Heritability of left ventricular mass and other morphologic variables in Caribbean Hispanic subjects: the Northern Manhattan Family Study.

linical characteristics and testing results in those with and without HF at the time of their AoD. Those with CHF tended to resent in atypical fashion, and whereas CHF at the time of AoD id not appear to lead to inordinate delays in patient presentation, potential impact of CHF on time to recognition of AoD was oted, and CHF was an independent predictor of surgical delay. In ur data set, it is unclear whether these delays were due to clinician reoccupation with CHF or the more subtle presentation of those ith CHF and AoD. Previous case reports have suggested that CHF in the presence f AoD is due to aortic regurgitation from aortic valve disease, ncomplete aortic leaflet closure (due to dilation of the sinotubular unction), or aortic valve disruption (1,2,5). An additional mechnism of CHF at the time of AoD includes high-output heart ailure (3,4,6). Although we confirm a high percentage of patients ith CHF secondary to proximal aortic involvement, we also emonstrated that as many as 20% of patients with CHF at the ime of AoD had a distal dissection; consequently, in this considrable minority, the mechanism of CHF must be something other han direct aortic valve involvement by the dissection itself, such as yocardial ischemia/infarction or hypertension. Delays in AoD iagnosis and treatment are notable in our subjects; this may reflect onsideration of diagnoses alternative to AoD, given the atypical resentation in our subjects.