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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2025-06-01
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| 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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| author | 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 |
| author_facet | 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 |
| author_sort | Tony Li |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-9f4ca6a9c2ee4c1283d3b82967ec9903 |
| institution | Kabale University |
| issn | 2308-3425 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-9f4ca6a9c2ee4c1283d3b82967ec99032025-08-20T03:24:36ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252025-06-0112622710.3390/jcdd12060227Prognostic Value of the Global Left Ventricular Contractility Index in Patients with Severe Mitral Regurgitation and Preserved Left Ventricular Ejection FractionTony Li0Vinay B. Panday1Jessele Lai2Nicholas Gao3Beth Lim4Aloysius Leow5Sarah Tan6Quek Swee Chye7Ching Hui Sia8William Kong9Tiong Cheng Yeo10Ru San Tan11Liang Zhong12Kian Keong Poh13Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, SingaporeYong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, SingaporeYong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, SingaporeYong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, SingaporeNational Heart Center Singapore, 5 Hospital Dr, Singapore 169609, SingaporeNational Heart Center Singapore, 5 Hospital Dr, Singapore 169609, SingaporeDepartment of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, SingaporeIntroduction: 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.https://www.mdpi.com/2308-3425/12/6/227mitral regurgitationglobal left ventricular contractility indexheart failurepreserved ejection fraction |
| spellingShingle | 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 Prognostic Value of the Global Left Ventricular Contractility Index in Patients with Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction Journal of Cardiovascular Development and Disease mitral regurgitation global left ventricular contractility index heart failure preserved ejection fraction |
| title | Prognostic Value of the Global Left Ventricular Contractility Index in Patients with Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction |
| title_full | Prognostic Value of the Global Left Ventricular Contractility Index in Patients with Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction |
| title_fullStr | Prognostic Value of the Global Left Ventricular Contractility Index in Patients with Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction |
| title_full_unstemmed | Prognostic Value of the Global Left Ventricular Contractility Index in Patients with Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction |
| title_short | Prognostic Value of the Global Left Ventricular Contractility Index in Patients with Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction |
| title_sort | prognostic value of the global left ventricular contractility index in patients with severe mitral regurgitation and preserved left ventricular ejection fraction |
| topic | mitral regurgitation global left ventricular contractility index heart failure preserved ejection fraction |
| url | https://www.mdpi.com/2308-3425/12/6/227 |
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