{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:10:59Z","timestamp":1791447059632,"version":"4.3.3"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>The optimum timing of surgery in asymptomatic patients with chronic severe primary degenerative mitral regurgitation (MR) remains controversial, and further markers are needed to improve decision-making. There are limited data that wall stress is increased in MR and may result in ventricular fibrosis. We investigated the hypothesis that chronic volume overload in MR is a stimulus for myocardial fibrosis using T1-mapping cardiac MRI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              A cross-sectional study of 35 patients (age 60\u00b114 years) with asymptomatic moderate and severe primary degenerative MR (mean effective regurgitant orifice area, 0.45\u00b10.25 cm)\n              <jats:sup>\n                <jats:xref ref-type=\"bibr\">2<\/jats:xref>\n              <\/jats:sup>\n              with no class I indication for surgery were compared with age and sex controls. Subjects were studied with cardiopulmonary exercise testing, echocardiography, and cardiac MRI.\n            <\/jats:p>\n            <jats:p>\n              Longitudinal and circumferential myocardial deformation was reduced with MR when left ventricular ejection fraction (67%\u00b110%) and N-terminal pro B Natriuretic peptide (126 [76\u2013428] ng\/L) were within the normal range. Myocardial extracellular volume was increased (0.32\u00b10.07 versus 0.25\u00b10.02,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01) and was associated with increased left ventricular end-systolic volume index (\n              <jats:italic>r<\/jats:italic>\n              =0.62,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01), left atrial volume index (\n              <jats:italic>r<\/jats:italic>\n              =0.41,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05) but lower left ventricular ejection fraction (\n              <jats:italic>r<\/jats:italic>\n              =\u22120.60,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01), longitudinal function (mitral annular plane systolic excursion,\n              <jats:italic>r<\/jats:italic>\n              =\u22120.46,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01), and peak V\n              <jats:sc>O<\/jats:sc>\n              <jats:sub>2 max<\/jats:sub>\n              (\n              <jats:italic>r<\/jats:italic>\n              =\u22120.51,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05). In a multivariable regression model, left ventricular end-systolic volume index and left atrial volume index were independent predictors of extracellular volume (\n              <jats:italic>r<\/jats:italic>\n              <jats:sup>2<\/jats:sup>\n              =0.42,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Patients with asymptomatic MR demonstrate a spectrum of myocardial fibrosis associated with reduced myocardial deformation and reduced exercise capacity. Future work is warranted to investigate whether left ventricle fibrosis affects clinical outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.114.002397","type":"journal-article","created":{"date-parts":[[2014,8,20]],"date-time":"2014-08-20T09:20:59Z","timestamp":1408526459000},"page":"946-953","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":99,"title":["Quantification of Left Ventricular Interstitial Fibrosis in Asymptomatic Chronic Primary Degenerative Mitral Regurgitation"],"prefix":"10.1161","volume":"7","author":[{"given":"Nicola C.","family":"Edwards","sequence":"first","affiliation":[{"name":"From the Department of Cardiovascular Medicine, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom (N.C.E., W.E.M., J.N.T., R.P.S.); Departments of Cardiology (N.C.E., W.E.M., M.Y., J.N.T.) and Pathology (D.N.), University of Birmingham and Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; and Imaging and Therapy Systems Department, Siemens Healthcare, Surrey, United Kingdom (P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William E.","family":"Moody","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom (N.C.E., W.E.M., J.N.T., R.P.S.); Departments of Cardiology (N.C.E., W.E.M., M.Y., J.N.T.) and Pathology (D.N.), University of Birmingham and Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; and Imaging and Therapy Systems Department, Siemens Healthcare, Surrey, United Kingdom (P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengshi","family":"Yuan","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom (N.C.E., W.E.M., J.N.T., R.P.S.); Departments of Cardiology (N.C.E., W.E.M., M.Y., J.N.T.) and Pathology (D.N.), University of Birmingham and Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; and Imaging and Therapy Systems Department, Siemens Healthcare, Surrey, United Kingdom (P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Weale","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom (N.C.E., W.E.M., J.N.T., R.P.S.); Departments of Cardiology (N.C.E., W.E.M., M.Y., J.N.T.) and Pathology (D.N.), University of Birmingham and Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; and Imaging and Therapy Systems Department, Siemens Healthcare, Surrey, United Kingdom (P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desley","family":"Neal","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom (N.C.E., W.E.M., J.N.T., R.P.S.); Departments of Cardiology (N.C.E., W.E.M., M.Y., J.N.T.) and Pathology (D.N.), University of Birmingham and Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; and Imaging and Therapy Systems Department, Siemens Healthcare, Surrey, United Kingdom (P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan N.","family":"Townend","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom (N.C.E., W.E.M., J.N.T., R.P.S.); Departments of Cardiology (N.C.E., W.E.M., M.Y., J.N.T.) and Pathology (D.N.), University of Birmingham and Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; and Imaging and Therapy Systems Department, Siemens Healthcare, Surrey, United Kingdom (P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard P.","family":"Steeds","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom (N.C.E., W.E.M., J.N.T., R.P.S.); Departments of Cardiology (N.C.E., W.E.M., M.Y., J.N.T.) and Pathology (D.N.), University of Birmingham and Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; and Imaging and Therapy Systems Department, Siemens Healthcare, Surrey, United Kingdom (P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69208-8"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000029"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs109"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.109.868109"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.868083"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2002.009621"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2008.09.023"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.55.3.504"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.11.013"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.847772"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.02.047"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.112.000192"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jeq031"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1080\/10976640600572889"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/1532-429X-12-65"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/1532-429X-10-61"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2010.07.018"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/1532-429X-13-16"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/1532-429X-11-5"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr481"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.167.2.211"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1249\/00005768-198205000-00012"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.03.035"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.3109\/07853898909149235"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht098"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.3.400"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.06.047"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.599175"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2009.09.029"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.02.086"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041451"}],"container-title":["Circulation: Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCIMAGING.114.002397","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T02:46:06Z","timestamp":1715568366000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCIMAGING.114.002397"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,11]]},"references-count":31,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2014,11]]}},"alternative-id":["10.1161\/CIRCIMAGING.114.002397"],"URL":"https:\/\/doi.org\/10.1161\/circimaging.114.002397","relation":{},"ISSN":["1941-9651","1942-0080"],"issn-type":[{"value":"1941-9651","type":"print"},{"value":"1942-0080","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,11]]},"assertion":[{"value":"2014-05-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-08-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-08-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}