{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T06:55:11Z","timestamp":1790578511979,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T00:00:00Z","timestamp":1788048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T00:00:00Z","timestamp":1788048000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Physio Funct Imaging"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    A reduction of intrathoracic pressure during the Mueller manoeuvre (MM) has been shown to decrease left ventricular (LV) forward stroke volume in patients with systolic heart failure. To assess the underlying mechanisms, we analyzed MM\u2010induced changes in LV inflow and outflow dynamics in 13 healthy individuals (mean age 42\u2009y, 8 men) and in 13 patients with dilated cardiomyopathy (DCM) (mean age 44\u2009y, 8 men) having LV ejection fraction &lt;40% without mitral regurgitation. The subjects performed MM with a target of \u221230\u2009mmHg pressure for &gt;10\u2009s. Doppler echocardiography was used to record systolic and diastolic flow velocities at the aortic and mitral valve annulus, respectively, during quiet respiration and the MM. The respective flow velocity\u2010time integrals (VTI) were measured. Compared with control subjects, patients with DCM had a larger MM\u2010induced decrease in the aortic VTI (\u22124.2\u2009\u00b1\u20090.3 vs. \u22121.6\u2009\u00b1\u20090.5\u2009cm;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) combined with a tendency to a smaller decrease in the mitral VTI (\u22121.4\u2009\u00b1\u20090.5 vs. \u20132.2\u2009\u00b1\u20090.3\u2009cm;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.070). The mitral\u2010to\u2010aortic VTI ratio, an indirect mitral regurgitant index, increased in DCM from 0.78\u2009\u00b1\u20090.04 to 1.03\u2009\u00b1\u20090.08 (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.006) but decreased in the control group from 0.70\u2009\u00b1\u20090.03 to 0.61\u2009\u00b1\u20090.03 (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.025). The group x MM interaction was statistically highly significant (\n                    <jats:italic>F<\/jats:italic>\n                    \u2009=\u200916.8,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). We conclude that, in DCM\u2010related heart failure, a reduction of intrathoracic pressure during the MM increases the mitral\u2010to\u2010aortic VTI ratio suggesting appearance of functional mitral regurgitation.\n                  <\/jats:p>","DOI":"10.1111\/cpf.70090","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:33:35Z","timestamp":1788154415000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mueller manoeuvre increases the mitral\u2010to\u2010aortic velocity\u2013time integral ratio, a mitral regurgitant index, in patients with dilated cardiomyopathy"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6609-9937","authenticated-orcid":false,"given":"Juha","family":"Virolainen","sequence":"first","affiliation":[{"name":"Heart and Lung Center Helsinki University Hospital Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6858-0179","authenticated-orcid":false,"given":"Markku","family":"Ventil\u00e4","sequence":"additional","affiliation":[{"name":"Heart and Lung Center Helsinki University Hospital Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5813-3477","authenticated-orcid":false,"given":"Markku","family":"Kupari","sequence":"additional","affiliation":[{"name":"Heart and Lung Center Helsinki University Hospital Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2362.1991.tb01361.x"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-7317(03)00004-X"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.119.6.1827"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.61.3.626"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197908303010901"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1998.85.4.1476"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00570-1"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(88)90618-7"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.64.2.129"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(93)90989-P"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-024-03249-x"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.07.050"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/joic.12401"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2015.02.061"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.05.002"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a060390"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-097X.1992.tb00365.x"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(93)90845-4"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1994.77.4.1999"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1995.79.2.455"}],"container-title":["Clinical Physiology and Functional Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cpf.70090","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cpf.70090","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cpf.70090","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:57:27Z","timestamp":1790575047000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cpf.70090"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,30]]},"references-count":20,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/cpf.70090"],"URL":"https:\/\/doi.org\/10.1111\/cpf.70090","archive":["Portico"],"relation":{},"ISSN":["1475-0961","1475-097X"],"issn-type":[{"value":"1475-0961","type":"print"},{"value":"1475-097X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,30]]},"assertion":[{"value":"2026-05-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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