Prognostic Value of the Global Left Ventricular Contractility Index in Patients with Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction

Introduction: Assessment of left ventricular (LV) systolic function is important in valvular heart disease. The global LV contractility index, <i>dσ*/dt<sub>max</sub></i>, is load-independent and has been reported to be associated with clinical outcomes in heart failure and a...

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Main Authors: Tony Li, Vinay B. Panday, Jessele Lai, Nicholas Gao, Beth Lim, Aloysius Leow, Sarah Tan, Quek Swee Chye, Ching Hui Sia, William Kong, Tiong Cheng Yeo, Ru San Tan, Liang Zhong, Kian Keong Poh
Format: Article
Language:English
Published: MDPI AG 2025-06-01
Series:Journal of Cardiovascular Development and Disease
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Online Access:https://www.mdpi.com/2308-3425/12/6/227
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Summary:Introduction: Assessment of left ventricular (LV) systolic function is important in valvular heart disease. The global LV contractility index, <i>dσ*/dt<sub>max</sub></i>, is load-independent and has been reported to be associated with clinical outcomes in heart failure and aortic stenosis. We aim to assess if <i>dσ*/dt<sub>max</sub></i> could predict adverse outcomes in patients with severe mitral regurgitation (MR). Methodology: We studied <i>dσ*/dt<sub>max</sub></i> in a cohort of 127 patients with isolated severe primary MR and preserved LVEF ≥ 60%. Patients with prior valvular intervention or concurrent valvular disease were excluded. We tested <i>dσ*/dt<sub>max</sub></i> against a composite of adverse outcomes including all-cause mortality, heart failure hospitalization, and mitral valve intervention. Results: The cohort had a mean age of 58 years old and was predominantly male. Of the 127 patients, eight (6.3%) needed subsequent hospitalization for heart failure, while 30 (23.6%) and 11 (8.7%) patients underwent mitral valve repair and replacement, respectively, And 14 (11.0%) passed away. Of the patients (<i>n</i> = 54 (42.5%)) who had an adverse outcome during follow-up, <i>dσ*/dt<sub>max</sub></i> demonstrated an independent association with composite adverse outcome, including its individual components. On ROC analysis, a cut-off of 2.15 s<sup>−1</sup> was identified. Based on this cut-off, <i>dσ*/dt<sub>max</sub></i> retained an independent association with composite adverse outcome after adjusting for covariates including age, sex, ischemic heart disease, pulmonary artery systolic pressure, and left ventricular end systolic diameter. Conclusions: In patients with severe primary MR and preserved LVEF, reduced <i>dσ*/dt<sub>max</sub></i> was an independent predictor of adverse outcomes. It can be a useful addition to the armamentarium for assessing patients with severe MR.
ISSN:2308-3425