Background-Mortality in patients with heart failure (HF) remains high, but causes of death are incompletely defined. As HF is a heterogeneous syndrome categorized according to the ejection fraction (EF), the association between EF and causes of death is important, yet elusive. Methods and Results-Community subjects with HF were classified according to the preserved (Ն50%) and the reduced EF (Ͻ50%). Deaths were classified as due to coronary heart disease and other cardiovascular and noncardiovascular diseases. Among 1063 persons with HF, 45% had preserved EF with fewer cardiovascular risk factors and less coronary disease than those with reduced EF. At 5 years, survival was 45% (95% CI, 43% to 49%), and 43% of the deaths were noncardiovascular. The leading cause of death in subjects with preserved EF was noncardiovascular disease (49%) versus coronary heart disease (43%) for subjects with reduced EF. The proportion of cardiovascular deaths decreased from 69% in 1979 -1984 to 40% in 1997) among subjects with preserved EF, which is in contrast to a modest change among those with reduced EF (77% to 64%, Pϭ0.08).Advanced age, male sex, diabetes, smoking, and kidney disease were associated with an increased risk of all-cause and cardiovascular deaths. After adjustment, preserved EF was associated with a lower risk of cardiovascular death but not all-cause death. Conclusions-Community subjects with HF experience a persistently high mortality, and a large proportion of deaths is noncardiovascular. Cardiovascular disease before death is less in subjects with preserved EF, and they are less likely to experience cardiovascular deaths compared with those with reduced EF. In those with preserved EF, the proportion of cardiovascular deaths declined over time. (Circ Heart Fail. 2008;1:91-97.)

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We present the results of deriving the Israel-Stewart equations of relativistic dissipative fluid dynamics from kinetic theory via Grad's 14-moment expansion. Working consistently to second order in the Knudsen number, these equations contain several new terms which are absent in previous treatments.

We present the results of deriving the Israel-Stewart equations of relativistic dissipative fluid dynamics from kinetic theory via Grad's 14-moment expansion. Working consistently to second order in the Knudsen number, these equations contain several new terms which are absent in previous treatments.Comment: 7 pages, proceedings of the Erice School on Nuclear Physics "Heavy Ion collisions from the Coulomb Barrier up to the Quark Gluon Plasma", Erice, Sicily, Sep. 16 - 24, 200

Objectives We sought to determine the prevalence, characteristics and outcomes of asymptomatic left ventricular (LV) systolic dysfunction in patients with severe aortic stenosis (AS). Background Management of asymptomatic patients with severe AS remains controversial. In these patients, LV systolic dysfunction, defined in the guidelines as ejection fraction < 50%, is a class I(C) indication for aortic valve replacement (AVR), but its prevalence is unknown. Methods A retrospective study of adults ≥ 40 years with severe valvular AS (peak velocity ≥ 4 m/sec, mean gradient > 40 mmHg, aortic valve area (AVA) < 1 cm2, or AVA index < 0.6 cm2/m2) from 1984 through 2010 was undertaken. Patients with prior cardiac surgery, severe coronary artery disease, or greater than moderate aortic regurgitation were excluded. Results Of 9940 patients with severe AS, 43 (0.4 %) patients had asymptomatic LV dysfunction. Age was 73 ± 14 years and 70% were male. Hypertension (78%) and LV hypertrophy (LV mass index 143 ± 36 g/m2) were characteristic. Fifty-three percent of these patients developed symptoms at 21 ± 19 months after diagnosis. During 7.5 ± 6.7 years follow-up, 5-year mortality was 48%. After multivariable adjustment, there was no survival advantage with AVR in asymptomatic, severe AS with LV dysfunction (p = 0.51). Conclusions In severe AS, the prevalence of asymptomatic LV systolic dysfunction is 0.4%. Despite an asymptomatic clinical status, patients with severe AS and LV ejection fraction < 50% have a poor prognosis, with or without AVR.