{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:38:22Z","timestamp":1787017102541,"version":"build-2736575974"},"reference-count":23,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[1998,4,30]]},"published-print":{"date-parts":[[1998,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate cardiac function in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) and clarify the clinical features of cardiomyopathy in MELAS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients<\/jats:title>\n                    <jats:p>11 consecutive patients with MELAS (mean age at initial examination 11.3 years, range 4 to 16 years) were enrolled in the study. Six were followed for more than five years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      On echocardiographic examination, three patients showed increased left ventricular end diastolic posterior wall thickness (LVPWTd), exceeding 140% of the normal value. Four patients, including these three, had an ejection fraction of less than 50%, and two also had increased left ventricular end diastolic volume (LVEDV) exceeding 140% of the normal value (%N). The LVPWTd%N was correlated positively with the LVEDV%N (\n                      <jats:italic>R<\/jats:italic>\n                      = 0.669, p\u2009&lt;\u20090.05) and negatively with the ejection fraction (\n                      <jats:italic>R<\/jats:italic>\n                      = \u22120.6701, p\u2009&lt;\u20090.05). One patient died of heart failure aged 22 years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The cardiomyopathy in MELAS is characterised by an abnormally thick left ventricular wall with progressive dilatation and poor left ventricular contraction developing over several years, indicating hypertrophic cardiomyopathy advancing to dilated cardiomyopathy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/hrt.80.3.292","type":"journal-article","created":{"date-parts":[[2014,10,22]],"date-time":"2014-10-22T15:31:45Z","timestamp":1413991905000},"page":"292-295","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":80,"title":["A follow up study of myocardial involvement in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS)"],"prefix":"10.1136","volume":"80","author":[{"given":"Y","family":"Okajima","sequence":"first","affiliation":[{"name":"aDivision of Cardiology, Chiba Children\u2019s Hospital, Chiba City, Japan, \n\nbDivision of Neurology, Chiba Children\u2019s Hospital, \n\ncDivision of Metabolism, Chiba Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y","family":"Tanabe","sequence":"additional","affiliation":[{"name":"aDivision of Cardiology, Chiba Children\u2019s Hospital, Chiba City, Japan, \n\nbDivision of Neurology, Chiba Children\u2019s Hospital, \n\ncDivision of Metabolism, Chiba Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Takayanagi","sequence":"additional","affiliation":[{"name":"aDivision of Cardiology, Chiba Children\u2019s Hospital, Chiba City, Japan, \n\nbDivision of Neurology, Chiba Children\u2019s Hospital, \n\ncDivision of Metabolism, Chiba Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Aotsuka","sequence":"additional","affiliation":[{"name":"aDivision of Cardiology, Chiba Children\u2019s Hospital, Chiba City, Japan, \n\nbDivision of Neurology, Chiba Children\u2019s Hospital, \n\ncDivision of Metabolism, Chiba Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1998,9,1]]},"reference":[{"key":"2025100705294916000_80.3.292.1","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1253\/jcj.54.1214","article-title":"Mitochondrial cytopathy.","volume":"54","author":"Ito","year":"1990","journal-title":"Jpn Circ 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presenting hypertrophic cardiomyopathy.","volume":"34","author":"Hiruta","year":"1995","journal-title":"Intern Med"},{"key":"2025100705294916000_80.3.292.10","doi-asserted-by":"publisher","DOI":"10.1006\/bbrc.1996.0722"},{"key":"2025100705294916000_80.3.292.11","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.91.4.955"},{"key":"2025100705294916000_80.3.292.12","doi-asserted-by":"publisher","DOI":"10.1038\/348651a0"},{"key":"2025100705294916000_80.3.292.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-291X(05)80860-5"},{"key":"2025100705294916000_80.3.292.14","doi-asserted-by":"publisher","DOI":"10.1016\/0925-4439(91)90042-8"},{"key":"2025100705294916000_80.3.292.15","first-page":"1756","article-title":"An exponential growth model for nonlinear regression analysis between diverse cardiac measurements and body size.","volume":"99","author":"Aotsuka","year":"1995","journal-title":"Jpn J 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