{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T19:04:24Z","timestamp":1790363064354,"version":"4.1.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The severity classification of functional mitral regurgitation (FMR) remains controversial despite adverse prognosis and rapidly evolving interventions. Furthermore, it is unclear if quantitative assessment with cardiac magnetic resonance can provide incremental risk stratification for patients with ischemic cardiomyopathy (ICM) or non-ICM (NICM) in terms of FMR and late gadolinium enhancement (LGE). We evaluated the impact of quantitative cardiac magnetic resonance parameters on event-free survival separately for ICM and NICM, to assess prognostic FMR thresholds and interactions with LGE quantification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Patients (n=1414) undergoing cardiac magnetic resonance for cardiomyopathy (ejection fraction&lt;50%) assessment from April 1, 2001 to December 31, 2017 were evaluated. The primary end point was all-cause death, heart transplant, or left ventricular assist device implantation during follow-up. Multivariable Cox analyses were conducted to determine the impact of FMR, LGE, and their interactions with event-free survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      There were 510 primary end points, 395\/782 (50.5%) in ICM and 114\/632 (18.0%) in NICM. Mitral regurgitation-fraction per 5% increase was independently associated with the primary end point, hazards ratios (95% CIs) of 1.04 (1.01\u20131.07;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.034) in ICM and 1.09 (1.02\u20131.16;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.011) in NICM. Optimal mitral regurgitation-fraction threshold for moderate and severe FMR were \u226520% and \u226535%, respectively, in both ICM and NICM, based on the prediction of the primary outcome. Similarly, optimal LGE thresholds were \u22655% in ICM and \u22652% in NICM. Mitral regurgitation-fraction\u00d7LGE emerged as a significant interaction for the primary end point in ICM (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.006), but not in NICM (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.971).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Mitral regurgitation-fraction and LGE are key quantitative cardiac magnetic resonance biomarkers with differential associations with adverse outcomes in ICM and NICM. Optimal prognostic thresholds may provide important clinical risk prognostication and may further facilitate the ability to derive selection criteria to guide therapeutic decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.122.015134","type":"journal-article","created":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T05:01:15Z","timestamp":1690520475000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Prognostic Power of Quantitative Assessment of Functional Mitral Regurgitation and Myocardial Scar Quantification by Cardiac Magnetic Resonance"],"prefix":"10.1161","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5570-9402","authenticated-orcid":true,"given":"Tom Kai Ming","family":"Wang","sequence":"first","affiliation":[{"name":"Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH."},{"name":"Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., Z.B.P., S.D.F., D.H.K.), Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5547-0235","authenticated-orcid":true,"given":"Duygu","family":"Kocyigit","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8150-4312","authenticated-orcid":true,"given":"Harry","family":"Choi","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris M.","family":"Anthony","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8765-7798","authenticated-orcid":true,"given":"Nicholas","family":"Chan","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Bullen","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences (J.B.), Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5692-2299","authenticated-orcid":true,"given":"Zoran B.","family":"Popovi\u0107","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH."},{"name":"Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., Z.B.P., S.D.F., D.H.K.), Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0026-3391","authenticated-orcid":true,"given":"Samir R.","family":"Kapadia","sequence":"additional","affiliation":[{"name":"Section of Invasive and Interventional Cardiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (S.R.K., A.K.), Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amar","family":"Krishnaswamy","sequence":"additional","affiliation":[{"name":"Section of Invasive and Interventional Cardiology, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (S.R.K., A.K.), Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6831-8611","authenticated-orcid":true,"given":"Brian P.","family":"Griffin","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Flamm","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., Z.B.P., S.D.F., D.H.K.), 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Wilson","family":"Tang","sequence":"additional","affiliation":[{"name":"Section of Heart Failure and Transplantation Medicine, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (W.H.W.T.), Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2191-4111","authenticated-orcid":true,"given":"Deborah H.","family":"Kwon","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (T.K.M.W., D.K., H.C., C.M.A., N.C., Z.B.P., B.P.G., D.H.K.), Cleveland Clinic, Cleveland, OH."},{"name":"Section of Cardiovascular Imaging, Imaging Institute (T.K.M.W., Z.B.P., S.D.F., D.H.K.), Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000923"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab395"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1410490"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1805374"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1806640"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2017.01.007"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.02.075"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2021.05.017"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.12.047"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2019.11.008"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2020.11.004"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.048477"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.113.000438"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2021.07.007"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-020-00610-6"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69208-8"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.09.019"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2011.225789"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.033173"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.05.028"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-020-00607-1"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.112.975623"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.017888"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.03.006"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2016.01.033"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.113.001768"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.02.070"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2020.11.006"}],"container-title":["Circulation: Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCIMAGING.122.015134","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T09:09:15Z","timestamp":1749028155000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCIMAGING.122.015134"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8]]},"references-count":28,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1161\/CIRCIMAGING.122.015134"],"URL":"https:\/\/doi.org\/10.1161\/circimaging.122.015134","relation":{},"ISSN":["1941-9651","1942-0080"],"issn-type":[{"value":"1941-9651","type":"print"},{"value":"1942-0080","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8]]},"assertion":[{"value":"2023-01-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-25","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}