{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T20:21:23Z","timestamp":1787602883403,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"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":["Echocardiography"],"published-print":{"date-parts":[[2026,8]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n The progression of mitral valve (MV) remodelling in atrial fibrillation (AF) patients without significant mitral regurgitation (MR) remains poorly characterized. We aimed to determine whether AF burden\u2014paroxysmal versus persistent\u2014differentially affects MV annular geometry, leaflet morphology, and functional dynamics using three\u2010dimensional transesophageal echocardiography (3D\u2010TEE).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n In prospective cross\u2010sectional observational study, 46 consecutive AF patients without significant MR (paroxysmal AF:\n n<\/jats:italic>\n = 18; persistent AF:\n n<\/jats:italic>\n = 28) underwent comprehensive 3D transesophageal echocardiography. Offline semi\u2010automated quantitative analysis (4D MV Assessment, TomTec) was performed to assess mitral annular dimensions and geometry, leaflet morphology (area and angulation), and functional parameters including tenting volume, coaptation depth, and dynamic annular motion.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Despite comparable demographics, persistent AF patients had larger LA diameter (45.4 \u00b1 7.1\u00a0vs. 40.3 \u00b1 6.3\u00a0mm;\n p<\/jats:italic>\n = 0.05), lower LVEF (45.5 \u00b1 15.4\u00a0vs. 56.5% \u00b1 15.2%;\n p<\/jats:italic>\n = 0.042), and greater LV end\u2010systolic dimension (41.3 \u00b1 9.7\u00a0vs. 33.1 \u00b1 9.4\u00a0mm;\n p<\/jats:italic>\n = 0.018). 3D\u2010TEE demonstrated significant annular enlargement in persistent AF: larger AP diameter (3.92 \u00b1 0.53\u00a0vs. 3.60 \u00b1 0.47\u00a0cm;\n p<\/jats:italic>\n = 0.042), AL\u2010PM diameter (3.74 \u00b1 0.50\u00a0vs. 3.49 \u00b1 0.34\u00a0cm;\n p<\/jats:italic>\n = 0.048), 3D annular area (11.98 \u00b1 3.19\u00a0vs. 10.34 \u00b1 2.05 cm\n 2<\/jats:sup>\n ;\n p<\/jats:italic>\n = 0.038), and 2D annular area (9.78 \u00b1 2.83\u00a0vs. 8.27 \u00b1 1.87 cm\n 2<\/jats:sup>\n ;\n p<\/jats:italic>\n = 0.035). Anterior leaflet area was larger (8.93 \u00b1 2.07\u00a0vs. 7.60 \u00b1 2.02 cm\n 2<\/jats:sup>\n ;\n p<\/jats:italic>\n = 0.036) and distal anterior leaflet angle was reduced (16.97 \u00b1 5.03\u00a0vs. 20.76 \u00b1 6.40\u00b0;\n p<\/jats:italic>\n = 0.042). Annular shape, tenting parameters, coaptation depth, and dynamic motion were preserved in both groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Persistent AF was associated with early mitral annular enlargement, anterior leaflet remodelling, impaired LV function, and LA dilation, even in the absence of significant MR. However, the higher heart rate in persistent AF, unrecorded AF duration, and lack of data on prior rhythm\u2010control therapy limit attribution of these changes to AF burden alone. These findings are hypothesis\u2010generating and require confirmation in prospective studies accounting for these potential confounders.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/echo.70579","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T15:34:05Z","timestamp":1786635245000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Atrial Fibrillation Burden and Early Mitral Valve Remodelling in Patients Without Significant Mitral Regurgitation: A 3D Transesophageal Echocardiographic Study"],"prefix":"10.1111","volume":"43","author":[{"given":"Amr Yosry","family":"Emam","sequence":"first","affiliation":[{"name":"Adult Cardiology Department Aswan Heart Centre Magdi Yacoub Foundation Aswan Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Shaaban","sequence":"additional","affiliation":[{"name":"Adult Cardiology Department Aswan Heart Centre Magdi Yacoub Foundation Aswan Egypt"},{"name":"Cardiology Department Tanta University Tanta Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Salah","family":"Elgendy","sequence":"additional","affiliation":[{"name":"Adult Critical Care department Aswan Heart Centre Magdi Yacoub Foundation Aswan Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karimeldeen","family":"Hafez","sequence":"additional","affiliation":[{"name":"Adult Cardiology Department Aswan Heart Centre Magdi Yacoub Foundation Aswan Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amany khaled","family":"Elagamy","sequence":"additional","affiliation":[{"name":"Nursing Department Aswan Heart Centre Aswan Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omnia","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Nursing Department Aswan Heart Centre Aswan Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman","family":"Omar","sequence":"additional","affiliation":[{"name":"Adult Cardiology Department Aswan Heart Centre Magdi Yacoub Foundation Aswan Egypt"},{"name":"Department of Cardiovascular Medicine Kasr Alainy Faculty of Medicine Cairo University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Mohy","family":"Zidan","sequence":"additional","affiliation":[{"name":"Adult Cardiology Department Aswan Heart Centre Magdi Yacoub Foundation Aswan Egypt"},{"name":"Department of Cardiovascular Medicine Kasr Alainy Faculty of Medicine Cairo University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bakeer Mohamed Bakeer","family":"Saleh","sequence":"additional","affiliation":[{"name":"Adult Cardiology Department Aswan Heart Centre Magdi Yacoub Foundation Aswan Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagwa","family":"Thabet","sequence":"additional","affiliation":[{"name":"Adult Cardiology Department Aswan Heart Centre Magdi Yacoub Foundation Aswan Egypt"},{"name":"Cardiology Department Aswan University Aswan Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soha","family":"Hekal","sequence":"additional","affiliation":[{"name":"Adult Cardiology Department Aswan Heart Centre Magdi Yacoub Foundation Aswan Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani","family":"Mahmoud\u2010Elsayed","sequence":"additional","affiliation":[{"name":"Adult Cardiology Department Aswan Heart Centre Magdi Yacoub Foundation Aswan Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.120.316340;PAGE:STRING:ARTICLE\/CHAPTER"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.020163"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.125.042016"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/MEDICINA62030520"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/JCM14093250"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeac045"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf194"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/S11748\u2010020\u201001406\u20102"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2012.05.014"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/S11897\u2010026\u201000744\u20101"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/IJMS252413253"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.003957"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/FPHYS.2025.1532972\/TEXT"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2017.09.013"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/EHJCI\/JEU300"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.117.006239;PAGE:STRING:ARTICLE\/CHAPTER"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/ECHO.12629"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.21037\/JTD\u201024\u2010189\/COIF"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/EHF2.15405"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/S43044\u2010024\u201000509\u2010Y"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2018.11.009"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.14814\/PHY2.15665"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70579","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/echo.70579","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70579","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T19:28:36Z","timestamp":1787599716000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.70579"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":22,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/echo.70579"],"URL":"https:\/\/doi.org\/10.1111\/echo.70579","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-06-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70579"}}