{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T06:09:50Z","timestamp":1760249390772,"version":"3.37.3"},"reference-count":23,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,8,22]],"date-time":"2017-08-22T00:00:00Z","timestamp":1503360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Doppler\u2010driven net atrioventricular compliance (<jats:italic>C<\/jats:italic><jats:sub>n<\/jats:sub>), which represents left atrial (<jats:styled-content style=\"fixed-case\">LA<\/jats:styled-content>) compliance, is an important determinant of pulmonary hypertension in mitral stenosis (<jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>We hypothesized that decreases in <jats:italic>C<\/jats:italic><jats:sub>n<\/jats:sub> during early\u2010stage exercise underlie exercise intolerance in patients with <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty\u2010three asymptomatic patients with significant <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content> (valve area 1.24\u00a0\u00b1\u00a00.16\u00a0cm<jats:sup>2<\/jats:sup>) underwent resting and bicycle exercise echocardiography. <jats:styled-content style=\"fixed-case\">LA<\/jats:styled-content> compliance and conventional parameters were assessed at each workload. The patients were classified into two groups based on whether they developed dyspnea during exercise: an exercise\u2010intolerance group (n\u00a0=\u00a022) and an exercise\u2010tolerance group (n\u00a0=\u00a011). Moreover, \u201c50\u00a0W\u201d was defined as an early exercise stage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Although the groups had similar resting characteristics, there were striking differences in their echocardiographic parameters from the early stages of exercise. The relative <jats:italic>C<\/jats:italic><jats:sub>n<\/jats:sub> decrease at 50\u00a0W (expressed as a percentage of the resting <jats:italic>C<\/jats:italic><jats:sub>n<\/jats:sub>) was significantly greater in the exercise\u2010intolerance group (70.3\u00a0\u00b1\u00a015.4% vs 49.7\u00a0\u00b1\u00a09.7%, <jats:italic>P\u00a0<\/jats:italic>&lt;\u00a0.001). The overall decrease in relative <jats:italic>C<\/jats:italic><jats:sub>n<\/jats:sub> was significantly greater in the exercise\u2010intolerance group (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.0005). Furthermore, differences in the trends in this parameter were observed between the two groups (<jats:italic>P\u00a0<\/jats:italic>&lt;\u00a0.0001 for interaction). Multivariate analysis revealed that the relative <jats:italic>C<\/jats:italic><jats:sub>n<\/jats:sub> decrease at 50\u00a0W was an independent predictor of exercise intolerance (adjusted <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.105, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.030\u20131.184) after adjustment for other conventional parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Decreases in <jats:italic>C<\/jats:italic><jats:sub>n<\/jats:sub> during early\u2010stage exercise are an important mechanism underlying exercise intolerance in <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.13666","type":"journal-article","created":{"date-parts":[[2017,8,23]],"date-time":"2017-08-23T03:20:51Z","timestamp":1503458451000},"page":"1633-1639","source":"Crossref","is-referenced-by-count":8,"title":["Decreases in left atrial compliance during early\u2010stage exercise are related to exercise intolerance in asymptomatic significant mitral stenosis"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0224-5178","authenticated-orcid":false,"given":"Mi\u2010Hyang","family":"Jung","sequence":"first","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine College of Medicine Seoul St. Mary's Hospital The Catholic University of Korea Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5102-9212","authenticated-orcid":false,"given":"Hae Ok","family":"Jung","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine College of Medicine Seoul St. Mary's Hospital The Catholic University of Korea Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jung\u2010Won","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine College of Medicine Seoul St. Mary's Hospital The Catholic University of Korea Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ho\u2010Joong","family":"Youn","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine College of Medicine Seoul St. Mary's Hospital The Catholic University of Korea Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,8,22]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2014.12.003"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000031"},{"key":"e_1_2_6_4_1","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/0735-1097(92)90284-T","article-title":"Calculation of atrioventricular compliance from the mitral flow profile: analytic and in vitro study","volume":"19","author":"Flachskampf 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