Abstract 13550: Prognostic Value of the Global Left Ventricular Contractility Index in Patients With Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction

Introduction: Global left ventricular (LV) contractility index, dσ*/dt _max , defined as the maximal rate of change of pressure-normalized LV wall stress, is given by the formula 3(dV/dt) _max /2V _m where dV/dt _max is the product of left ventricular outflow tract (LVOT) velocity and area; and V _m , left ventricular mass index (LVMI). In published reports, prediction of clinical outcomes in aortic stenosis were observed. It is unknown if dσ*/dt _max would predict clinical outcomes in patients with severe mitral regurgitation (MR).

Aim: We studied the association of dσ*/dt _max with clinical outcomes in severe MR with preserved LV ejection fraction (EF).

Methods: Consecutive patients with severe MR and LVEF ≥50% diagnosed on index echocardiogram at a single centre were retrospectively analyzed. Patients with other valvular lesions of moderate severity or more, or valvular interventions, were excluded. Clinical outcomes were ascertained by review of medical records. The primary outcome was a composite of heart failure hospitalizations and all-cause mortality.

Results: 176 patients were included in the analysis. Table 1 depicts the characteristics of the study population. Patients with composite outcomes were older, more likely to be female, had higher LVMI, lower regurgitation volume and dσ*/dt _max (2.2 +/- 0.7 vs 2.7 +/- 0.9, p = 0.02). On multivariable Cox regression (Table 2), only age and dσ*/dt _max (adjusted HR 0.42, 95% CI: 0.220 - 0.806, p = 0.01) remained independently associated with occurrence of the primary outcome.

Conclusions: In patients with isolated severe mitral regurgitation and preserved LVEF, low dσ*/dt _max was an independent predictor of adverse clinical outcomes.