{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T04:07:10Z","timestamp":1773979630875,"version":"3.50.1"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T00:00:00Z","timestamp":1766188800000},"content-version":"vor","delay-in-days":1569,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T00:00:00Z","timestamp":1630627200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004738","name":"E-Da Hospital","doi-asserted-by":"publisher","award":["EDAHP105027"],"award-info":[{"award-number":["EDAHP105027"]}],"id":[{"id":"10.13039\/501100004738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004738","name":"E-Da Hospital","doi-asserted-by":"publisher","award":["EDAHP106026"],"award-info":[{"award-number":["EDAHP106026"]}],"id":[{"id":"10.13039\/501100004738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["106-2314-B-038-094"],"award-info":[{"award-number":["106-2314-B-038-094"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["109-2314-B-650-014"],"award-info":[{"award-number":["109-2314-B-650-014"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004738","name":"E-Da Hospital","doi-asserted-by":"publisher","award":["EDAHP105027"],"award-info":[{"award-number":["EDAHP105027"]}],"id":[{"id":"10.13039\/501100004738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004738","name":"E-Da Hospital","doi-asserted-by":"publisher","award":["EDAHP106026"],"award-info":[{"award-number":["EDAHP106026"]}],"id":[{"id":"10.13039\/501100004738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["106\u20102314\u2010B\u2010038\u2010094"],"award-info":[{"award-number":["106\u20102314\u2010B\u2010038\u2010094"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["109\u20102314\u2010B\u2010650\u2010014"],"award-info":[{"award-number":["109\u20102314\u2010B\u2010650\u2010014"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Little is known of the impact of systolic pulmonary regurgitation (PR) on acute decompensated heart failure (HF). We assessed the prevalence and prognostic significance of systolic PR in patients with severe HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>According to recent 10 year echocardiographic database of E-Da Hospital, 533 patients admitted for first systolic heart failure (HF) and left ventricular ejection fraction &amp;lt;35% were under investigation. Systolic PR was defined as the presence of pulmonary backward flow persistent after QRS in electrocardiogram. Isovolumic contraction\/relaxation time and myocardial performance index were derived by tissue Doppler imaging. Right ventricular (RV) function was assessed by RV fractional area change. Estimated pulmonary vascular resistance (PVR) was assessed by the ratio of peak tricuspid regurgitation velocity to the RV outflow tract time\u2013velocity integral. The factors associated with systolic PR were assessed by multivariate logistic regression. Cox proportional regression analyses were used to estimate the impact of cardiovascular events including HF rehospitalization and cardiovascular death. For estimated prevalence of 5480 control subjects, echocardiographic screens in those with normal left ventricular ejection fraction were performed. Of 533 systolic HF cases, 143 (26.8%) had systolic PR during indexed hospitalization. Among 143 cases, 86% systolic PR disappeared during late follow-up. In control subjects, 0.3% (18\/5480) had systolic PR. Systolic PR correlated to RV dysfunction, estimated PVR, E\/e\u2032, sign of low cardiac output, and pulmonary oedema. Systolic PR was associated independently with further cardiovascular events (hazard ratio 2.266, 95% confidence interval 1.682\u20133.089, P &amp;lt; 0.0001) including cardiovascular death and HF rehospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Systolic PR is not uncommon in systolic HF and is associated with high PVR and RV dysfunction. Systolic PR significantly impacts cardiovascular outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.13581","type":"journal-article","created":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T06:58:16Z","timestamp":1630652296000},"page":"5121-5131","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Systolic Pulmonary Regurgitation Affects the Outcome of Patients with Severe Systolic Heart Failure"],"prefix":"10.1093","volume":"8","author":[{"given":"Shih-Hung","family":"Hsiao","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University , Kaohsiung ,","place":["Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao-Sheng","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University , Kaohsiung ,","place":["Taiwan"]},{"name":"Department of Internal Medicine, College of Medicine, Fu Jen Catholic University , New Taipei City ,","place":["Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuan-Rau","family":"Chiou","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University , No. 291, Jhongzheng Road, Jhonghe District, New Taipei City, 23561 ,","place":["Taiwan"]},{"name":"School of Medicine, Taipei Medical University , Taipei ,","place":["Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,9,3]]},"reference":[{"key":"2026012114202612300_ehf213581-bib-0001","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.ihj.2017.08.012","article-title":"Systolic aortic regurgitation in rheumatic carditis: mechanistic insight by doppler echocardiography","volume":"70","author":"Mohan","year":"2018","journal-title":"Indian Heart J"},{"key":"2026012114202612300_ehf213581-bib-0002","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1111\/ijcp.12566","article-title":"Accuracy of systolic aortic regurgitation in the diagnosis of heart failure: a predictive approach","volume":"69","author":"Saura","year":"2015","journal-title":"Int J Clin Pract"},{"key":"2026012114202612300_ehf213581-bib-0003","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.recesp.2014.09.011","article-title":"Systolic aortic regurgitation. a new prognostic marker in heart failure patients?","volume":"68","author":"Bonaque","year":"2015","journal-title":"Rev Esp Cardiol"},{"key":"2026012114202612300_ehf213581-bib-0004","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/S0894-7317(05)80022-7","article-title":"Systolic aortic regurgitation: a hemodynamic challenge for the clinician","volume":"8","author":"Kronzon","year":"1995","journal-title":"J Am Soc Echocardiogr"},{"key":"2026012114202612300_ehf213581-bib-0005","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.ijcard.2009.09.559","article-title":"Systolic aortic regurgitation: a not-so-rare phenomenon","volume":"145","author":"Saura","year":"2010","journal-title":"Int J Cardiol"},{"key":"2026012114202612300_ehf213581-bib-0006","first-page":"284","article-title":"Systolic aortic regurgitation","volume":"9","author":"Saura","year":"2008","journal-title":"Eur J Echocardiogr"},{"key":"2026012114202612300_ehf213581-bib-0007","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.case.2020.08.010","article-title":"Phantom systole: a failed ejection phenomenon between pulsus alternans and systolic aortic regurgitation","volume":"4","author":"Ramos","year":"2020","journal-title":"CASE (Phila)"},{"key":"2026012114202612300_ehf213581-bib-0008","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.amjcard.2016.11.008","article-title":"Impact of elevated end-diastolic pulmonary regurgitation gradient on worse clinical outcome in hospitalized patients with heart failure","volume":"119","author":"Honda","year":"2017","journal-title":"Am J Cardiol"},{"key":"2026012114202612300_ehf213581-bib-0009","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.2337\/dc16-S005","article-title":"Classification and diagnosis of diabetes. 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