{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:11:09Z","timestamp":1791616269012,"version":"4.3.4"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fund for Scientific Research Flanders","award":["FWO 11PGA24N"],"award-info":[{"award-number":["FWO 11PGA24N"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The shift in mitral stenosis (MS) aetiology from rheumatic to calcific valve disease complicates distinguishing valve-related from myocardial-driven haemodynamic abnormalities. This study examines how left-heart myopathy influences flow velocity-based echocardiographic MS severity assessment and evaluates haemodynamic changes following mitral valve (MV) intervention at rest and during exercise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>The CircAdapt biophysical model was used to create a virtual cohort with varying MS severity, left ventricular (LV) compliance, and left atrial (LA) function. Mean gradient (MG) was evaluated alongside left-heart pressures at rest and during exercise. To study acute haemodynamic effects of MV intervention, the mitral valve\u2019s effective orifice area was restored to 5.9\u2005cm\u00b2. MG showed variation of 1\u2005mmHg attributable to left-heart myopathy. Following virtual MV intervention for clinically significant MS, mean left atrial pressure (mLAP) decreased by 50% in patients with preserved myocardial function but remained elevated in those with LV and LA dysfunction due to persistently elevated LV end-diastolic pressure, resulting in persistently impaired exercise capacity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Virtual patient cohorts suggest that MV intervention reduces MG but may not normalize mLAP in patients with impaired LV and LA function. Persistent myocardial dysfunction may limit both symptomatic and exercise capacity improvement, despite successful intervention. As percutaneous treatment options expand, distinguishing myocardial from valve-driven abnormalities is essential for accurate assessment, patient selection, and optimizing outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjdh\/ztaf097","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T11:19:31Z","timestamp":1755515971000},"source":"Crossref","is-referenced-by-count":2,"title":["Impact of left-heart myopathy on mitral valve stenosis assessment and interventional outcomes: an\n                    <i>in-silico<\/i>\n                    trial"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6304-4371","authenticated-orcid":false,"given":"Gitte P H","family":"van den Acker","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, CARIM Cardiovascular Research Institute Maastricht, Maastricht University , Universiteitssingel 40, Maastricht 6229 ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5615-3191","authenticated-orcid":false,"given":"Sebastiaan","family":"Dhont","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, CARIM Cardiovascular Research Institute Maastricht, Maastricht University , Universiteitssingel 40, Maastricht 6229 ,","place":["The Netherlands"]},{"name":"Faculty of Medicine and Life Sciences, LCRC, Hasselt University , Diepenbeek ,","place":["Belgium"]},{"name":"Department of Cardiology and Future Health, Ziekenhuis Oost-Limburg , Genk ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4187-8948","authenticated-orcid":false,"given":"Tim","family":"van Loon","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, CARIM Cardiovascular Research Institute Maastricht, Maastricht University , Universiteitssingel 40, Maastricht 6229 ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0215-3049","authenticated-orcid":false,"given":"Timothy W","family":"Churchill","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center, Massachusetts General Hospital , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Timmermans","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Ghent , Ghent ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6897-9700","authenticated-orcid":false,"given":"Tammo","family":"Delhaas","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, CARIM Cardiovascular Research Institute Maastricht, Maastricht University , Universiteitssingel 40, Maastricht 6229 ,","place":["The 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