Key result
LVOT VTI < 13 cm linked to ~91% higher mortality in hospitalized patients.
Why the study?
LVEF has limited ability to reflect forward flow, and the incremental prognostic value of LVOT VTI beyond LVEF remains incompletely defined.
Does LVOT VTI < 13 cm predict mortality beyond LVEF in hospitalized patients?
Cohort (n=1,325)
No
Does LVOT VTI < 13 cm predict mortality beyond LVEF in hospitalized patients?
Effect estimate: HR 1.91 (95% CI 1.41-2.59)
p-value: p=< 0.001
LVOT VTI < 13 cm is an independent predictor of long-term mortality in hospitalized patients, providing incremental prognostic value beyond LVEF.
May extend mortality risk stratification beyond LVEF in hospitalized patients; hypothesis-generating and requires prospective validation.
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.
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Eng‐Frost et al. (2025) conducted a cohort in Hospitalized patients (n=1,325). LVOT VTI < 13 cm vs. LVOT VTI > 13 cm was evaluated on mortality (HR 1.91, 95% CI 1.41-2.59, p=< 0.001). Left ventricular outflow tract velocity time integral < 13 cm was associated with increased mortality in hospitalized patients (HR 1.91; 95% CI 1.41-2.59; p < 0.001).
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