{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T21:32:47Z","timestamp":1773437567600,"version":"3.50.1"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Long-term follow-up studies in severe mitral stenosis (MS) with low transmitral mean diastolic pressure gradient (MDPG) are not available. We evaluated the prognostic implications of severe MS with low MDPG in our MASTER (Multicenter Mitral Stenosis with Rheumatic Etiology) registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      We included patients with severe rheumatic MS (mitral valve area \u22641.5 cm\n                      <jats:sup>2<\/jats:sup>\n                      ) from the long-term MASTER registry. Patients were categorized into high (\u22655 mm Hg) or low (&lt;5 mm Hg) MDPG groups. The primary outcome was a composite of all-cause mortality and stroke.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 1248 patients with severe MS, 322 (25.8%) had low MDPG and 926 (74.2%) had high MDPG. Their mean age was 59\u00b113 years, 25% were men, and 74% had atrial fibrillation. Patients with low MDPG were older and had a higher prevalence of atrial fibrillation. During a mean follow-up of 6.8\u00b15.9 years, 194 (15.5%) patients experienced major adverse events. Patients who had low MDPG sustained more events than those with high MDPG (hazard ratio, 1.56 [95% CI, 1.15\u20132.12];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.004), and low MDPG was independently associated with poor outcome (hazard ratio, 1.42 [95% CI, 1.02\u20131.97];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.038) in the multivariable model. In the subgroup analysis of patients with low MDPG, decreased left atrial reservoir strain was independently associated with poor outcome (hazard ratio, 3.22 [95% CI, 1.25\u20138.31];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.016).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Patients with severe MS and low MDPG carried a greater risk of adverse events than those with high MDPG and had less frequent and delayed mitral valve intervention. Also, it is not necessarily indicative of milder hemodynamic encumbrance. Left atrial reservoir strain could help identify a subgroup associated with poor prognosis in patients with low MDPG.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.125.018124","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T09:00:09Z","timestamp":1752656409000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Long-Term Follow-Up in Severe Mitral Stenosis With Low Transmitral Diastolic Pressure Gradient: From MASTER Registry"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5927-5410","authenticated-orcid":true,"given":"Iksung","family":"Cho","sequence":"first","affiliation":[{"name":"Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (I.C., H.J. Lim, K.K., S.-Y.G., H.-J.L., C.Y.S., J.-W.H., G.-R.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7334-6083","authenticated-orcid":true,"given":"Dae-Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea (D.-Y.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinseob","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Statistical Analysis, Zarathu Co., Ltd, Seoul, South Korea (J.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3567-2347","authenticated-orcid":true,"given":"Ha Jeong","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (I.C., H.J. Lim, K.K., S.-Y.G., H.-J.L., C.Y.S., J.-W.H., G.-R.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7641-3739","authenticated-orcid":true,"given":"Jiwon","family":"Seo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyu","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (I.C., H.J. Lim, K.K., S.-Y.G., H.-J.L., C.Y.S., J.-W.H., G.-R.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5550-4156","authenticated-orcid":true,"given":"Seo-Yeon","family":"Gwak","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (I.C., H.J. Lim, K.K., S.-Y.G., H.-J.L., C.Y.S., J.-W.H., G.-R.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7498-0705","authenticated-orcid":true,"given":"Hyun-Jung","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (I.C., H.J. Lim, K.K., S.-Y.G., H.-J.L., C.Y.S., J.-W.H., G.-R.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0243-6954","authenticated-orcid":true,"given":"Hee Jeong","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea (H.J. Lee, S.L., I.-C.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4516-7651","authenticated-orcid":true,"given":"Kyu-Yong","family":"Ko","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, South Korea (K.-Y.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6136-0136","authenticated-orcid":true,"given":"Chi Young","family":"Shim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (I.C., H.J. Lim, K.K., S.-Y.G., H.-J.L., C.Y.S., J.-W.H., G.-R.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8260-2958","authenticated-orcid":true,"given":"Jong-Won","family":"Ha","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea (I.C., H.J. Lim, K.K., S.-Y.G., H.-J.L., C.Y.S., J.-W.H., G.-R.H.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1620-795X","authenticated-orcid":true,"given":"Seonhwa","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea (H.J. 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