{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T01:51:12Z","timestamp":1793670672222,"version":"4.5.1"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"27","license":[{"start":{"date-parts":[[2019,5,23]],"date-time":"2019-05-23T00:00:00Z","timestamp":1558569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Edwards LLC"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To define the hitherto unknown aetiology\/mechanism distributions of mitral regurgitation (MR) in the community and the linked clinical characteristics\/outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We identified all isolated, moderate\/severe MR diagnosed in our community (Olmsted County, MN, USA) between 2000 and 2010 and classified MR aetiology\/mechanisms. Eligible patients (n\u2009=\u2009727) were 73\u2009\u00b1\u200918\u2009years, 51% females, with ejection fraction (EF) 49\u2009\u00b1\u200917%. MR was functional (FMR) in 65%, organic (OMR) in 32% and 2% mixed. Functional MR was linked to left ventricular remodelling (FMR-v) 38% and isolated atrial dilatation (FMR-a) 27%. At diagnosis FMR-v vs. FMR-a, vs. OMR displayed profound differences (all P\u2009&amp;lt;\u20090.0001) in age (73\u2009\u00b1\u200914, 80\u2009\u00b1\u200910, 68\u2009\u00b1\u200921years), male-sex (59, 33, 51%), atrial-fibrillation (28, 54, 13%), EF (33\u2009\u00b1\u200914, 57\u2009\u00b1\u200911, 61\u2009\u00b1\u200910%), and regurgitant-volume (38\u2009\u00b1\u200913, 37\u2009\u00b1\u200911, 51\u2009\u00b1\u200924\u2009mL\/beat). Dominant MR mechanism was Type I (normal valve-movement) 38%, Type II (excessive valve-movement) 25%, Type IIIa (diastolic movement-restriction) 3%, and Type IIIb (systolic movement-restriction) 34%. Outcomes were mediocre with excess-mortality vs. general-population in FMR-v [risk ratio 3.45 (2.98\u20133.99), P\u2009&amp;lt;\u20090.0001] but also FMR-a [risk ratio 1.88 (1.52\u20132.25), P\u2009&amp;lt;\u20090.0001] and OMR [risk ratio 1.83 (1.50\u20132.22), P\u2009&amp;lt;\u20090.0001]. Heart failure was frequent, particularly in FMR-v (5-year 83\u2009\u00b1\u20093% vs. 59\u2009\u00b1\u20094% FMR-a, 40\u2009\u00b1\u20093% OMR, P\u2009&amp;lt;\u20090.0001). Mitral surgery during patients\u2019 lifetime was performed in 4% of FMR-v, 3% of FMR-a, and 37% of OMR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Moderate\/severe isolated MR in the community displays considerable aetiology\/mechanism heterogeneity. Functional MR dominates, mostly FMR-v but FMR-a is frequent and degenerative MR dominates OMR. Outcomes are mediocre with excess-mortality particularly with FMR-v but FMR-a, despite normal EF incurs notable excess-mortality and frequent heart failure. Pervasive undertreatment warrants clinical trials of therapies tailored to specific MR cause\/mechanisms.<\/jats:p>\n                    <jats:p\/>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehz314","type":"journal-article","created":{"date-parts":[[2019,5,7]],"date-time":"2019-05-07T15:43:51Z","timestamp":1557243831000},"page":"2194-2202","source":"Crossref","is-referenced-by-count":289,"title":["Causes and mechanisms of isolated mitral regurgitation in the community: clinical context and outcome"],"prefix":"10.1093","volume":"40","author":[{"given":"Volha","family":"Dziadzko","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector I","family":"Michelena","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan A","family":"Crestanello","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Maalouf","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, 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