{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T01:45:41Z","timestamp":1790214341948,"version":"4.1.0"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2011,7,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>Whether morphological abnormalities of the mitral valve represent part of the hypertrophic cardiomyopathy (HCM) disease process is unresolved. Therefore, we applied cardiovascular magnetic resonance to characterize mitral valve morphology in a large HCM cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>\n                      Cine cardiac magnetic resonance images were obtained in 172 HCM patients (age, 42\u00b118 years; 62% men) and 172 control subjects. In addition, 15 HCM gene-positive\/phenotype-negative relatives were studied. Anterior mitral leaflet (AML) and posterior mitral leaflet lengths were greater in HCM patients than in control subjects (26\u00b15 versus 19\u00b15 mm,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001; and 14\u00b14 versus 10\u00b13 mm,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001, respectively), including 59 patients (34%) in whom AML length alone, posterior mitral leaflet length alone, or both were particularly substantial (&gt;2 SDs above controls). Leaflet length was increased compared with controls in virtually all HCM age groups, including young patients 15 to 20 years of age (AML, 26\u00b15 versus 21\u00b14 mm;\n                      <jats:italic>P<\/jats:italic>\n                      =0.0002) and those \u226560 years of age (AML, 26\u00b14 versus 19\u00b12 mm;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). No relation was evident between mitral leaflet length and LV thickness or mass index (\n                      <jats:italic>P<\/jats:italic>\n                      =0.09 and\n                      <jats:italic>P<\/jats:italic>\n                      =0.16, respectively). A ratio of AML length to LV outflow tract diameter of &gt;2.0 was associated with subaortic obstruction (\n                      <jats:italic>P<\/jats:italic>\n                      =0.001). In addition, AML length in 15 genotype-positive relatives without LV hypertrophy exceeded that of matched control subjects (21\u00b13 versus 18\u00b13 mm;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>In HCM, mitral valve leaflets are elongated independently of other disease variables, likely constituting a primary phenotypic expression of this heterogeneous disease, and are an important morphological abnormality responsible for LV outflow obstruction in combination with small outflow tract dimension. These findings suggest a novel role for cardiac magnetic resonance in the assessment of HCM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.110.985812","type":"journal-article","created":{"date-parts":[[2011,6,13]],"date-time":"2011-06-13T23:51:55Z","timestamp":1308009115000},"page":"40-47","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":379,"title":["Mitral Valve Abnormalities Identified by Cardiovascular Magnetic Resonance Represent a Primary Phenotypic Expression of Hypertrophic Cardiomyopathy"],"prefix":"10.1161","volume":"124","author":[{"given":"Martin S.","family":"Maron","sequence":"first","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (M.S.M., C.H., J.E.U.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy (I.O.); PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iacopo","family":"Olivotto","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (M.S.M., C.H., J.E.U.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy (I.O.); PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Harrigan","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (M.S.M., C.H., J.E.U.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy (I.O.); PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Appelbaum","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (M.S.M., C.H., J.E.U.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy (I.O.); PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Michael","family":"Gibson","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (M.S.M., C.H., J.E.U.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy (I.O.); PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"Lesser","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (M.S.M., C.H., J.E.U.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy (I.O.); PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammy S.","family":"Haas","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (M.S.M., C.H., J.E.U.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy (I.O.); PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James E.","family":"Udelson","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (M.S.M., C.H., J.E.U.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy (I.O.); PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren J.","family":"Manning","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (M.S.M., C.H., J.E.U.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy (I.O.); PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry J.","family":"Maron","sequence":"additional","affiliation":[{"name":"From the Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA (M.S.M., C.H., J.E.U.); Referral Center for Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence, Italy (I.O.); PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., C.M.G., W.J.M.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","first-page":"IV-3","article-title":"Idiopathic Hypertrophic subaortic stenosis, I: a description of the disease based upon an analysis of 64 patients","volume":"30","author":"Braunwald E","year":"1964","unstructured":"Braunwald E, Lambrew CT, Rockoff SD, Ross J, Morrow AG . Idiopathic Hypertrophic subaortic stenosis, I: a description of the disease based upon an analysis of 64 patients. 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Importance of leaflet elongation in causing systolic anterior motion of the mitral valve. J Heart Valve Dis. 1997;6:149\u2013159.","journal-title":"J Heart Valve Dis"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(87)90701-0"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2005.01.064"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2008.07.048"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(96)00103-9"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.04.063"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2003.09.040"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.9.122"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000092912.57140.14"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(96)00213-6"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.78.3.487"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.105.553313"},{"key":"e_1_3_3_42_2","first-page":"II-60","article-title":"Initial results of combined anterior mitral leaflet plication and ventricular septal myotomy-myectomy for relief of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy","volume":"86","author":"McIntosh CL","year":"1992","unstructured":"McIntosh CL, Maron BJ, Cannon RO, Klues HG . Initial results of combined anterior mitral leaflet plication and ventricular septal myotomy-myectomy for relief of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. 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