{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T15:28:42Z","timestamp":1789831722209,"version":"4.0.1"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>The relationship between annular dilatation caused by atrial fibrillation (AF) and mitral regurgitation (MR) remains controversial. We hypothesized that the small ratio of total leaflet area\/annulus area (TLA\/AA), reflecting insufficient leaflet remodeling to annular dilatation, is a main component of MR in patients with AF.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Three-dimensional transesophageal echocardiographic data of the mitral valve were analyzed in 28 AF patients with moderate or severe MR (MR group), age- and sex-matched 56 AF patients with mild or less MR (non-MR group), and 16 control subjects. AA was significantly greater in both the MR (645\u00b1126 mm\n              <jats:sup>2<\/jats:sup>\n              \/m\n              <jats:sup>2<\/jats:sup>\n              ,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and non-MR groups (568\u00b1121 mm\n              <jats:sup>2<\/jats:sup>\n              \/m\n              <jats:sup>2<\/jats:sup>\n              ,\n              <jats:italic>P<\/jats:italic>\n              =0.001) compared with control subjects (444\u00b1108 mm\n              <jats:sup>2<\/jats:sup>\n              \/m\n              <jats:sup>2<\/jats:sup>\n              ). However, TLA\/AA was significantly smaller in the MR (1.29\u00b10.10,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), but not in the non-MR group (1.65\u00b10.24,\n              <jats:italic>P<\/jats:italic>\n              &gt;0.99), compared with control subjects (1.70\u00b10.29). In linear regression analysis, TLA\/AA was inversely associated with the effective regurgitant orifice (\n              <jats:italic>r<\/jats:italic>\n              =\u22120.73,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). The area under the receiver-operating-characteristics curve of TLA\/AA was significantly greater than that of AA (0.95 versus 0.72,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Multivariable analysis revealed that small TLA\/AA (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) was independently associated with significant MR, while AA was not (\n              <jats:italic>P<\/jats:italic>\n              =0.26).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>In patients with AF, insufficient leaflet remodeling to annular dilatation, rather than crude annular dilatation, was strongly associated with the severity of MR.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.116.005451","type":"journal-article","created":{"date-parts":[[2017,3,14]],"date-time":"2017-03-14T01:14:10Z","timestamp":1489454050000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":115,"title":["Insufficient Leaflet Remodeling in Patients With Atrial Fibrillation"],"prefix":"10.1161","volume":"10","author":[{"given":"Nobuyuki","family":"Kagiyama","sequence":"first","affiliation":[{"name":"From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Hayashida","sequence":"additional","affiliation":[{"name":"From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misako","family":"Toki","sequence":"additional","affiliation":[{"name":"From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shota","family":"Fukuda","sequence":"additional","affiliation":[{"name":"From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minako","family":"Ohara","sequence":"additional","affiliation":[{"name":"From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Hirohata","sequence":"additional","affiliation":[{"name":"From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keizo","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuaki","family":"Isobe","sequence":"additional","affiliation":[{"name":"From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyoshi","family":"Yoshida","sequence":"additional","affiliation":[{"name":"From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan 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