Granger causality analysis identifies structural determinants predicting beat-to-beat mitral regurgitation variability in functional mitral regurgitation.
This exploratory Granger causality study investigated structural determinants predicting beat-to-beat mitral regurgitation variability within a cohort of 41 patients with functional mitral regurgitation, comprising 21 with atrial and 20 with ventricular subtypes. The intervention involved beat-to-beat echocardiographic time series analysis to assess predictive relationships between structural metrics and regurgitation area. No comparator was reported, and the study setting was not specified. Funding or conflicts of interest were not reported.
Main results indicated that left ventricular volume Granger-predicting mitral regurgitation area was the strongest predictor at short lags, with atrial p=0.011 and ventricular p=0.006. Left atrial volume Granger-predicting mitral regurgitation area emerged at longer lags (lag 7), showing atrial p=0.043 and ventricular p=0.011. Systolic papillary muscle length was not predictive in pooled analysis, whereas papillary muscle length Granger-predicting regurgitation was predictive only in the ventricular subtype (p=0.001). Conversely, regurgitation predicting papillary muscle displacement was observed only in the atrial subtype (p<0.001). No structural determinant correlated with severity.
Safety and tolerability were not reported, as adverse events, serious adverse events, discontinuations, and tolerability data were not collected or reported. Key limitations include marked heterogeneity in individual models and subtype-specific dissociation in full-cycle analysis. Static analyses cannot capture temporal patterns, and relative contributions vary between atrial and ventricular subtypes. The practice relevance lies in a framework that may support patient-specific temporal phenotyping of functional mitral regurgitation, though this is an exploratory study with uncertain certainty.
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