# Role of 3D left ventricular end-systolic volume in risk stratification and outcome prediction in significant mitral regurgitation

## TL;DR

This study shows that measuring 3D left ventricular end-systolic volume improves risk prediction in patients with significant mitral regurgitation.

## Contribution

The study introduces 3D LV end-systolic volume as a more accurate tool for risk stratification in mitral regurgitation compared to standard methods.

## Key findings

- Increased 3D LV end-systolic volume was linked to higher risk of adverse outcomes in both primary and secondary mitral regurgitation.
- 3D LV end-systolic volume and LV end-systolic diameter often provided conflicting results in identifying LV dilatation.
- Patients with elevated 3D LV end-systolic volume had significantly higher risks of adverse events, even after adjusting for intervention guidelines.

## Abstract

In the follow-up of patients with mitral regurgitation (MR), assessment of left ventricular (LV) dilatation using standard echocardiography often yields inconsistent results. We investigated whether measuring 3D LV end-systolic volume (3DLVESV) improves risk stratification in moderate or greater MR.

In the prospective 3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation (3D-PRIME) study, 227 patients −142 with primary (PMR) and 85 secondary MR (SMR)- underwent 2D/3D echocardiography. 3DLVESV was increased if ≥41.5/35 mL/m², and LV end-systolic diameter (LVESD) enlarged if ≥39.8/34.8 mm in men/women. The primary outcome was a composite of MR progression towards intervention, death, or heart failure hospitalization (HFH). Death or HFH was a secondary outcome.

At baseline, 28% of PMR and 54% of SMR patients had increased 3DLVESV. After 21 (15–25) months, increased 3DLVESV was associated with 1.9-fold (1.2–3.2) higher adjusted risk of the primary outcome in PMR, and 4.1-fold (1.6–10.7) higher risk of death or HFH in SMR (P < 0.05). 3DLVESV and LVESD concordantly identified LV dilatation in 20% of PMR patients and were discordant in 27%. Both patients with increased 3DLVESV only, and those with increased both 3DLVESV and LVESD, had high risk of the primary outcome after adjusting for recommendations for intervention in PMR: HR 7.1 (2.9–16.9) and 4.9 (2.1–11.1), respectively (P < 0.001).

Increased 3DLVESV is associated with a higher risk of adverse events in patients with significant MR. In PMR, evaluating LV dilatation using both 3DLVESV and LVESD may enhance risk stratification and aid in patient selection for close follow-up.

NCT04442828, 17 April 2020.

Graphical AbstractIncreased 3D LV ESV and clinical outcomes in moderate or greater MR

Increased 3D LV ESV and clinical outcomes in moderate or greater MR