{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:18:29Z","timestamp":1789496309222,"version":"build-2803163510"},"reference-count":36,"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":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Left ventricular (LV) remodeling in mitral valve prolapse (MVP) may occur disproportionally to mitral regurgitation (MR) severity, especially in patients with Barlow disease. This study hypothesized an underlying MVP cardiomyopathy, potentially driven by ventricular arrhythmias or a genetic substrate. We investigated the determinants of LV remodeling in patients with MVP beyond MR volume load.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      Prospective inclusion of patients with nonsyndromic MVP at 3 centers. Patients were scheduled for cardiac magnetic resonance scans, 24-hour Holter monitoring and the presence of an underlying cardiomyopathy-associated genetic variant was assessed. Disproportionate LV remodeling was defined as LV end-diastolic volume above the age- and sex-specific upper limit of normal (LVEDVi\n                      <jats:sub>ULN<\/jats:sub>\n                      ) after correction for the total MR volume load, using the following formula: (LV end-diastolic volume\u2212MR volume)\/body surface area\u2013LVEDVi\n                      <jats:sub>ULN<\/jats:sub>\n                      &gt;0.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      A total of 103 patients with MVP were included (58% males, age 52\u00b117 years). Disproportionate LV remodeling was present in 37% and was more frequent in Barlow disease compared with nonclassic MVP (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.067). After correction for age, sex, and MR volume load, Barlow disease phenotypic features like mitral annular dilatation are independently associated with LV dilatation (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001 at multivariable regression analysis for LV end-systolic volume index,\n                      <jats:italic toggle=\"yes\">R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =0.518). The total volume load (MR volume+prolapse volume) had a stronger correlation with LV remodeling than MR volume alone. In addition, ventricular arrhythmia\u2014particularly \u22653% premature ventricular contractions\u2014was independently associated with increased LV end-systolic volume index even after correction for other classical risk factors (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.024,\n                      <jats:italic toggle=\"yes\">R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =0.518). None of the patients carried a likely pathogenic or pathogenic variant in cardiomyopathy-associated genes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>LV remodeling in MVP is a multifactorial process, where, especially in patients with Barlow disease, the associated mitral annular dilatation and larger prolapse volume drive LV dilatation beyond MR severity. In addition, a burden of \u22653% ventricular ectopy is strongly correlated with LV dilatation and dysfunction. Finally, a monogenic cardiomyopathy substrate appears unlikely.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.126.019974","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:00:19Z","timestamp":1787648419000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Left Ventricular Remodelling in Mitral Valve Prolapse: More Than Volume Overload"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9679-0996","authenticated-orcid":true,"given":"Lobke L.","family":"Pype","sequence":"first","affiliation":[{"name":"Department of Cardiology (L.L.P., S.L.V.L., H.M.B., N.S., E.M.V.C., C.M.V.D.H.), University Hospital Antwerp, Edegem, Belgium."},{"name":"Research group of Cardiovascular Diseases, Department of Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Antwerp, Belgium (L.L.P., S.L.V.L., B.P.P., H.M.B., N.S., E.M.V.C., C.M.V.D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4909-8347","authenticated-orcid":true,"given":"Oksana","family":"Marchenko","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King\u2019s College London, United Kingdom (O.M., P.G.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven L.","family":"Van Laer","sequence":"additional","affiliation":[{"name":"Department of Cardiology (L.L.P., S.L.V.L., H.M.B., N.S., E.M.V.C., C.M.V.D.H.), University Hospital Antwerp, Edegem, Belgium."},{"name":"Research group of Cardiovascular Diseases, Department of Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Antwerp, Belgium (L.L.P., S.L.V.L., B.P.P., H.M.B., N.S., E.M.V.C., C.M.V.D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3478-6801","authenticated-orcid":true,"given":"Bernard P.","family":"Paelinck","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery (B.P.P.), University Hospital Antwerp, Edegem, Belgium."},{"name":"Research group of Cardiovascular Diseases, Department of Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Antwerp, Belgium (L.L.P., S.L.V.L., B.P.P., H.M.B., N.S., E.M.V.C., C.M.V.D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanne M.","family":"Boen","sequence":"additional","affiliation":[{"name":"Department of Cardiology (L.L.P., S.L.V.L., H.M.B., N.S., E.M.V.C., C.M.V.D.H.), University Hospital Antwerp, Edegem, Belgium."},{"name":"Research group of Cardiovascular Diseases, Department of Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Antwerp, Belgium (L.L.P., S.L.V.L., B.P.P., H.M.B., N.S., E.M.V.C., C.M.V.D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3826-5541","authenticated-orcid":true,"given":"Nicole","family":"Sturkenboom","sequence":"additional","affiliation":[{"name":"Department of Cardiology (L.L.P., S.L.V.L., H.M.B., N.S., E.M.V.C., C.M.V.D.H.), University Hospital Antwerp, Edegem, Belgium."},{"name":"Research group of Cardiovascular Diseases, Department of Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Antwerp, Belgium (L.L.P., S.L.V.L., B.P.P., H.M.B., N.S., E.M.V.C., C.M.V.D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5196-9530","authenticated-orcid":true,"given":"Pier Giorgio","family":"Masci","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King\u2019s College London, United Kingdom (O.M., P.G.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4278-0132","authenticated-orcid":true,"given":"Rachel M.A.","family":"Ter Bekke","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center+, the Netherlands (R.M.A.T.B., P.G.A.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4620-6234","authenticated-orcid":true,"given":"Julia","family":"Grapsa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London, United Kingdom (J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2652-1598","authenticated-orcid":true,"given":"Paul G.A.","family":"Volders","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center+, the Netherlands (R.M.A.T.B., P.G.A.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7686-2668","authenticated-orcid":true,"given":"Emeline M.","family":"Van Craenenbroeck","sequence":"additional","affiliation":[{"name":"Department of Cardiology (L.L.P., S.L.V.L., H.M.B., N.S., E.M.V.C., C.M.V.D.H.), University Hospital Antwerp, Edegem, Belgium."},{"name":"Research group of Cardiovascular Diseases, Department of Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Antwerp, Belgium (L.L.P., S.L.V.L., B.P.P., H.M.B., N.S., E.M.V.C., C.M.V.D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline M.","family":"Van De Heyning","sequence":"additional","affiliation":[{"name":"Department of Cardiology (L.L.P., S.L.V.L., H.M.B., N.S., E.M.V.C., C.M.V.D.H.), University Hospital Antwerp, Edegem, Belgium."},{"name":"Research group of Cardiovascular Diseases, Department of Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton (GENCOR), University of Antwerp, Antwerp, Belgium (L.L.P., S.L.V.L., B.P.P., H.M.B., N.S., E.M.V.C., 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