{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T19:22:38Z","timestamp":1790796158763,"version":"4.1.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Mitral regurgitation (MR) is a frequent comorbidity in patients with hypertrophic cardiomyopathy (HCM), which includes distinct subtypes with various characteristics. However, data on the long-term prognostic impact of MR and its progression or regression over time remain limited, particularly across individual HCM subtypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Patients with HCM were retrospectively included from a Japanese multicenter registry and compared by MR severity (moderate or greater versus mild or less) within each subtype: hypertrophic obstructive cardiomyopathy (HOCM), end-stage HCM (ES-HCM), and other HCM (including nonobstructive, midventricular obstruction, and apical HCM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 3602 patients (HOCM: n=837; ES-HCM: n=275; other HCM: n=2490), the prevalence of moderate or greater MR was highest in HOCM (36.3%), followed by ES-HCM (21.5%) and other HCM (8.5%). During a median follow-up of 5.3 (interquartile range, 2.1\u20139.3) years, the cumulative 5-year incidence of all-cause death or heart failure hospitalization was not significantly different between the moderate or greater MR and mild or less MR groups in HOCM (14.6% versus 12.4%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.35) or ES-HCM (60.7% versus 54.7%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.84). After adjustment for clinical covariates, no significant association was observed in either subtype (HOCM: hazard ratio, 1.13 [95% CI, 0.79\u20131.60],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.51; ES-HCM: hazard ratio, 0.84 [95% CI, 0.55\u20131.28],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.42). In contrast, in other HCM, moderate or greater MR was significantly associated with the higher 5-year cumulative incidence of all-cause death or heart failure hospitalization (34.2% versus 13.9%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), which remained significant after adjustment, with a significant interaction (hazard ratio, 1.45 [95% CI, 1.09\u20131.91],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.01;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      =0.02). MR severity improved over time in HOCM, showed no clear change in ES-HCM, and worsened in other HCM (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001, 0.46, and &lt;0.001, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In patients with HCM, moderate or greater MR was not associated with worse outcomes in HOCM or ES-HCM, but had significant prognostic implications in other HCM subtypes, suggesting the need for HCM subtype-specific MR management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circheartfailure.125.013977","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T10:00:11Z","timestamp":1770199211000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic Implications of Mitral Regurgitation Across Hypertrophic Cardiomyopathy Subtypes: A Report From REVEAL-HCM Study"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0387-8877","authenticated-orcid":true,"given":"Yuki","family":"Obayashi","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (Y.O., T.K., H.S., K.O.)."},{"name":"Department of Cardiology, Leiden University Medical Center, the Netherlands (Y.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8213-7999","authenticated-orcid":true,"given":"Takao","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (Y.O., T.K., H.S., K.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7234-023X","authenticated-orcid":true,"given":"Hiroki","family":"Shiomi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (Y.O., T.K., H.S., K.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3741-6347","authenticated-orcid":true,"given":"Kiyomasa","family":"Nakatsuka","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Epidemiology (K. 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Nishimura), National Cerebral and Cardiovascular Center, Suita, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0529-7125","authenticated-orcid":true,"given":"Hiroaki","family":"Kitaoka","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan (H.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5618-4721","authenticated-orcid":true,"given":"Yasushi","family":"Sakata","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Japan (Y.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaoru","family":"Dohi","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan (K.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9897-0918","authenticated-orcid":true,"given":"Yukichi","family":"Tokita","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (Y.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9774-4513","authenticated-orcid":true,"given":"Shouji","family":"Matsushima","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan (S.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Amano","sequence":"additional","affiliation":[{"name":"Department of Heart Failure and Transplantation (M.A., C.I.), National Cerebral and Cardiovascular Center, Suita, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4585-2437","authenticated-orcid":true,"given":"Yutaka","family":"Furukawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8655-0203","authenticated-orcid":true,"given":"Toshihiro","family":"Tamura","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tenri Hospital, Japan (T.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9074-9407","authenticated-orcid":true,"given":"Akihiro","family":"Hayashida","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Sakakibara Heart Institute of Okayama, Japan (A.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1579-0071","authenticated-orcid":true,"given":"Haruhiko","family":"Abe","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, National Hospital Organization Osaka National Hospital, Japan (H.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0699-4248","authenticated-orcid":true,"given":"Kenji","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (K.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Yuda","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan (S.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moriaki","family":"Inoko","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Center, Medical Research Institute Kitano Hospital, Osaka, Japan (M.I.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4163-980X","authenticated-orcid":true,"given":"Koh","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (Y.O., T.K., H.S., K.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0639-0949","authenticated-orcid":true,"given":"Kunihiro","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Epidemiology (K. 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