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Myocardial Contraction Fraction is not a Predictor of Clinical Outcomes in Acute Systolic Heart Failure: A Brief
Andrew K Chang1, Jakrin Kewcharoen1, Danielle M Henkel1
1Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA.
Insights
Myocardial contraction fraction (MCF) is not a reliable predictor of outcomes in patients with systolic heart failure (SHF). Echocardiographic measures like tricuspid regurgitation velocity and left atrial diameter are better indicators of adverse events.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Myocardial contraction fraction (MCF) is a volumetric measure of myocardial shortening.
- Its utility in patients with systolic heart failure (SHF) remains under-evaluated.
- Accurate prognostic markers for SHF are crucial for patient management.
Purpose of the Study:
- To evaluate the prognostic value of MCF in patients hospitalized with acute SHF.
- To compare MCF with ejection fraction (EF) in predicting 30-day and 365-day adverse outcomes.
- To identify other echocardiographic parameters associated with adverse events in SHF.
Main Methods:
- Retrospective cohort study of 1282 adult patients admitted with acute SHF (2013-2018).
- Analysis of transthoracic echocardiogram (TTE), laboratory, and demographic data.
- MCF calculated from M-mode measurements; primary outcomes were 30-day readmission/mortality and 365-day mortality.
Main Results:
- MCF showed a weak correlation with visually estimated ejection fraction (EF) (r=0.356, P<0.001).
- Neither MCF nor EF was significantly associated with 30-day or 365-day adverse outcomes.
- Higher tricuspid regurgitation velocity, larger left atrial diameter, and moderate/greater mitral or tricuspid regurgitation predicted adverse events.
Conclusions:
- MCF and EF do not provide prognostic information in patients with acute SHF.
- Echocardiographic predictors of postdischarge adverse events include TR velocity, LA diameter, and MR/TR severity.
- These findings highlight the limitations of MCF and EF in SHF prognostication.
Introduction:
The utility of myocardial contraction fraction (MCF), a volumetric measure of myocardial shortening, has not been well evaluated in patients with systolic heart failure (SHF).
Materials And Methods:
A single-center, retrospective cohort study of all adults admitted with acute SHF from 2013 to 2018 at an academic medical center. A chart review was performed to identify key echocardiographic transthoracic echocardiogram (TTE), laboratory, and demographic characteristics. MCF was calculated based on M-mode measurements of estimated stroke volume and myocardial volume based on admission TTE. The primary outcome was 30-day combined all-cause readmission/mortality and 365-day all-cause mortality.
Results:
A total of 1282 patients were analyzed. The 30-day composite outcome occurred in 310 patients (24.2%), and all-cause death at 365 days occurred in 375 patients (29.3%). There was a weak correlation between the visually estimated ejection fraction (EF) and MCF (r = 0.356, P < 0.001). Neither MCF nor EF was associated with either component of the primary outcome. Other parameters on TTE that were associated with higher risk of primary outcome were higher tricuspid regurgitation (TR) velocity, larger left atrial (LA) diameter, and moderate or greater TR and mitral regurgitation (MR).
Conclusion:
Echocardiographic predictors of postdischarge adverse events among patients hospitalized with acute SHF include higher TR velocity, larger LA diameter, and at least moderate MR or TR. MCF does not correlate well with visually assessed EF among patients with acute SHF, and neither MCF nor EF provides prognostic information in this population.
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