{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:23:50Z","timestamp":1760059430632,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T00:00:00Z","timestamp":1749772800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National University of Singapore\u2019s Junior Academic Fellowship Scheme as well as the Singapore Ministry of Health National Medical Research Council\u2019s Transition Award","award":["MOH-001368-00"],"award-info":[{"award-number":["MOH-001368-00"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Introduction: Assessment of left ventricular (LV) systolic function is important in valvular heart disease. The global LV contractility index, d\u03c3*\/dtmax, is load-independent and has been reported to be associated with clinical outcomes in heart failure and aortic stenosis. We aim to assess if d\u03c3*\/dtmax could predict adverse outcomes in patients with severe mitral regurgitation (MR). Methodology: We studied d\u03c3*\/dtmax in a cohort of 127 patients with isolated severe primary MR and preserved LVEF \u2265 60%. Patients with prior valvular intervention or concurrent valvular disease were excluded. We tested d\u03c3*\/dtmax 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 (n = 54 (42.5%)) who had an adverse outcome during follow-up, d\u03c3*\/dtmax demonstrated an independent association with composite adverse outcome, including its individual components. On ROC analysis, a cut-off of 2.15 s\u22121 was identified. Based on this cut-off, d\u03c3*\/dtmax 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 d\u03c3*\/dtmax was an independent predictor of adverse outcomes. It can be a useful addition to the armamentarium for assessing patients with severe MR.<\/jats:p>","DOI":"10.3390\/jcdd12060227","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T06:19:28Z","timestamp":1749795568000},"page":"227","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Value of the Global Left Ventricular Contractility Index in Patients with Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1234-1334","authenticated-orcid":false,"given":"Tony","family":"Li","sequence":"first","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinay B.","family":"Panday","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessele","family":"Lai","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Gao","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beth","family":"Lim","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3659-1650","authenticated-orcid":false,"given":"Aloysius","family":"Leow","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quek Swee","family":"Chye","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Division of Paediatric Cardiology, Department of Paediatrics, Khoo Teck Puat-National University Children\u2019s Medical Institute, National University Hospital, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2764-2869","authenticated-orcid":false,"given":"Ching Hui","family":"Sia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiong Cheng","family":"Yeo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ru San","family":"Tan","sequence":"additional","affiliation":[{"name":"National Heart Center Singapore, 5 Hospital Dr, Singapore 169609, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang","family":"Zhong","sequence":"additional","affiliation":[{"name":"National Heart Center Singapore, 5 Hospital Dr, Singapore 169609, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3515-7924","authenticated-orcid":false,"given":"Kian Keong","family":"Poh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1016\/S0140-6736(09)60692-9","article-title":"Mitral regurgitation","volume":"373","author":"Akins","year":"2009","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.1161\/CIR.0000000000000029","article-title":"2014 AHA\/ACC Guideline for the Management of Patients with Valvular Heart Disease: Executive summary: A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"129","author":"Nishimura","year":"2014","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the 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