Forward Left Ventricular Ejection Fraction: A Simple Risk Marker in Patients With Primary Mitral Regurgitation

Abstract

BackgroundThe timing of mitral valve surgery in asymptomatic patients with primary mitral regurgitation (MR) is controversial. We hypothesized that the forward left ventricular (LV) ejection fraction (LVEF; ie, LV outflow tract stroke volume divided by LV end‐diastolic volume) is superior to the total LVEF to predict outcomes in MR. The objective of this study was to examine the association between echocardiographic parameters of MR severity and LV function and outcomes in patients with MR.Methods and ResultsThe clinical and Doppler‐echocardiographic data of 278 patients with ≥mild MR and no class I indication of mitral valve surgery at baseline were retrospectively analyzed. The primary study end point was the composite of mitral valve surgery or death. During a mean follow‐up of 5.4±3.2 years, there were 147 (53%) events: 96 (35%) MV surgeries and 66 (24%) deaths. Total LVEF and global longitudinal strain were not associated with the occurrence of events, whereas forward LVEF (P<0.0001) and LV end‐systolic diameter (P=0.0003) were. After adjustment for age, sex, MR severity, Charlson probability, coronary artery disease, and atrial fibrillation, forward LVEF remained independently associated with the occurrence of events (adjusted hazard ratio: 1.09, [95% confidence interval]: 1.02–1.17 per 5% decrease; P=0.01), whereas LV end‐systolic diameter was not (P=0.48).ConclusionsThe results of this study suggest that the forward LVEF may be superior to the total LVEF and LV end‐systolic diameter to predict outcomes in patients with primary MR. This simple and easily measurable parameter may be useful to improve risk stratification and select the best timing for intervention in patients with primary MR.

Corrected calculation of the overestimated ejection fraction in valvular heart disease by phase-contrast cardiac magnetic resonance imaging for better prediction of patient morbidity

“…Dupuis et al [33] stated that the forward LVEF (LV outflow tract SV divided by LVEDV) is superior to the total LVEF in predicting outcomes in mitral regurgitation. Other similar studies have described the use of PC-CMR for calculation of the mitral regurgitant volume by subtraction of the aortic forward flow calculated at the aortic root from the total left ventricular stroke volume (LVSV) obtained from planimetry of the LV end-diastolic and end-systolic contours [34].…”

The analysis of left ventricular ejection fraction after minimally invasive surgery for primary mitral valve regurgitation

“…Forward LVEF less than 35% has been demonstrated as a cut off value to predict higher short‐term mortality after MV surgery 17 . Therefore, forward LVEF may be a superior parameter to the “total” LVEF and may be employed to predict LV dysfunction after MV surgery 18 . On the other hand, it has been shown that a postoperative (6 months) LVEF less than 50% indicates decreased long‐term survival in patients undergoing surgery for MR 19 .…”

“…LVEF and may be employed to predict LV dysfunction after MV surgery. 18 On the other hand, it has been shown that a postoperative…”

Forward Left Ventricular Ejection Fraction as a Predictor of Postoperative Left Ventricular Dysfunction in Patients with Degenerative Mitral Regurgitation

“…Forward LVEF was calculated using the following equation: forward LVEF = 100 × forward SV/LVEDV, where the forward SV was measured by pulsed wave Doppler in the LV outflow tract [ 14 ]. To determine intra-observer and inter-observer variability, a random sample of 25% of left ventricular outflow tract (LVOT) recordings was submitted twice to the first investigator and once to a second investigator.…”

“…Forward LVEF, calculated as forward stroke volume (SV) divided by LV end-diastolic volume (LVEDV), may helpful in stratifying the long-term risk in patients with ≥ mild MR [ 14 ]. Few studies to date have evaluated the ability of forward LVEF to predict short-term risk, especially in terms of LVD after mitral valve surgery.…”