{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:18:37Z","timestamp":1789154317532,"version":"build-2803163510"},"reference-count":18,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T00:00:00Z","timestamp":1711584000000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,3,11]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Though the concomitant occurrence of non-severe aortic stenosis (AS) and mitral regurgitation (MR) is highly prevalent, there are limited data to guide clinical decision-making in this condition. Here, we attempt to determine an aortic valve area (AVA) cut-off value associated with worse clinical outcomes in patients with combined non-severe AS and MR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Single-centre, retrospective analysis of consecutive patients who underwent echocardiography examination between 2010 and 2021 with evidence of combined non-severe AS and MR. We excluded patients with \u2265moderate aortic valve regurgitation or mitral stenosis, as well as patients who underwent any aortic or mitral intervention either prior or following our assessment (n=372).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The final cohort consisted of 2933 patients with non-severe AS, 506 of them with &gt;mild MR. Patients with both pathologies had lower cardiac output and worse diastolic function.<\/jats:p>\n                    <jats:p>Patients with an AVA \u22641.35 cm\u00b2 in the presence of &gt;mild MR had the highest rates of heart failure (HF) hospitalisations (HR 3.1, IQR 2.4\u20134, p&lt;0.001) or mortality (HR 2, IQR 1.8\u20132.4, p&lt;0.001), which remained significant after adjusting for clinical and echocardiographic parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with combined non-severe AS and MR have a higher rate of HF hospitalisations and mortality. An AVA\u22641.35 cm\u00b2 in the presence of &gt;mild MR is associated with worse clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-080914","type":"journal-article","created":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T22:12:27Z","timestamp":1711750347000},"page":"e080914","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Prognostic impact of combined non-severe aortic stenosis and mitral regurgitation on clinical outcomes: a single-centre retrospective study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3863-4493","authenticated-orcid":false,"given":"Yoav","family":"Granot","sequence":"first","affiliation":[{"name":"Icahn School of Medicine, New York, New York, USA"},{"name":"Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orly Ran","family":"Sapir","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel"},{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Laufer-Perl","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Viskin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shmuel","family":"Banai","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Topilsky","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5097-2698","authenticated-orcid":false,"given":"Ofer","family":"Havakuk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,29]]},"reference":[{"key":"2025120618202642000_14.3.e080914.1","doi-asserted-by":"crossref","unstructured":"Unger P , Pibarot P , Tribouilloy C , et al . European society of cardiology council on valvular heart disease. Multiple and Mixed Valvular Heart Diseases Circ Cardiovasc Imaging 2018. doi:10.1161\/CIRCIMAGING.118.007862","DOI":"10.1161\/CIRCIMAGING.118.007862"},{"key":"2025120618202642000_14.3.e080914.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-668X(03)00201-X"},{"key":"2025120618202642000_14.3.e080914.3","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2016-310894"},{"key":"2025120618202642000_14.3.e080914.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000932"},{"key":"2025120618202642000_14.3.e080914.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab395"},{"key":"2025120618202642000_14.3.e080914.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2005.10.005"},{"key":"2025120618202642000_14.3.e080914.7","article-title":"Valvular heart disease epidemiology","volume":"10","author":"Aluru","year":"2022","journal-title":"Med Sci (Basel)"},{"key":"2025120618202642000_14.3.e080914.8","first-page":"33","article-title":"Aortic stenosis with other concomitant valvular disease: aortic regurgitation, mitral regurgitation, mitral stenosis, or tricuspid regurgitation","volume":"38","author":"Unger","year":"2020","journal-title":"Cardiol Clin"},{"key":"2025120618202642000_14.3.e080914.9","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2021.744497","article-title":"When aortic stenosis is not alone: epidemiology, pathophysiology diagnosis and management in mixed and combined valvular disease","volume":"8","author":"Mantovani","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"2025120618202642000_14.3.e080914.10","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.echo.2021.02.014","article-title":"Natural history of moderate aortic stenosis with preserved and low ejection fraction","volume":"34","author":"Mann","year":"2021","journal-title":"J Am Soc Echocardiogr"},{"key":"2025120618202642000_14.3.e080914.11","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2021-001743","article-title":"Moderate aortic stenosis: culprit or bystander","volume":"9","author":"Pankayatselvan","year":"2022","journal-title":"Open Heart"},{"key":"2025120618202642000_14.3.e080914.12","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1016\/j.jcin.2022.06.022","article-title":"Impact of moderate aortic stenosis on long-term clinical outcomes: a systematic review and meta-analysis","volume":"15","author":"Coisne","year":"2022","journal-title":"JACC Cardiovasc Interv"},{"key":"2025120618202642000_14.3.e080914.13","doi-asserted-by":"crossref","first-page":"E358","DOI":"10.1532\/hsf.2971","article-title":"Long term clinical outcomes in patients with moderate aortic stenosis","volume":"23","author":"Bae","year":"2020","journal-title":"Heart Surg Forum"},{"key":"2025120618202642000_14.3.e080914.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.04.065"},{"key":"2025120618202642000_14.3.e080914.15","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1016\/j.jcmg.2021.04.009","article-title":"Prognostic implications of associated cardiac abnormalities detected on echocardiography in patients with moderate aortic stenosis","volume":"14","author":"Amanullah","year":"2021","journal-title":"JACC Cardiovasc Imaging"},{"key":"2025120618202642000_14.3.e080914.16","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.amjcard.2020.09.016","article-title":"Relevance of functional mitral regurgitation in aortic valve stenosis","volume":"136","author":"Benfari","year":"2020","journal-title":"Am J Cardiol"},{"key":"2025120618202642000_14.3.e080914.17","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-017-15316-6","article-title":"Causes of death in patients with severe aortic stenosis: an observational study","volume":"7","author":"Minamino-Muta","year":"2017","journal-title":"Sci Rep"},{"key":"2025120618202642000_14.3.e080914.18","doi-asserted-by":"crossref","unstructured":"Strange G , Stewart S , Celermajer D , et al . National echocardiography database of Australia contributing sites. poor long-term survival in patients with moderate aortic stenosis. 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