{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:21:16Z","timestamp":1790194876979,"version":"4.1.0"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T00:00:00Z","timestamp":1721606400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Heart Fail"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>In patients with degenerative mitral regurgitation (DMR), left ventricular (LV) dysfunction is associated with increased risk of heart failure and excess mortality. LV end\u2010systolic diameter (LVESD) is an established trigger for intervention, yet recommended LVESD thresholds apply poorly to patients with small body size. Whether LV normalization to body surface area (BSA) may be used as a trigger for DMR correction is unknown. We examined the link between LVESD index (LVESDi) and outcome in DMR to identify appropriate thresholds for excess mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      This study focuses on 2753 consecutive patients with DMR due to flail leaflets diagnosed in tertiary centres from Europe and the United States, with prospective echocardiographic measurement of LVESD and BSA and long\u2010term follow\u2010up. The primary endpoint was mortality after diagnosis under conservative management. Secondary endpoints were mortality under conservative and surgical management and postoperative mortality of patients who underwent surgery. The optimal LVESDi cut\u2010off for mortality prediction was 20\u2009mm\/m\n                      <jats:sup>2<\/jats:sup>\n                      . Irrespective of management type, 10\u2010year survival was lower with LVESDi \u226520\u2009mm\/m\n                      <jats:sup>2<\/jats:sup>\n                      than with LVESDi &lt;20\u2009mm\/m\n                      <jats:sup>2<\/jats:sup>\n                      (both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). After covariate adjustment, LVESDi \u226520\u2009mm\/m\n                      <jats:sup>2<\/jats:sup>\n                      was independently predictive of mortality under conservative management (adjusted hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.15\u20131.75), and with conservative and surgical management (adjusted HR 1.34, 95% CI 1.17\u20131.54). LVESDi remained associated with poorer postoperative outcome in patients who underwent intervention. LVESDi showed higher incremental predictive value over the baseline model compared to LVESD. The association between LVESDi \u226520\u2009mm\/m\n                      <jats:sup>2<\/jats:sup>\n                      and outcome was consistent in subgroups of patients with DMR.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In severe DMR due to flail leaflets, LVESDi is a marker of risk additive and incremental to LVESD. Its use in clinical practice should lead to earlier referral to mitral valve surgery and improved long\u2010term outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.3393","type":"journal-article","created":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T06:31:20Z","timestamp":1721629880000},"page":"2563-2569","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Indexing left ventricular end\u2010systolic dimension to body size: Association with mortality in patients with degenerative mitral regurgitation"],"prefix":"10.1093","volume":"26","author":[{"given":"Christophe","family":"Tribouilloy","sequence":"first","affiliation":[{"name":"UR UPJV 7517, Jules Verne University  Amiens France"},{"name":"University Hospital Amiens  Amiens France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Rusinaru","sequence":"additional","affiliation":[{"name":"UR UPJV 7517, Jules Verne University  Amiens France"},{"name":"University Hospital Amiens  Amiens France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Grigioni","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Campus Bio\u2010Medico Universit\u00e0 Campus Bio\u2010Medico  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Fran\u00e7ois","family":"Avierinos","sequence":"additional","affiliation":[{"name":"Cardiology Department La Timone Hospital, AP\u2013HM  Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Louis","family":"Vanoverschelde","sequence":"additional","affiliation":[{"name":"P\u00f4le de Recherche Cardiovasculaire, Institut de Recherche Exp\u00e9rimentale et Clinique Universit\u00e9 Catholique de Louvain  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Benfari","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease Mayo Clinic  Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Bursi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Health Sciences San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Barbieri","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine Policlinico University Hospital of Modena  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohann","family":"Bohbot","sequence":"additional","affiliation":[{"name":"UR UPJV 7517, Jules Verne University  Amiens France"},{"name":"University Hospital Amiens  Amiens France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Essayagh","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease Mayo Clinic  Rochester MN USA"},{"name":"Division of Echocardiography, Cardio X Clinic  Cannes France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector","family":"Michelena","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease Mayo Clinic  Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurice","family":"Enriquez\u2010Sarano","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases Minneapolis Heart Institute, Abbott Northwestern Hospital  Minneapolis MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,7,22]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000923"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab395"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735\u20101097(94)90151\u20101"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735\u20101097(03)00649\u20101"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.89.1.191"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2008.10.026"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.06.047"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2016.02.017"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2017.01.007"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jeq031"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0894\u20107317(03)00335\u20103"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.023340"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejhf.3393","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T12:17:48Z","timestamp":1767701868000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ejhf.3393"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,22]]},"references-count":12,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1002\/ejhf.3393"],"URL":"https:\/\/doi.org\/10.1002\/ejhf.3393","archive":["Portico"],"relation":{},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,22]]},"assertion":[{"value":"2024-03-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}