Incremental Prognostic Value of Left Ventricular Outflow Tract Velocity Time Integral (LVOT VTI) Beyond Ejection Fraction in a Large Cohort of Hospitalized Patients

Background Left ventricular ejection fraction (LVEF) is a widely used echocardiographic prognostic marker; however, its ability to reflect forward flow is limited. Left ventricular outflow tract velocity time integral (LVOT VTI) reflects stroke distance and has prognostic value in patients with cardiac and non‐cardiac pathology, yet its incremental value beyond LVEF remains incompletely defined. Objective To determine whether LVOT VTI confers prognostic value beyond LVEF in a large real‐world cohort of hospitalized patients. Methods Index echocardiograms performed between January and June 2021 at a single tertiary hospital were retrospectively analyzed. Demographics, echocardiographic parameters, biomarkers, and mortality data were collected. Patients were stratified by LVOT VTI ( > 13 and <13 cm) and LVEF ( > 40% and <40%). Associations with mortality were evaluated with Cox proportional hazard models. Results Altogether, 1325 patients (mean age 70 years) were included; 368 (28%) died over a median follow‐up of 35.9 months (IQR 34.4–37.4). Both LVEF < 40% (HR 1.95, 95% CI 1.52–2.50; p < 0.001) and LVOT VTI < 13 cm (HR 1.91, 95% CI 1.41–2.59; p < 0.001) were associated with increased mortality. LVOT VTI < 13 cm remained predictive after adjustment for LVEF, although this was attenuated after adjustment for age. Mortality was greatest in patients with both LVEF < 40% and LVOT VTI < 13 cm (HR 2.37, 95% CI 1.63–3.46; p < 0.001). Conclusion LVOT VTI < 13 cm is independently associated with long‐term mortality in hospitalized patients. Its incremental prognostic value beyond LVEF warrants prospective validation as a reproducible marker to enhance risk stratification in hospitalized patients.