Prognostic Value of Left Ventricular Contractility Index in Patients with Coarctation of Aorta and Preserved Ejection Fraction

BACKGROUND Although more than 90% of adults with repaired coarctation of aorta (COA) have preserved left ventricular ejection fraction (LVEF), heart failure (HF) and cardiovascular mortality are relatively common in this population. The purpose of this study was to assess the relationship between LV contractility and clinical outcomes in adults with repaired COA and preserved LVEF. METHOD Retrospective cohort study of adults with repaired COA and preserved LVEF (LVEF ≥50%) (2003-2024). LV contractility index (LVCi) was assessed as the ratio of brachial systolic blood pressure and LV end-systolic volume index. Based on LVEF and LVCi obtained from the baseline echocardiogram, patients were dichotomized using the median value of LVEF (LVEF_low/normal versus LVEF_high/normal) and LVCi (LVCi_low versus LVCi_high). Study outcomes were peak VO2, NT-proBNP, and all-cause mortality. RESULTS Of 821 patients, median LVEF was 63% (56,70), and median LVCi was 5.8 (4.8,7.1) mmHg/ml/m2. Compared to LVCi_high group, the LVCi_low group had lower predicted peak VO2, higher NT-proBNP levels and higher incidence of mortality. In contrast, there was no difference in peak VO2, NT-proBNP levels, and mortality between the LVEF_low/normal versus LVEF_high/normal groups. LVCi was independently associated with all-cause mortality and had superior prognostic performance compared to LVEF and LV global longitudinal strain. CONCLUSIONS Further studies are required to determine the optimal cutoff point of LVCi that defines reduced LV contractility, and whether patients with reduced LV contractility (in the setting of preserved LVEF) would benefit from medical therapy considering the higher risk of mortality in this subgroup of patients.