{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:01:23Z","timestamp":1773792083735,"version":"3.50.1"},"reference-count":13,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,7,12]],"date-time":"2020-07-12T00:00:00Z","timestamp":1594512000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Although significant stenosis and regurgitation can be observed on a single heart valve, studies on the outcome predictors for mixed valve disease are limited. The purpose of the current study was to investigate the fate and determinants of clinical outcomes in patients with mixed single mitral valve disease who have concomitant mitral stenosis (MS) and mitral regurgitation (MR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed 82 consecutive patients with rheumatic heart disease who had both significant MS (MVA\u00a0\u2264\u00a01.5\u00a0cm<jats:sup>2<\/jats:sup>) and at least moderate MR, excluding patients with significant aortic valve stenosis or regurgitation. The primary endpoint was a composite of all\u2010cause mortality during follow\u2010up, mitral valve replacement, heart failure admission, and stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 37 events (45.1%), 5 all\u2010cause deaths (6.0%), and 32 mitral valve replacements (39.0%). In a multivariable Cox regression analysis, a transmitral mean pressure gradient (TMPG) over 6\u00a0mm\u00a0Hg was the only independent echocardiographic predictor for events (hazard ratio 3.69, 95% confidential interval 1.31\u201310.44, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.014), after adjusting for sex, age, symptoms, and the severity of MS and MR. The estimated 6\u2010year event\u2010free survival rate was significantly lower in patients with TMPG\u00a0\u2265\u00a06\u00a0mm\u00a0Hg than in those with TMPG\u00a0&lt;\u00a06\u00a0mm\u00a0Hg (76.3% vs 22.9%, log\u2010rank <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Transmitral mean pressure gradient, which reflects the hemodynamic burden of the mitral valve lesion, appears to be the most important echocardiographic predictor of clinical outcomes in patients with mixed mitral valve disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.14673","type":"journal-article","created":{"date-parts":[[2020,7,12]],"date-time":"2020-07-12T14:46:30Z","timestamp":1594565190000},"page":"1164-1170","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Determinants of clinical outcomes in patients with mixed mitral valve disease"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1209-5129","authenticated-orcid":false,"given":"In\u2010Jeong","family":"Cho","sequence":"first","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine College of Medicine Ewha Womans University Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang\u2010Eun","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine College of Medicine Ewha Womans University Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyeonju","family":"Jeong","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Internal Medicine Myungji Hospital Goyang Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6139-7545","authenticated-orcid":false,"given":"Hyuk\u2010Jae","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Cardiology Severance Cardiovascular Hospital Yonsei University College of Medicine Seoul Korea"},{"name":"Severance Biomedical Science Institute Yonsei University College of Medicine Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,7,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S12977"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2010.212282"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx391"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-668X(03)00201-X"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2010.202"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ihj.2014.03.010"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.10.003"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.82.3.792"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2017.01.007"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jet105"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.05.014"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000029210.14716.01"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2016.03.012"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fecho.14673","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.14673","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/echo.14673","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.14673","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T17:12:01Z","timestamp":1693933921000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.14673"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,12]]},"references-count":13,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2020,8]]}},"alternative-id":["10.1111\/echo.14673"],"URL":"https:\/\/doi.org\/10.1111\/echo.14673","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,12]]},"assertion":[{"value":"2020-03-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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