Rusinaru D, Bohbot Y, Kubala M, et al. - The usefulness of myocardial contraction fraction (MCF) was evident as a marker of risk in low-gradient severe aortic stenosis with preserved ejection fraction and it also confers improved decision-making, particularly in normal-flow low-gradient severe aortic stenosis with preserved ejection fraction.

• This study included 643 patients with low-gradient severe aortic stenosis with preserved ejection fraction.

• At baseline, MCF was recorded among patients.

• Higher mortality was noted in lower MCF tertiles vs the highest tertile, throughout follow-up with medical and surgical management.

• For mortality prediction, 41% was defined as the optimal MCF cutoff point.

• MCF showed better performance than ejection fraction for mortality prediction.

• On classifying patients based on stroke volume (SV) index and MCF, low mortality risk was noted with SV index ≥30 mL/m ² and MCF>41%; higher and extremely high risk were noted with SV index ≥30 mL/m ² and MCF≤41% and for patients with SV index <30 mL/m ² , respectively.