{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T12:06:44Z","timestamp":1788091604225,"version":"build-2803163510"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2021,8,18]],"date-time":"2021-08-18T00:00:00Z","timestamp":1629244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>This study investigated geometric differences in mitral valve apparatus between atrial functional mitral regurgitation (A-FMR) and functional mitral regurgitation (FMR) with left ventricular (LV) dysfunction in patients with atrial fibrillation (AF) using 3D transoesophageal echocardiography (TOE).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results\u2003<\/jats:title>\n                  <jats:p>In total, 135 moderate or greater FMR patients with persistent AF or atrial flutter underwent 3D TOE. Fifty-six patients had A-FMR, defined as preserved LV ejection fraction (LVEF) of \u226550% and normal LV wall motion. Seventy-nine patients had ventricular FMR (V-FMR), defined as LV dysfunction (LVEF of &amp;lt;50%) or LV wall motion abnormality. To evaluate mitral leaflet coaptation, the coapted area was calculated as follows: total leaflet area (TLA) in end-diastole \u2212 closed leaflet area in mid-systole. Although annular area (AA) did not significantly differ between the two groups, TLA was significantly smaller in A-FMR than in V-FMR (P\u2009=\u20090.005). TLA\/AA, indicating the degree of the leaflet remodelling, was significantly smaller in A-FMR than in V-FMR (P\u2009&amp;lt;\u20090.001). A-FMR had significantly smaller posterior mitral leaflet tethering height and angle measured at three anteroposterior planes (lateral, central, and medial) than V-FMR (all P\u2009&amp;lt;\u20090.001). However, vena contracta width (VCW) measured on long-axis view on TOE and coapted area, which correlated with VCW (r\u2009=\u2009\u22120.464, P\u2009&amp;lt;\u20090.001), were similar between the two groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Mitral leaflet remodelling may be less in A-FMR compared with V-FMR. However, leaflet tethering was smaller in A-FMR than in V-FMR, and this may result in a similar degree of mitral leaflet coaptation and mitral regurgitation severity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeab130","type":"journal-article","created":{"date-parts":[[2021,6,29]],"date-time":"2021-06-29T19:07:09Z","timestamp":1624993629000},"page":"1106-1116","source":"Crossref","is-referenced-by-count":19,"title":["Differences in mitral valve geometry between atrial and ventricular functional mitral regurgitation in patients with atrial fibrillation: a 3D transoesophageal echocardiography study"],"prefix":"10.1093","volume":"22","author":[{"given":"Goki","family":"Uno","sequence":"first","affiliation":[{"name":"Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A 3411, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taku","family":"Omori","sequence":"additional","affiliation":[{"name":"Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A 3411, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Shimada","sequence":"additional","affiliation":[{"name":"Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A 3411, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Rader","sequence":"additional","affiliation":[{"name":"Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A 3411, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J","family":"Siegel","sequence":"additional","affiliation":[{"name":"Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A 3411, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Shiota","sequence":"additional","affiliation":[{"name":"Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A 3411, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,8,18]]},"reference":[{"key":"2021101918545067100_jeab130-B1","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1161\/01.CIR.96.6.1999","article-title":"Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry","volume":"96","author":"Otsuji","year":"1997","journal-title":"Circulation"},{"key":"2021101918545067100_jeab130-B2","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1161\/01.CIR.102.12.1400","article-title":"Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction: a quantitative clinical study","volume":"102","author":"Yiu","year":"2000","journal-title":"Circulation"},{"key":"2021101918545067100_jeab130-B3","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1111\/j.1540-8175.2009.00904.x","article-title":"Mitral regurgitation associated with mitral annular dilation in patients with lone atrial fibrillation: an echocardiographic study","volume":"26","author":"Kihara","year":"2009","journal-title":"Echocardiography"},{"key":"2021101918545067100_jeab130-B4","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1016\/j.jacc.2011.06.032","article-title":"Evidence of atrial functional mitral regurgitation due to atrial fibrillation: reversal with arrhythmia control","volume":"58","author":"Gertz","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"2021101918545067100_jeab130-B5","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1093\/ehjci\/jet191","article-title":"Mechanisms of atrial mitral regurgitation: insights using 3D transoesophageal echo","volume":"15","author":"Ring","year":"2014","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2021101918545067100_jeab130-B6","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.116.005451","article-title":"Insufficient leaflet remodeling in patients with atrial fibrillation: association with the severity of mitral regurgitation","volume":"10","author":"Kagiyama","year":"2017","journal-title":"Circ Cardiovasc Imaging"},{"key":"2021101918545067100_jeab130-B7","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.jjcc.2017.03.013","article-title":"Mechanism of atrial functional mitral regurgitation in patients with atrial fibrillation: a study using three-dimensional transesophageal echocardiography","volume":"70","author":"Ito","year":"2017","journal-title":"J Cardiol"},{"key":"2021101918545067100_jeab130-B8","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.jcmg.2017.09.013","article-title":"Mitral valve adaptation to isolated annular dilation: insights into the mechanism of atrial functional mitral regurgitation","volume":"12","author":"Kim","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"2021101918545067100_jeab130-B9","doi-asserted-by":"crossref","first-page":"2240","DOI":"10.1253\/circj.CJ-16-0435","article-title":"Novel mechanistic insights into atrial functional mitral regurgitation- 3-dimensional echocardiographic study","volume":"80","author":"Machino-Ohtsuka","year":"2016","journal-title":"Circ J"},{"key":"2021101918545067100_jeab130-B10","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s12947-018-0131-1","article-title":"Quantitative analysis of mitral valve morphology in atrial functional mitral regurgitation using real-time 3-dimensional echocardiography atrial functional mitral regurgitation","volume":"16","author":"Cong","year":"2018","journal-title":"Cardiovasc Ultrasound"},{"key":"2021101918545067100_jeab130-B11","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1093\/ehjci\/jet105","article-title":"Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging","volume":"14","author":"Lancellotti","year":"2013","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2021101918545067100_jeab130-B12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"2021101918545067100_jeab130-B13","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.echo.2010.05.010","article-title":"Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography","volume":"23","author":"Rudski","year":"2010","journal-title":"J Am Soc Echocardiogr"},{"key":"2021101918545067100_jeab130-B14","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.echo.2017.01.007","article-title":"Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance","volume":"30","author":"Zoghbi","year":"2017","journal-title":"J Am Soc Echocardiogr"},{"key":"2021101918545067100_jeab130-B15","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1161\/CIRCULATIONAHA.107.749440","article-title":"Mitral leaflet adaptation to ventricular remodeling: occurrence and adequacy in patients with functional mitral regurgitation","volume":"118","author":"Chaput","year":"2008","journal-title":"Circulation"},{"key":"2021101918545067100_jeab130-B16","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1161\/CIRCULATIONAHA.108.846782","article-title":"Active adaptation of the tethered mitral valve: insights into a compensatory mechanism for functional mitral regurgitation","volume":"120","author":"Dal-Bianco","year":"2009","journal-title":"Circulation"},{"key":"2021101918545067100_jeab130-B17","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1093\/ehjci\/jey117","article-title":"Comparison of mitral valve geometrical effect of percutaneous edge-to-edge repair between central and eccentric functional mitral regurgitation: clinical implications","volume":"20","author":"Utsunomiya","year":"2019","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2021101918545067100_jeab130-B18","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1016\/S0735-1097(02)01838-7","article-title":"Isolated annular dilation does not usually cause important functional mitral regurgitation: comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy","volume":"39","author":"Otsuji","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2021101918545067100_jeab130-B19","doi-asserted-by":"crossref","first-page":"S99","DOI":"10.1161\/CIRCULATIONAHA.109.844019","article-title":"Mitral leaflet adaptation to ventricular remodeling: prospective changes in a model of ischemic mitral regurgitation","volume":"120","author":"Chaput","year":"2009","journal-title":"Circulation"},{"key":"2021101918545067100_jeab130-B20","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1093\/ehjci\/jeu216","article-title":"Leaflet remodelling in functional mitral valve regurgitation: characteristics, determinants, and relation to regurgitation severity","volume":"16","author":"Debonnaire","year":"2015","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2021101918545067100_jeab130-B21","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.amjcard.2006.05.036","article-title":"Value of mitral valve tenting volume determined by real-time three-dimensional echocardiography in patients with functional mitral regurgitation","volume":"98","author":"Song","year":"2006","journal-title":"Am J Cardiol"},{"key":"2021101918545067100_jeab130-B22","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.jcmg.2011.10.004","article-title":"Influence of chronic tethering of the mitral valve on mitral leaflet size and coaptation in functional mitral regurgitation","volume":"5","author":"Saito","year":"2012","journal-title":"JACC Cardiovasc Imaging"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/22\/10\/1106\/40758981\/jeab130.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/22\/10\/1106\/40758981\/jeab130.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T23:46:00Z","timestamp":1634773560000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/22\/10\/1106\/6354112"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,18]]},"references-count":22,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,8,18]]},"published-print":{"date-parts":[[2021,9,20]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jeab130","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"value":"2047-2404","type":"print"},{"value":"2047-2412","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,10,1]]},"published":{"date-parts":[[2021,8,18]]}}}