{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T16:55:08Z","timestamp":1765558508693,"version":"3.48.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":56,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"British Heart Foundation Clinical Training Research"},{"DOI":"10.13039\/501100024598","name":"British Heart Foundation Centre of Research Excellence","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100024598","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013373","name":"NIHR Oxford Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013373","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["RG\/18\/12\/34040"],"award-info":[{"award-number":["RG\/18\/12\/34040"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000288","name":"Royal Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000288","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018956","name":"NIHR Cambridge Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018956","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Understanding changes in ATP metabolism may lead to improved risk stratification in severe primary mitral regurgitation (MR). Here, we seek to compare the energetic phenotype of volume-overload pathological hypertrophy with athletic hypertrophy and with the normal heart under catecholamine stress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Nineteen severe-MR patients underwent cardiac magnetic resonance and 31P-spectroscopy for energetics, including phosphocreatine to adenosine triphosphate ratio (PCr\/ATP), the pseudo-first-order forward rate constant of the creatine kinase reaction (kf) and CK flux (kf \u00d7 [PCr]). When compared with 20 healthy controls, severe MR was associated with lower PCr\/ATP (1.58 \u00b1 0.32 vs. 2.08 \u00b1 0.28, P &amp;lt; 0.001). This is related to the severity of regurgitation (r \u22120.59, P &amp;lt; 0.001) but not to LVEF (r \u22120.20, P = 0.23) or LV systolic strain (P = 0.18). When compared to 17 athletes with similarly increased end-diastolic volume (athletes 107 \u00b1 10\u2005mL\/m2 vs. 114 \u00b1 22, P = 0.29), severe MR had greater total cardiac output (by 42%, P &amp;lt; 0.001), and lower PCr\/ATP (by 28%, P &amp;lt; 0.001) and CK flux (by 41%, P = 0.04). When compared to normal hearts during dobutamine stress at matched cardiac output levels, median kf (by 45%, P = 0.08) and CK flux (by 53%, P = 0.02) were lower in severe MR. PCr\/ATP increased (by 17%, P = 0.04) following mitral valve repair (MVR) in a subset of patients (n = 14, median 7 months). Seven patients during MVR and six patients without volume loading donated LV biopsy, revealing that creatine was not lower in severe MR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Even with normal LVEF, severe MR is associated with reduced PCr\/ATP, CK kf, and CK flux. PCr\/ATP reduction resolved with MVR. Thus, targeting CK capacity and\/or flux may be a therapeutic strategy to prevent\/treat systolic failure in MR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjimp\/qyaf146","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T12:35:40Z","timestamp":1763987740000},"source":"Crossref","is-referenced-by-count":0,"title":["Cardiac energetics in severe mitral regurgitation: relationship with eccentric hypertrophy, stroke volume, and effects of valve repair"],"prefix":"10.1093","volume":"3","author":[{"given":"Mark A","family":"Peterzan","sequence":"first","affiliation":[{"name":"Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford , John Radcliffe Hospital, Oxford OX3 9DU 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,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7650-0963","authenticated-orcid":false,"given":"John A","family":"Henry","sequence":"additional","affiliation":[{"name":"Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford , John Radcliffe Hospital, Oxford OX3 9DU ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J M","family":"Lewis","sequence":"additional","affiliation":[{"name":"Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford , John Radcliffe Hospital, Oxford OX3 9DU ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moritz J","family":"Hundertmark","sequence":"additional","affiliation":[{"name":"Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford , John Radcliffe Hospital, Oxford OX3 9DU ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer J","family":"Rayner","sequence":"additional","affiliation":[{"name":"Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford , John Radcliffe Hospital, Oxford OX3 9DU ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew P","family":"Apps","sequence":"additional","affiliation":[{"name":"Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford , John Radcliffe Hospital, Oxford OX3 9DU ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William D","family":"Watson","sequence":"additional","affiliation":[{"name":"Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford , John Radcliffe Hospital, Oxford OX3 9DU ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2887-1874","authenticated-orcid":false,"given":"Rana A","family":"Sayeed","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Oxford Heart Centre, John Radcliffe Hospital , Oxford ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig A","family":"Lygate","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford , Oxford 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