{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T16:04:59Z","timestamp":1780761899638,"version":"3.54.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T00:00:00Z","timestamp":1666051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Little data exist about the natural history and disease progression of secondary mitral regurgitation (SMR). We sought to study the temporal progression of left-sided volumes and functions in patients who progress to develop severe SMR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>We screened patients with chronic severe SMR who had at least one previous transthoracic echocardiography showing non-severe MR. Unsupervised phenotypic clustering based on baseline and rate of change in left ventricular (LV) and left atrial (LA) volumes, ejection fraction (EF), and MR severity progression identified two different phenotypes. We then compared them in terms of clinical characteristics, mechanistic and anatomical features, management, and outcomes. A total of 257 patients were included. Cluster 1 started with lower EF and LA strain and higher LV and LA volumes compared with Cluster 2, with a slower progression into severe SMR. At the onset of severe MR, Cluster 2 still had higher EF, lower LV volumes, but similar LA volumes and strain, and less proportionate SMR, compared with Cluster 1. They also had higher tenting height and more compensatory leaflet growth. On follow-up, Cluster 1 had more ventricular-directed therapies, whereas Cluster 2 received more mitral valve interventions. While the heart failure burden was higher in Cluster 1, there was no difference in mortality rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Based on disease progression, two distinct progression patterns of SMR exist, having different anatomical and mechanistic features with variation in management and outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeac200","type":"journal-article","created":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T17:19:38Z","timestamp":1666113578000},"page":"223-231","source":"Crossref","is-referenced-by-count":8,"title":["Differences in patterns of progression of secondary mitral regurgitation"],"prefix":"10.1093","volume":"24","author":[{"given":"Habib","family":"Layoun","sequence":"first","affiliation":[{"name":"Heart, Vascular, and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Cleveland, OH 44118 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amgad","family":"Mentias","sequence":"additional","affiliation":[{"name":"Heart, Vascular, and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Cleveland, OH 44118 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Kanaan","sequence":"additional","affiliation":[{"name":"Medicine Institute, Cleveland Clinic , 9500 Euclid Avenue, Cleveland, OH 44118 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamah","family":"Badwan","sequence":"additional","affiliation":[{"name":"Medicine Institute, Cleveland Clinic , 9500 Euclid Avenue, Cleveland, OH 44118 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milad","family":"Matta","sequence":"additional","affiliation":[{"name":"Medicine Institute, Cleveland Clinic , 9500 Euclid Avenue, Cleveland, OH 44118 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Kassab","sequence":"additional","affiliation":[{"name":"Heart, Vascular, and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Cleveland, OH 44118 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A","family":"Gillinov","sequence":"additional","affiliation":[{"name":"Heart, Vascular, and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Cleveland, OH 44118 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Hodges","sequence":"additional","affiliation":[{"name":"Heart, Vascular, and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Cleveland, OH 44118 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian P","family":"Griffin","sequence":"additional","affiliation":[{"name":"Heart, Vascular, and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Cleveland, OH 44118 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0026-3391","authenticated-orcid":false,"given":"Samir R","family":"Kapadia","sequence":"additional","affiliation":[{"name":"Heart, Vascular, and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Cleveland, OH 44118 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serge C","family":"Harb","sequence":"additional","affiliation":[{"name":"Heart, Vascular, and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Cleveland, OH 44118 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,10,18]]},"reference":[{"key":"2023012300001495100_jeac200-B1","doi-asserted-by":"crossref","first-page":"3515","DOI":"10.1093\/eurheartj\/ehw229","article-title":"Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study","volume":"37","author":"d\u2019Arcy","year":"2016","journal-title":"Eur Heart J"},{"key":"2023012300001495100_jeac200-B2","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.jcmg.2018.01.009","article-title":"Mitral valve regurgitation in the contemporary era","volume":"11","author":"Sabbagh","year":"2018","journal-title":"JACC Cardiovasc Imaging"},{"key":"2023012300001495100_jeac200-B3","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/j.jacc.2015.02.009","article-title":"Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and therapeutic considerations","volume":"65","author":"Asgar","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2023012300001495100_jeac200-B4","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1080\/24748706.2021.1943765","article-title":"Anatomic and functional determinants of atrial functional mitral 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A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy","volume":"97","author":"Rossi","year":"2011","journal-title":"Heart"},{"key":"2023012300001495100_jeac200-B31","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1016\/j.jacc.2019.02.061","article-title":"Atrial functional mitral regurgitation: JACC review topic of the week","volume":"73","author":"Deferm","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2023012300001495100_jeac200-B32","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1001\/jamacardio.2017.2976","article-title":"Survival and cardiovascular outcomes of patients with secondary mitral regurgitation: a systematic review and meta-analysis","volume":"2","author":"Sannino","year":"2017","journal-title":"JAMA Cardiol"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/24\/2\/223\/48756257\/jeac200.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/24\/2\/223\/48756257\/jeac200.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T00:00:46Z","timestamp":1674432046000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/24\/2\/223\/6763078"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,18]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,10,18]]},"published-print":{"date-parts":[[2023,1,23]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jeac200","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"value":"2047-2404","type":"print"},{"value":"2047-2412","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,2,1]]},"published":{"date-parts":[[2022,10,18]]}}}