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Introduction: Global left ventricular (LV) contractility index, dσ*/dt_max, defined as the maximal rate of change of pressure-normalized LV wall stress, is given by the formula 3(dV/dt)_max /2V_m where dV/dt_max is the product of left ventricular outflow tract (LVOT) velocity and area; and V_m, left ventricular mass index (LVMI). In published reports, prediction of clinical outcomes in aortic stenosis were observed. It is unknown if dσ*/dt_max would predict clinical outcomes in patients with severe mitral regurgitation (MR).

Aim: We studied the association of dσ*/dt_max with clinical outcomes in severe MR with preserved LV ejection fraction (EF).

Methods: Consecutive patients with severe MR and LVEF ≥50% diagnosed on index echocardiogram at a single centre were retrospectively analyzed. Patients with other valvular lesions of moderate severity or more, or valvular interventions, were excluded. Clinical outcomes were …