{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T23:05:05Z","timestamp":1781564705190,"version":"3.54.5"},"reference-count":35,"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":[[2019,6]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>In contemporary patients with suspected significant mitral stenosis (MS) undergoing rest and treadmill stress echocardiography, we assessed characteristics and factors associated with longer-term survival.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>\n              We studied 515 consecutive patients (asymptomatic\/atypical symptoms, mean left ventricular ejection fraction 58\u00b12%; 43% male) with suspected at least moderate MS ([1] native mitral valve [MV]: resting mean MV gradient \u22655 mm\u2009Hg or area \u22641.5 cm\n              <jats:sup>2<\/jats:sup>\n              and [2] prosthetic valve: resting mean MV gradient \u22655 mm\u2009Hg or effective orifice area \u22642 cm) who underwent rest and treadmill stress echocardiography between 1\/2003 and 12\/2013. MS was categorized as rheumatic (n=170, 33%), postsurgical (prior mitral repair\/replacement, n=245, 48%), and primary nonrheumatic (n=100, 19%). Primary outcome was all-cause mortality.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Mean resting MV gradient and right ventricular systolic pressure were 8.5\u00b13 and 39\u00b113 mm\u2009Hg. Patients achieved 95\u00b129% age-sex predicted metabolic equivalents; peak-stress MV gradient and right ventricular systolic pressure were 17\u00b17 and 61\u00b114 mm\u2009Hg, respectively. At 54 days (median), 224 (44%) underwent invasive mitral procedure. At 6\u00b14 years, 76 (15%) died. On survival analysis, primary nonrheumatic MS (hazard ratio [HR], 4.92), higher Society of Thoracic Surgeons score (HR, 1.92), lower % age-sex predicted metabolic equivalents (HR, 1.22), and higher peak-stress right ventricular systolic pressure (HR, 1.35), was associated with higher mortality, while invasive mitral procedures were associated with improved survival (HR, 0.67; all\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>In asymptomatic patients (or with atypical symptoms) with significant MS undergoing treadmill stress echocardiography, higher mortality was associated with primary nonrheumatic MS, lower % age-sex predicted metabolic equivalents, and higher peak-stress right ventricular systolic pressure, while invasive MV procedures were associated with survival.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.119.009062","type":"journal-article","created":{"date-parts":[[2019,6,17]],"date-time":"2019-06-17T09:00:24Z","timestamp":1560762024000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Characteristics and Outcomes in a Contemporary Group of Patients With Suspected Significant Mitral Stenosis Undergoing Treadmill Stress Echocardiography"],"prefix":"10.1161","volume":"12","author":[{"suffix":"III","given":"James L.","family":"Gentry","sequence":"first","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parth K.","family":"Parikh","sequence":"additional","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa","family":"Alashi","sequence":"additional","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A Marc","family":"Gillinov","sequence":"additional","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gosta B.","family":"Pettersson","sequence":"additional","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L Leonardo","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoran B.","family":"Popovic","sequence":"additional","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimi","family":"Sato","sequence":"additional","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Grimm","sequence":"additional","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir R.","family":"Kapadia","sequence":"additional","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E Murat","family":"Tuzcu","sequence":"additional","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars G.","family":"Svensson,","sequence":"additional","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian P.","family":"Griffin","sequence":"additional","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milind Y.","family":"Desai","sequence":"additional","affiliation":[{"name":"Heart valve center, Heart and Vascular Institute, Cleveland Clinic, 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