Forward ejection fraction: a new index of left ventricular function in mitral regurgitation

Area of Science:

• Cardiology
• Cardiac Physiology
• Echocardiography

Background:

• Normal ejection fraction (EF) is unreliable for assessing left ventricular (LV) function in mitral regurgitation (MR).
• A new index, forward EF, representing LV emptying into the aorta, was proposed.

Purpose of the Study:

• To evaluate the utility of forward EF as an index of LV function in patients with chronic MR and normal LVEF.
• To correlate forward EF with other hemodynamic parameters and assess its prognostic value.

Main Methods:

• Forward EF was calculated as forward stroke volume divided by end-diastolic volume in 54 MR patients with normal LVEF (≥50%).
• Correlations with end-diastolic volume index, end-systolic volume index, cardiac index, and systolic pressure-to-end-systolic volume ratio were analyzed.
• Patients were grouped by forward EF (<35% vs. >35%) to assess outcomes after mitral valve replacement.

Main Results:

• Forward EF significantly correlated with LV volumes, cardiac index, and systolic pressure-to-end-systolic volume ratio.
• Patients with lower forward EF (Group I) were more likely to undergo mitral valve replacement and had higher mortality.
• Functional class improved in 75% of surgical survivors, with no significant difference between groups.

Conclusions:

• Forward EF appears to be a valuable index for assessing LV performance in MR patients with preserved LVEF.
• This index may offer better prognostic information than traditional LVEF in this specific patient population.