{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:23:20Z","timestamp":1791919400474,"version":"4.3.4"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>In severe asymptomatic primary mitral valve regurgitation without risk factors, surgery strategy is controversial. We sought to clarify whether being symptomatic corresponds to the hemodynamic burden and reduced exercise capacity. A better understanding of this may contribute to optimize timing of surgery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Subjects with asymptomatic (New York Heart Association functional class I, n=29) or symptomatic (New York Heart Association functional class II and III, n=28) significant primary mitral valve regurgitation (effective regurgitant orifice, \u22650.30 cm\n              <jats:sup>2<\/jats:sup>\n              ; left ventricular ejection fraction, &gt;60%) were included. Right heart catheterization during rest and exercise, echocardiography, magnetic resonance imaging, and peak oxygen consumption test was performed. Symptomatic subjects had significantly higher pulmonary capillary wedge pressure at rest (14\u00b14 versus 11\u00b13 mm\u2009Hg;\n              <jats:italic>P<\/jats:italic>\n              =0.003) and at maximal exercise (30\u00b16 versus 25\u00b17 mm\u2009Hg;\n              <jats:italic>P<\/jats:italic>\n              =0.02) and higher mean pulmonary artery pressure (PAP) at rest (22\u00b17 versus 18\u00b14 mm\u2009Hg;\n              <jats:italic>P<\/jats:italic>\n              =0.005) and maximal exercise (46\u00b18 versus 39\u00b17 mm\u2009Hg;\n              <jats:italic>P<\/jats:italic>\n              =0.005) than asymptomatic subjects. Among asymptomatic subjects with normal resting value, exercise testing revealed a systolic PAP &gt;60 mm\u2009Hg in 34%. Also the reverse response with minimal increase in pulmonary capillary wedge pressure and mean PAP during exercise was seen, especially in asymptomatic subjects. Among symptomatic subjects, we found a significant inverse correlation between resting mean PAP and left ventricular ejection fraction (\n              <jats:italic>r<\/jats:italic>\n              =\u22120.52;\n              <jats:italic>P<\/jats:italic>\n              =0.02) and right ventricular ejection fraction (\n              <jats:italic>r<\/jats:italic>\n              =\u22120.67;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01). Peak oxygen consumption was equal and normal in both groups and correlated with left ventricular stroke volume but not with pulmonary capillary wedge pressure.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Symptoms in patients with severe mitral valve regurgitation relate to congestion (pulmonary capillary wedge pressure and PAP), but not to peak oxygen consumption, which is determined by forward left ventricular stroke volume. Exercise testing reveals a higher mitral valve regurgitation burden in apparently asymptomatic patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT02961647.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.117.007171","type":"journal-article","created":{"date-parts":[[2018,2,16]],"date-time":"2018-02-16T01:10:29Z","timestamp":1518743429000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":40,"title":["Hemodynamic Characteristics in Significant Symptomatic and Asymptomatic Primary Mitral Valve Regurgitation at Rest and During Exercise"],"prefix":"10.1161","volume":"11","author":[{"given":"Rine","family":"Bakkestr\u00f8m","sequence":"first","affiliation":[{"name":"From the Department of Cardiology, Odense University Hospital, Denmark (R.B., A.B., N.L.C., R.P., A.I., J.E.M.); Odense Patient Data Explorative Network, University of Southern Denmark, Denmark (R.B., J.E.M.); Department of Cardiology, Aarhus University Hospital, Denmark (M.A.); and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Banke","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Odense University Hospital, Denmark (R.B., A.B., N.L.C., R.P., A.I., J.E.M.); Odense Patient Data Explorative Network, University of Southern Denmark, Denmark (R.B., J.E.M.); Department of Cardiology, Aarhus University Hospital, Denmark (M.A.); and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolaj L.","family":"Christensen","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Odense University Hospital, Denmark (R.B., A.B., N.L.C., R.P., A.I., J.E.M.); Odense Patient Data Explorative Network, University of Southern Denmark, Denmark (R.B., J.E.M.); Department of Cardiology, Aarhus University Hospital, Denmark (M.A.); and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Redi","family":"Pecini","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Odense University Hospital, Denmark (R.B., A.B., N.L.C., R.P., A.I., J.E.M.); Odense Patient Data Explorative Network, University of Southern Denmark, Denmark (R.B., J.E.M.); Department of Cardiology, Aarhus University Hospital, Denmark (M.A.); and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akhmadjon","family":"Irmukhamedov","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Odense University Hospital, Denmark (R.B., A.B., N.L.C., R.P., A.I., J.E.M.); Odense Patient Data Explorative Network, University of Southern Denmark, Denmark (R.B., J.E.M.); Department of Cardiology, Aarhus University Hospital, Denmark (M.A.); and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mads","family":"Andersen","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Odense University Hospital, Denmark (R.B., A.B., N.L.C., R.P., A.I., J.E.M.); Odense Patient Data Explorative Network, University of Southern Denmark, Denmark (R.B., J.E.M.); Department of Cardiology, Aarhus University Hospital, Denmark (M.A.); and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry A.","family":"Borlaug","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Odense University Hospital, Denmark (R.B., A.B., N.L.C., R.P., A.I., J.E.M.); Odense Patient Data Explorative Network, University of Southern Denmark, Denmark (R.B., J.E.M.); Department of Cardiology, Aarhus University Hospital, Denmark (M.A.); and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob E.","family":"M\u00f8ller","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Odense University Hospital, Denmark (R.B., A.B., N.L.C., R.P., A.I., J.E.M.); Odense Patient Data Explorative Network, University of Southern Denmark, Denmark (R.B., J.E.M.); Department of Cardiology, Aarhus University Hospital, Denmark (M.A.); and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.)."}],"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":"10.1093\/eurheartj\/ehs109"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000031"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000503"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.599175"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.8643"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041451"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.3.400"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199611073351902"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.08.1025"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.02.026"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jet105"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2016.10.012"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/1532-429X-15-35"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-015-0111-7"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/hc0402.102975"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31826fb946"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/circimaging.116.005156"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2009.01.007"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.109.930701"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.112.967919"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.12.073"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2007.05.046"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.07.046"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2007.07.003"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.017888"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.02.043"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-016-0277-7"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1186\/1532-429X-10-35"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jev321"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.12.047"}],"container-title":["Circulation: Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCIMAGING.117.007171","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T02:20:24Z","timestamp":1715566824000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCIMAGING.117.007171"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2]]},"references-count":31,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2018,2]]}},"alternative-id":["10.1161\/CIRCIMAGING.117.007171"],"URL":"https:\/\/doi.org\/10.1161\/circimaging.117.007171","relation":{},"ISSN":["1941-9651","1942-0080"],"issn-type":[{"value":"1941-9651","type":"print"},{"value":"1942-0080","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2]]},"assertion":[{"value":"2017-09-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-12-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-02-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e007171"}}