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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1410859
This article is part of the Research Topic Pre-Interventional Cardiac Imaging View all 7 articles

Imminent Risk of LVEF Decline in Asymptomatic Patients with Primary Mitral Regurgitation

Provisionally accepted
Jingyi Zheng Jingyi Zheng 1Shao-wei Huang Shao-wei Huang 1Mustafa I. Ahmed Mustafa I. Ahmed 2Betty Pat Betty Pat 2,3Steven G. Lloyd Steven G. Lloyd 2,3Oleg F. Sharifov Oleg F. Sharifov 2Thomas S. Denney Thomas S. Denney 1Louis J. Dell'Italia Louis J. Dell'Italia 2,3*
  • 1 Auburn University, Auburn, Alabama, United States
  • 2 University of Alabama at Birmingham, Birmingham, United States
  • 3 Birmingham VA Medical Center, Birmingham, Alabama, United States

The final, formatted version of the article will be published soon.

    Background. 2020 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines state that the ideal time for mitral valve surgery in primary mitral regurgitation (PMR) is when the LV approaches but has not yet reached echocardiographic LV ejection fraction (EF) < 60% or LV end-systolic dimension (ESD) > 40 mm. However, it is difficult to know the imminent risk of crossing this threshold when the surgical outcome is less optimal. Objective. Using machine learning and statistical models, we have shown that cardiac magnetic resonance (CMR) LV sphericity index (SI) and LV mid circumferential strain rate (SRcirc) added to LVEF and LVESD predict LVEF < 50% after mitral valve surgery. Here we test the hypothesis that these features predict LVEF < 60% in asymptomatic PMR patients at 18 months. Methods. 33 asymptomatic PMR patients with moderate to severe mitral regurgitation had CMR with tissue tagging at baseline and every 6 months for 18 months. Two types of models were employed to predict LVEF < 60% at 18 months: a model using CMR features at a single time point (e.g., baseline) and a model utilizing repeated measurements over time. Results. CMR LVEF decreased below 60% in 13 patients over 18 months. LVEF varied over time with an inverse relation to mean arterial pressure and mean end-systolic wall stress. Random forest models utilizing LV SI, LV mid SRcirc, LVESD and LVEF at a single time point (baseline) had a predictive accuracy of 64%. LV mid SRcirc, LVESD and LVEF at baseline, 6, and 12 months achieved a higher predictive accuracy of 79%, improved sensitivity from 57% to 85% than baseline alone and identified a threshold of LVEF 64% signaling LVEF < 60%. Conclusion. The variability of LVEF due to blood pressure dependence may require a longitudinal study that incorporates LVEF, LVESD, SRcirc at multiple time points to identify the threshold at which LVEF is at risk for decline to less than 60%.

    Keywords: abbreviations, introduction, Materials and methods, results, discussion, Contribution to the Field, References, Figure Legends

    Received: 01 Apr 2024; Accepted: 27 Sep 2024.

    Copyright: © 2024 Zheng, Huang, Ahmed, Pat, Lloyd, Sharifov, Denney and Dell'Italia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Louis J. Dell'Italia, University of Alabama at Birmingham, Birmingham, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.