C28 LEFT VENTRICULAR OUTFLOW TRACT VELOCITY–TIME INTEGRAL (LVOT–VTI) IMPROVES RISK STRATIFICATION IN HEART FAILURE PATIENTS WITH SECONDARY MITRAL REGURGITATION

Abstract Background Reduced left ventricular ejection fraction (LVEF) has been used as a key criterion for the management of mitral regurgitation (MR) in patients with heart failure (HF), including decision about valve repair. However, LVEF, not taking into account regurgitant volume, may be an imprecise predictor outcome HF MR. Conversely, estimation forward volume through LV outflow tract (LVOT) better metric this setting. In regard, LVOT velocity time integral (LVOT–VTI), relying on geometrical assumptions, shown to more reproducible than calculated stroke (i.e., LVOT–VTI * cross sectional area). Objective To assess prognostic significance contemporary cohort chronic and significant Methods Consecutive reduced (≤40%) or mildly (41–49%) LVEF moderate–to–severe severe MR, according latest European Society Cardiology criteria, were selected followed–up endpoint cardiac death. Results 287 enrolled study (74±11 years, 70% men, 46% ischemic etiology, HFrEF 89%, 30±9%, mean 20±5 cm). Most showed NYHA class II (40%) III (31%) received beta–blockers (93%), ACE–inhibitors/ARBs ARNI (77%), mineralocorticoid receptor antagonists (76%). One hundred ten (39%) had permanent atrial fibrillation 82 (29%) resynchronization therapy device. Over median follow–up 33 (16–47) months, 114 died, 71 whom cause, 28 underwent repair/replacement. The risk death increased proportionally decrease (Figure 1, panel A), optimal cut–off 17 cm B). was associated higher class, NT–proBNP concentration, worse right ventricle systolic function (all p<0.005). At multivariable competing risks regression analysis, unit (HR 0.87 [95%CI 0.80–0.93], p<0.001), but (p=0.254), independently C). Conclusion Left noninvasively estimated LVOT–VTI, predicts