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Prognostic value of left ventricular contractility index in patients with coarctation of aorta and preserved ejection

Marwan Ahmed1, William R Miranda1, Ahmed E Ali1

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.

American Heart Journal
|June 17, 2026
PubMed

Insights

Reduced left ventricular contractility index (LVCi), not ejection fraction (LVEF), predicts worse outcomes in adults with repaired coarctation of the aorta (COA). Lower LVCi is linked to higher mortality risk, highlighting its importance in managing COA survivors.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Clinical Outcomes Research

Background:

  • Adults with repaired coarctation of the aorta (COA) often maintain preserved left ventricular ejection fraction (LVEF) but face significant heart failure and mortality risks.
  • Assessing left ventricular (LV) contractility is crucial for understanding clinical outcomes in this population.

Purpose of the Study:

  • To investigate the relationship between LV contractility and clinical outcomes in adults with repaired COA and preserved LVEF.
  • To evaluate LV contractility index (LVCi) as a predictor of peak oxygen consumption (VO2), NT-proBNP levels, and all-cause mortality.

Main Methods:

  • Retrospective cohort study of 821 adults with repaired COA and LVEF ≥50% from 2003-2024.
  • LV contractility index (LVCi) calculated as brachial systolic blood pressure divided by LV end-systolic volume index.
  • Patients stratified by median LVEF (low/normal vs. high/normal) and LVCi (low vs. high) to compare outcomes.

Main Results:

  • The low LVCi group exhibited lower peak VO2, higher NT-proBNP, and increased mortality compared to the high LVCi group.
  • No significant differences in peak VO2, NT-proBNP, or mortality were observed between low/normal and high/normal LVEF groups.
  • LVCi demonstrated independent association with all-cause mortality and superior prognostic value over LVEF and LV global longitudinal strain.

Conclusions:

  • LV contractility, assessed by LVCi, is a critical determinant of outcomes in adults with repaired COA and preserved LVEF.
  • Further research is needed to define optimal LVCi cutoffs and explore therapeutic benefits for patients with reduced LV contractility.
Abstract

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