{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:38:40Z","timestamp":1790419120652,"version":"4.1.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Severe functional mitral regurgitation (fMR) is a heterogenous disease that exhibits different underlying pathophysiological mechanisms and represents independent entities. The aim of this study was to characterize remodeling patterns defined by the left atrial (LA) to left ventricular (LV) volume ratio in patients with severe fMR and heart failure, and to examine its prognostic implications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>A total of 13\u2009052 patients with fMR were included. Based on the LA\/LV volume ratio, patients with severe fMR were divided into 2 distinct groups: predominant LV remodeling (PLVR [ratio \u22640.56, n=581]) and predominant LA remodeling (PLAR [ratio &gt;0.56, n=582]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Patients with PLAR were more often female, with the peak age a decade later. PLAR was associated with lower leaflet tethering indices, as indicated by the leaflet tenting area (PLVR versus PLAR: 227 mm\n                      <jats:sup>2<\/jats:sup>\n                      versus 181 mm\n                      <jats:sup>2<\/jats:sup>\n                      ,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) and angles (PLVR versus PLAR: posterior leaflet: 42\u00b0 versus 36\u00b0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001; anterior leaflet: 28\u00b0 versus 23\u00b0,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). PLAR was the predominant subtype in heart failure with preserved (76%) and heart failure with mildly reduced ejection fraction (61%), but a significant proportion could be observed in heart failure with reduced ejection fraction (32%). The median follow-up time for severe fMR was 66 months (interquartile range, 60\u201385). After 4 years, 42.1% with PLAR and 34.1% with PLVR had died. At 8 years, 57.3% of patients with PLAR, and 49.6% of patients with PLVR had died. Compared with PLVR, PLAR showed excess mortality, with a hazard ratio of 1.37 ([95% CI, 1.13\u20131.65];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.001) in the univariate analysis. This effect remained after multivariable adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The LA\/LV volume ratio indicates the prevailing remodeling pattern in severe fMR. It is associated with morphological features of valve apparatus distortion resulting from differential remodeling. A strong correlation is observed between the LA\/LV volume ratio and mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.124.017872","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T05:00:14Z","timestamp":1749013214000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Left Atrial to Left Ventricular Volume Ratio in Patients With Severe Functional Mitral Regurgitation"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0918-8217","authenticated-orcid":true,"given":"Sophia","family":"Koschatko","sequence":"first","affiliation":[{"name":"Department of Internal Medicine II, Medical University of Vienna, 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