed lag nonlinear model and adjusting for potential confounders. A total of 183,692 varicella cases were reported. The analysis revealed that meteorological factors exhibited nonlinear relationships with varicella incidence. Notably, the strongest cumulative effects were observed for mean temperature (14.0°C, RR = 1.246, 95% CI: 1.157-1.340), diurnal temperature range (0.6°C, RR = 1.249, 95% CI: 0.993-1.571), relative humidity (97%, RR = 1.995, 95% CI: 1.639-2.429), aggregate rainfall (119.5mm, RR = 5.062, 95% CI: 1.001-25.593), and mean air pressure (991.4hPa, RR = 1.438, 95% CI: 1.331-1.554). Sunshine hours ≥ 5.6h and wind speeds ≥ 2.1m/s were protective. Adolescents aged 12 to 18years exhibited the highest prevalence during periods of moderate temperature, high rainfall, and high humidity. Furthermore, the attributable risk analysis confirmed that meteorological factors significantly contribute to the varicella burden. These findings underscore the importance of incorporating meteorological patterns into public health strategies, including early warning systems and meteorologically specific interventions, to mitigate varicella transmission risk, particularly in the context of climate change.

BackgroundAlthough meteorological changes can affect the incidence of the onset of certain diseases, no study has investigated the correlation between meteorological factors and emergency operations. This study aimed to examine a possible association between meteorological factors and the need for anesthetic care for emergency surgery. We hypothesized that changes in atmospheric pressure, temperature, and humidity would be associated with the daily volume of emergency surgeries.MethodsThis retrospective multicenter observational study of emergency operations performed between 2009 and 2017 at 24 Japanese hospitals included a total of 2,423 emergency operations. Meteorological data, including daily mean values of atmospheric pressure, temperature, and humidity, were obtained from the Japan Meteorological Agency. Statistical analysis was performed using univariate and multivariate ordinal logistic regression to elucidate the correlation between the incidence of emergency operations and meteorological factors.ResultsThe most common types of operations were gastrointestinal surgery (n = 1161; 47.9%), followed by neurosurgery (n = 496; 20.5%), and obstetrics and gynecology procedures (n = 419; 17.3%). Multivariate ordinal logistic regression analysis revealed a correlation between daily mean atmospheric pressure (OR: 1.0131, 95% CI: 1.0009-1.0255, P = 0.0352) and the number of emergency operations, with the number of emergency operations increasing as daily mean atmospheric pressure increased. Further, multivariate ordinal logistic analysis showed that an increase in mean humidity compared to the previous day was associated with an increase in the number of emergency operations for subarachnoid hemorrhage (OR: 1.1944, 95% CI: 1.0228-1.3966, P = 0.0252).ConclusionThese results suggest that meteorological factors might enable anesthesiologists to predict the kinds of emergency surgeries likely to be scheduled. However, the mechanisms underlying these findings need to be clarified.

The aim of the presented study was to characterize the territory of Poland in terms of the frequency of occurrence of specific values of IAPC (interdiurnal atmospheric pressure changes) and to determine synoptic situations accompanying their particularly high values. The study is based on the daily mean atmospheric pressure data from the years 1966-2022 taking from 48 meteorological stations in Poland. In the presented paper four IAPC categories were used: A < 4.0hPa (weak sense of change), B 4.1-8.0 (moderate sense of change), C 8.1-12.0 (strong sense of change), and D > 12.1 (very strong sense of change). Taking into account the negative impact on human health and well-being of the IAPC value, and especially its declines (conductive to the increase of suicides, heart and kidney diseases, asthma), the most unfavorable in this respect in Poland is the northern part of the country. The greatest frequency of synoptic situations causing the above-mentioned influence occurs in the cold half of the year, especially in winter. In turn the beneficial impact of the increase in IAPC on human health and well-being in terms of blood oxygenation and reduced suicide mortality caused by IAPC also occurs in the northern Poland. The frequency of synoptic situations felt in this respect is also highest in the cold half of the year.

To predict the potential geographic distribution of Oncomelania hupensis in Yunnan Province using random forest (RF) and maximum entropy (MaxEnt) models, so as to provide insights into O. hupensis surveillance and control in Yunnan Province. The O. hupensis snail survey data in Yunnan Province from 2015 to 2016 were collected and converted into O. hupensis snail distribution site data. Data of 22 environmental variables in Yunnan Province were collected, including twelve climate variables (annual potential evapotranspiration, annual mean ground surface temperature, annual precipitation, annual mean air pressure, annual mean relative humidity, annual sunshine duration, annual mean air temperature, annual mean wind speed, ≥ 0 ℃ annual accumulated temperature, ≥ 10 ℃ annual accumulated temperature, aridity and index of moisture), eight geographical variables (normalized difference vegetation index, landform type, land use type, altitude, soil type, soil textureclay content, soil texture-sand content and soil texture-silt content) and two population and economic variables (gross domestic product and population). Variables were screened with Pearson correlation test and variance inflation factor (VIF) test. The RF and MaxEnt models and the ensemble model were created using the biomod2 package of the software R 4.2.1, and the potential distribution of O. hupensis snails after 2016 was predicted in Yunnan Province. The predictive effects of models were evaluated through cross-validation and independent tests, and the area under the receiver operating characteristic curve (AUC), true skill statistics (TSS) and Kappa statistics were used for model evaluation. In addition, the importance of environmental variables was analyzed, the contribution of environmental variables output by the models with AUC values of > 0.950 and TSS values of > 0.850 were selected for normalization processing, and the importance percentage of environmental variables was obtained to analyze the importance of environmental variables. Data of 148 O. hupensis snail distribution sites and 15 environmental variables were included in training sets of RF and MaxEnt models, and both RF and MaxEnt models had high predictive performance, with both mean AUC values of > 0.900 and all mean TSS values and Kappa values of > 0.800, and significant differences in the AUC (t = 19.862, P < 0.05), TSS (t = 10.140, P < 0.05) and Kappa values (t = 10.237, P < 0.05) between two models. The AUC, TSS and Kappa values of the ensemble model were 0.996, 0.954 and 0.920, respectively. Independent data verification showed that the AUC, TSS and Kappa values of the RF model and the ensemble model were all 1, which still showed high performance in unknown data modeling, and the MaxEnt model showed poor performance, with TSS and Kappa values of 0 for 24%(24/100) of the modeling results. The modeling results of 79 RF models, 38 MaxEnt models and their ensemble models with AUC values of > 0.950 and TSS values of > 0.850 were included in the evaluation of importance of environmental variables. The importance of annual sunshine duration (SSD) was 32.989%, 37.847% and 46.315% in the RF model, the MaxEnt model and their ensemble model, while the importance of annual mean relative humidity (RHU) was 30.947%, 15.921% and 28.121%, respectively. Important environment variables were concentrated in modeling results of the RF model, dispersed in modeling results of the MaxEnt model, and most concentrated in modeling results of the ensemble model. The potential distribution of O. hupensis snails after 2016 was predicted to be relatively concentrated in Yunnan Province by the RF model and relatively large by the MaxEnt model, and the distribution of O. hupensis snails predicted by the ensemble model was mostly the joint distribution of O. hupensis snails predicted by RF and MaxEnt models. Both RF and MaxEnt models are effective to predict the potential distribution of O. hupensis snails in Yunnan Province, which facilitates targeted O. hupensis snail control.

The aim of this study is to assess future hazards due to extreme meteorological events in the Wielkopolska region, Poland, based on five climate model projections and three scenarios: SSP126, 370, and 585. The paper analyzes the changes of mean and extreme precipitation, mean and extreme temperatures, and humidity index, as well as changes in difference between maximum temperatures observed from day to day and changes in difference between mean atmospheric pressure at the sea level observed from day to day. Additionally, we look at possible future occurrence of wildfires due to changes in fire weather conditions. Based on climate model projections, future hazard due to extreme meteorological events in Wielkopolska region is to be more serious and will be most noticeable in the end of twenty-first century and for two higher scenarios: SSP370 and SSP585. For near future, 2021–2050, projected conditions of meteorological extremes for analyzed scenarios are quite consistent. Therefore, there is a strong need for implementing adaptation actions. Nevertheless, such activities are so far lacking, and several adaptation options are not present in local and national legislation, even though they are recognized as effective.

The Yellow River Basin has been instrumental in advancing ecological preservation and fostering national high-quality development. However, since the advent of China's reform and opening-up policies, the basin has faced severe environmental pollution issues. This study leverages remote sensing data from 1998 to 2019. As per the "Basin Scope and Its Historical Changes" published by the Yellow River Conservancy Commission of the Ministry of Water Resources, the Yellow River Basin is categorized into upstream, midstream, and downstream regions for analysis of their spatial and temporal distribution traits using spatial autocorrelation methods. Additionally, we employed probes to study the effects of 10 factors, including mean surface temperature and air pressure, on PM2.5. The study findings reveal that (1) the annual average concentration of PM2.5 in the Yellow River Basin exhibited a fluctuating trend from 1998 to 2019, initially increasing, then decreasing, followed by another increase before ultimately declining. (2) The air quality in the Yellow River Basin is relatively poor, making it challenging for large-scale areas with low PM2.5 levels to occur. (3) The PM2.5 concentration in the Yellow River Basin exhibits distinct high and low-value concentration areas indicative of air pollution. Low-value areas are predominantly found in the sparsely populated central and southwestern plateau regions of Inner Mongolia, characterized by a better ecological environment. In contrast, high-value areas are prevalent in the inland areas of Northwest China, with poorer natural conditions, as well as densely populated zones with high energy demand and a relatively developed economy. (4) The overall population density in the Yellow River Basin, as well as in the upstream, midstream, and downstream regions, serves as a primary driving factor. (5) The primary drivers in the middle reaches and the entire Yellow River Basin remain consistent, whereas those in the upper and lower reaches have shifted. In the upstream, air pressure emerges as a primary driver of PM2.5, while in the downstream, NDVI and precipitation become the main influencing factors.

Cold static storage and normothermic ex vivo heart perfusion are routinely limited to 6 h. This report describes intermittent left atrial (LA) perfusion that allows cardiac functional assessment in a working heart mode. Using our adult porcine model, general anesthesia was induced and a complete cardiectomy was performed following cardioplegic arrest. Back-table instrumentation was completed and normothermic ex vivo heart perfusion (NEHP) was initiated in a nonworking heart mode (Langendorff). After 1 h of resuscitation and recovery, LA perfusion was initiated and the heart was transitioned to a coronary flow-only working heart mode for 30 min. Baseline working heart parameters were documented and the heart was returned to nonworking mode. Working heart assessments were performed for 30 min every 6 h for 24 h. Twenty-four-hour NEHP on 9 consecutive hearts (280 ± 42.1 g) was successful and no significant differences were found between working heart parameters at baseline and after 24 h of perfusion. There was no difference between initial and final measurements of LA mean pressures (5.0 ± 3.1 versus 9.0 ± 6.5 mm Hg, P = 0.22), left ventricular systolic pressures (44.3 ± 7.2 versus 39.1 ± 9.0 mm Hg, P = 0.13), mean aortic pressures (30.9 ± 5.8 versus 28.1 ± 8.1 mm Hg, P = 0.37), and coronary resistance (0.174 ± 0.046 versus 0.173 ± 0.066 mL/min/g, P = 0.90). There were also no significant differences between lactate (2.4 ± 0.5 versus 2.6 ± 0.4 mmol/L, P = 0.17) and glucose (173 ± 75 versus 156 ± 70 mg/dL, P = 0.37). A novel model using intermittent LA perfusion to create a coronary flow-only working heart mode for assessment of ex vivo cardiac function has been successfully developed.

ObjectivesThe association of pulmonary hypertension (PH) with the outcome after mitral transcatheter edge-to-edge repair (M-TEER) focusing on the new ESC/ERS guidelines definition for PH.BackgroundPH is frequently found in patients with...

The effects of meteorological conditions on asthma in Haikou, a tropical city in China, are still unclear. This study aimed to determine the relationships between meteorological factors and the number of asthma hospital visits in Haikou. A Poisson generalized additive model combined with a distributed lag nonlinear model is used to model the nonlinear exposure–response relationship between the daily mean temperature and asthma hospital visits. The daily mean pressure and air quality are used as covariates and simultaneously control the mixed effects of holiday effects, weekend effects, and long-term trends. The results indicate that there is a significant statistical relationship between the daily mean temperature and asthma hospital visits, which shows an inverted J-shaped relationship. When the daily mean temperature is below the reference value (29.3 °C), the number of asthma patients increases considerably, and there is a marked lag in the prevalence of asthma. The longest lag is 9 days, and the most pronounced impact of the daily mean temperature on the number of asthma hospital visits can be found when the lag time is 1–4 days. When the daily mean temperature is 10 °C, the cumulative effect of the relative risk of asthma is 2.204, an increase of 120.4% (95% CI 1.294–3.755). If the daily mean temperature is below the 2.5th percentile value (14.8 °C), the relative risk significantly increases by more than 5.3% (95% CI 1.000–1.110), and the longest lasting impact time is 5 days. This indicates that increases in asthma hospital visits in Haikou, China, are significantly correlated with low-temperature weather. We suggest that preventive measures for asthma should take low-temperature weather into account. Additionally, we also found that extremely high temperatures have a certain impact on the increase in asthma hospital visits, but that the correlation is not significant.

Empirical exploration of predictive maintenance in concrete manufacturing: Harnessing machine learning for enhanced equipment reliability in construction project management

Background With increased use of thoracic paravertebral block (TPVB) in thoracic surgery, many faced the challenge of locating the thoracic paravertebral space (TPVS) ultrasonographically. This observational study aimed to investigate the waveform characteristics and pressure value within the TPVS in anaesthetized patients with controlled ventilation. Methods 50 patients scheduled for elective lung surgery were enrolled. After conduction of anesthesia, all patients underwent TPVB at T4/5 and T6/7 using transverse, in-plane ultrasound guidance. A pressure transducer system with a desktop monitor was connected to the needle hub to measure pressure values and waveform characteristics in three locations: the paraspinal muscles, immediately behind the superior costotransverse ligament, and within the TPVS. Next, 15 mL of 0.33% bupivacaine was injected into each desired TPVS. After completion of the surgery, the extent of dermatomal blockade and the pain score was assessed in all patients. Results 98 typical regular respiratory waveforms with a mean pressure of ≤ 25 mmHg were detected in the TPVS of 50 patients. The sensitivity of the combined ultrasound and pressure waveform measurement technique to identify the TPVS was 95.45% (95% confidence interval, 84.527–99.445). Nontypical respiratory waveforms were present in two patients. Factors interfering with the TPVS waveform characteristics were previous thoracic surgery and chronic pleural inflammation. Conclusion The TPVS had low pressure and showed a smooth, regular waveform pattern corresponding to respiration.

Barochallenge-induced Eustachian tube dysfunction (ETD) is difficult to diagnose because the examination is often normal during clinical assessment. In adults, functional tympanometry testing, performed by asking the patient to Valsalva and Toynbee while measuring the pressure shift, can aid in the diagnosis of ETD. However, standardized values do not exist in children. We aim to determine the age at which children can perform these maneuvers and the normative values in this population. Patients with a normal basic ear examination 4 years and older, presenting to the pediatric Otolaryngology clinic, were recruited. Otoscopy, baseline tympanometry, followed by Valsalva and Toynbee maneuvers were performed. Because there are no pediatric norms, we hypothesized that children would achieve the same minimum normal pressure shift as cited in the adult literature (+20 daPa or higher for Valsalva and -20 daPa or lower for Toynbee). The data were analyzed using receiver operating characteristic curves and logistic regression. One hundred sixty-eight children (276 ears) were assessed. Participants as young as 4 years old were able to perform a Valsalva and Toynbee. Age cut-offs at which children achieved adult norms were 12.5 years ( p = 0.016) and 8.5 years ( p = 0.071) for Valsalva and Toynbee maneuvers, respectively. Mean pressure shift ranged from +29 to -36 daPa, and males were 2.5 times more likely to achieve Toynbee compared with females ( p = 0.006). Functional tympanometry testing may be used to help diagnose barochallenge-induced ETD in older children.

Abstract This numerical study focuses on the characterization of prechamber-enabled mixing-controlled combustion (PC-MCC) at ∼18 bar brake mean effective pressure (BMEP) and 2200 rpm with 10% by volume ethanol-gasoline blend (E10) and pure ethanol (E100). Computational fluid dynamic (CFD) simulations of a stock and prechamber retrofitted single-cylinder Caterpillar C9.3B are carried out using CONVERGE. Prechamber equivalence ratio at spark timing, prechamber spark timing advance, and main chamber injection strategy are assessed with respect to their impact on ignition assistance performance and emissions characteristics relative to a diesel baseline at the same boundary conditions. Simulation results indicate that PC-MCC is flex-fuel capable and operates well for both E10 and E100 at the operating conditions considered. The results demonstrate that the use of a pilot-main injection strategy enables spark timing in the prechamber to be advanced and thus reduces spark plug firing pressure while maintaining robust ignition assistance. Results also indicate that the rich prechamber operation is favored for improved ignition assistance capabilities. The findings of this work suggest that a heavy-duty vehicle using a PC-MCC engine can utilize any blend of gasoline and ethanol, up to including pure ethanol, with no major sacrifices in performance relative to the diesel engine.

To assess the occurrence, predictors, and outcomes of hypo-attenuated leaflet thickening (HALT) and thrombus outside the prosthetic valve following surgical aortic valve replacement. A total of 118 patients underwent surgical aortic valve replacement with bioprosthetic valves between July 2020 and June 2022. Sixty-two (52.5%) patients, which is a fairly high number of patients, underwent cardiac computed tomography and transthoracic echocardiography one week after surgery. Patients were divided into two groups, those with HALT (n = 14) and those without HALT (n = 48). Of the 62 patients who underwent cardiac computed tomography, HALT was observed in 14 (22.5%) patients during the very early postoperative phase. Reduced leaflet motion was observed in two of the 14 patients. The low-attenuation areas were located outside the prosthetic valve in 10 cases (71.4%) in the HALT group and in 14 cases (29.2%) in the non-HALT group. More than 50% of patients (57.1%) with HALT and 79.2% without HALT were administered warfarin. Neither in-hospital deaths nor postoperative thromboembolic events were observed during hospitalization. No patient had a mean pressure gradient > 20mmHg in either group. HALT was observed in one-fifth of the cases after surgical aortic valve replacement during the very early postoperative phase in an institution wherein administration of continuous heparin infusion after surgery is a standard practice. HALT did not affect the early prognosis or incidence of cerebral infarction.

Prior studies investigating the impact of residual mitral regurgitation (MR), tricuspid regurgitation (TR), and elevated predischarge transmitral mean pressure gradient (TMPG) on outcomes after mitral transcatheter edge-to-edge repair (TEER) have assessed each parameter in isolation. We sought to examine the prognostic value of combining predischarge MR, TR, and TMPG to study long-term outcomes after TEER. We reviewed the records of 291 patients who underwent successful mitral TEER at our institution between March 2014 and June 2022. Using well-established outcomes-related cutoffs for predischarge MR (≥moderate), TR (≥moderate), and TMPG (≥5 mm Hg), 3 echo profiles were developed based on the number of risk factors present (optimal: 0 risk factors, mixed: 1 risk factor, poor: ≥2 risk factors). Discrimination of the profiles for predicting the primary composite end point of all-cause mortality and heart failure hospitalization at 2 years was examined using Cox regression. Overall, mean age was 76.7±10.6 years, 43.3% were women, and 53% had primary MR. Two-year event-free survival was 61%. Predischarge TR≥moderate, MR≥moderate, and TMPG≥5 mm Hg were risk factors associated with the primary end point. Compared with the optimal profile, there was an incremental risk in 2-year event-rate with each worsening profile (optimal as reference; mixed profile: hazard ratio (HR), 2.87 [95% CI, 1.71-5.17], P<0.001; poor profile: HR, 3.76 [95% CI, 1.84-6.53], P<0.001). Echocardiographic profile was statistically associated with the 2-year mortality end point (optimal as reference; mixed profile: HR, 3.55 [95% CI, 1.81-5.96], P<0.001; poor profile: HR, 3.39 [95% CI, 2.56-7.33], P=0.02). The echocardiographic profile integrating predischarge TR, MR, and TMPG presents a novel prognostic stratification tool for patients undergoing mitral TEER.

Aortic arch blood flow measurements as a predictor of successful ECMO weaning in cardiogenic shock

This study explores the potentiality of low/zero carbon fuels such as methanol, methane and hydrogen for motor applications to pursue the goal of energy security and environmental sustainability. An experimental investigation was performed on a spark ignition engine equipped with both a port fuel and a direct injection system. Liquid fuels were injected into the intake manifold to benefit from a homogeneous charge formation. Gaseous fuels were injected in direct mode to enhance the efficiency and prevent abnormal combustion. Tests were realized at a fixed indicated mean effective pressure and at three different engine speeds. The experimental results highlighted the reduction of CO and CO2 emissions for the alternative fuels to an extent depending on their properties. Methanol exhibited high THC and low NOx emissions compared to gasoline. Methane and, even more so, hydrogen, allowed for a reduction in THC emissions. With regard to the impact of gaseous fuels on the NOx emissions, this was strongly related to the operating conditions. A surprising result concerns the particle emissions that were affected not only by the fuel characteristics and the engine test point but also by the lubricating oil. The oil contribution was particularly evident for hydrogen fuel, which showed high particle emissions, although they did not contain carbon atoms.

Severe traumatic brain injury (sTBI) represents a diffuse, heterogeneous disease where therapeutic targets for optimizing clinical outcome remain unclear. Mean pressure reactivity index (PRx) values have demonstrated associations with clinical outcome in sTBI. However, the retrospective derivation of a mean value diminishes its bedside significance. We evaluated PRx temporal profiles for patients with sTBI and identified time thresholds suggesting optimal neuroprognostication. Patients with sTBI and continuous bolt intracranial pressure monitoring were identified. Outcomes were dichotomized by disposition status ("good outcome" was denoted by home and acute rehabilitation). PRx values were obtained every minute by taking moving correlation coefficients of intracranial pressures and mean arterial pressures. Average PRx trajectories for good and poor outcome groups were calculated by extending the last daily averaged PRx value to day 18. Each patient also had smoothed PRx trajectories that were used to generate "candidate features." These "candidate features" included daily average PRx's, cumulative first-order changes in PRx and cumulative second-order changes in PRx. Changes in sensitivity over time for predicting poor outcome was then evaluated by generating penalized logistic regression models that were derived from the "candidate features" and maximized specificity. Among 33 patients with sTBI, 18 patients achieved good outcome and 15 patients had poor outcome. Average PRx trajectories for the good and poor outcome groups started on day 6 and consistently diverged at day 9. When targeting a specificity >83.3%, an 85% maximum sensitivity for determining poor outcome was achieved at hospital day 6. Subsequent days of PRx monitoring showed diminishing sensitivities. Our findings suggest that in a population of sTBI, PRx sensitivities for predicting poor outcome was maximized at hospital day 6. Additional study is warranted to validate this model in larger populations.

Nicorandil is widely used as a vasodilator for the physiological assessment of coronary arteries because of its usefulness and safety; however, there are no data on its use in peripheral arteries. To identify the utility of nicorandil and its appropriate dose for the physiological assessment on the femoropopliteal artery. We retrospectively enrolled patients from three institutes in which physiological assessment was carried out with various doses of nicorandil before treatment. Twenty-four femoropopliteal artery stenotic lesions from 22 patients were included. The nicorandil doses used were 2, 4, and 6 mg. Twenty-two lesions were also assessed using 30 mg of papaverine. The pressure gradient (PG) and peripheral fractional flow reserve (pFFR) were calculated based on the mean and systolic pressure levels. We examined the correlation of each parameter with the peak systolic velocity ratio (PSVR) based on the duplex ultrasound images using Spearman's rank correlation coefficient. Systemic blood pressure was assessed for safety. The correlations were higher for mean pressure-based parameters than for systolic pressure-based parameters. As the nicorandil dose increased, the correlations among PG, pFFR, and PSVR also increased (mean pressure-based PG: 2 mg, r = 0.360; 4 mg, r = 0.498; 6 mg, r = 0.694, mean pressure-based pFFR: 2 mg, r = -0.479; 4 mg, r = -0.469; 6 mg, r = -0.641). The blood pressure after the administration of 6 mg of nicorandil was low, and the median systemic mean pressure was 65 mmHg. A 4 mg dose of nicorandil is effective and safe for the mean pressure-based physiological assessment of lesions in the femoropopliteal artery.

Patients with paradoxical low-flow (LF) severe aortic stenosis (AS) despite preserved left ventricular ejection fraction (LVEF) appear distinct from normal-flow (NF) patients, showing worse prognosis, more concentric hypertrophy and smaller left ventricular (LV) cavities. The left ventricular remodelling index (LVRI) has been demonstrated to reliably discriminate between physiologically adapted athlete's heart and pathological LV remodelling. We studied patients with index echocardiographic diagnosis of severe AS (aortic valve area <1 cm2) with preserved LVEF (>50%). The LVRI was determined by the ratio of the LV mass to the end-diastolic volume, as previously reported, and was compared between patients with LF and NF AS. Patients were prospectively followed up for at least 3 years, and clinical outcomes were examined in association with LVRI. Of the 450 patients studied, 112 (24.9%) had LF AS. While there were no significant differences in baseline clinical profile between LF and NF patients, LVRI was significantly higher in the LF group. Patients with high LVRI (>1.56 g/mL) had increased all-cause mortality (log-rank 9.18, P = 0.002) and were more likely to be admitted for cardiac failure (log-rank 7.61, P = 0.006) or undergo aortic valve replacement (log-rank 18.4, P < 0.001). After adjusting for the effect of age, hypertension, aortic valve area and mean pressure gradient on multivariate Cox regression, high LVRI remained independently associated with poor clinical outcomes (hazard ratio 1.64, 95% confidence interval 1.19-2.25, P = 0.002). Pathological LV remodelling (increased LVRI) was more common in patients with LF AS, and increased LVRI independently predicts worse clinical outcomes.