{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:07:24Z","timestamp":1790708844682,"version":"4.1.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2014,3,25]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Significant myxomatous mitral regurgitation leads to progressive left ventricular (LV) decline, resulting in congestive heart failure and death. Such patients benefit from mitral valve surgery. Exercise echocardiography aids in risk stratification and helps decide surgical timing. We sought to assess predictors of outcomes in such patients undergoing exercise echocardiography.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              This is an observational study of 884 consecutive patients (age, 58\u00b114 years; 67% men) with grade III+ or greater myxomatous mitral regurgitation who underwent exercise echocardiography between January 2000 and December 2011 (excluding functional mitral regurgitation, prior valvular surgery, hypertrophic cardiomyopathy, rheumatic valvular disease, or greater than mild mitral stenosis). Clinical and echocardiographic data (mitral regurgitation, LV ejection fraction, LV dimensions, right ventricular systolic pressure) and exercise variables (metabolic equivalents, heart rate recovery at 1 minute after exercise) were recorded. Composite events of death, myocardial infarction, stroke, and progression to congestive heart failure were recorded. Mean LV ejection fraction, indexed LV end-systolic dimension, resting right ventricular systolic pressure, peak stress right ventricular systolic pressure, metabolic equivalents achieved, and heart rate recovery were 58\u00b15%, 1.6\u00b10.4 mm\/m\n              <jats:sup>2<\/jats:sup>\n              , 31\u00b112 mm Hg, 46\u00b117 mm Hg, 9.6\u00b13, and 33\u00b114 beats, respectively. During 6.4\u00b14 years of follow-up, there were 87 events. On stepwise multivariable Cox analysis, percent of age\/sex-predicted metabolic equivalents (hazard ratio, 0.99; 95% confidence interval, 0.98\u20130.99;\n              <jats:italic>P<\/jats:italic>\n              =0.005), heart rate recovery (hazard ratio, 0.29; 95% confidence interval, 0.17\u20130.50;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), resting right ventricular systolic pressure (hazard ratio, 1.03; 95% confidence interval, 1.004\u20131.05;\n              <jats:italic>P<\/jats:italic>\n              =0.02), atrial fibrillation (hazard ratio, 1.91; 95% confidence interval, 1.07\u20133.41;\n              <jats:italic>P<\/jats:italic>\n              =0.03), and LV ejection fraction (hazard ratio, 0.96; 95% confidence interval, 0.92\u20130.99;\n              <jats:italic>P<\/jats:italic>\n              =0.04) predicted outcomes.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>In patients with grade III+ or greater myxomatous mitral regurgitation undergoing exercise echocardiography, lower percent of age\/sex-predicted metabolic equivalents, lower heart rate recovery, atrial fibrillation, lower LV ejection fraction, and high resting right ventricular systolic pressure predicted worse outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.113.005287","type":"journal-article","created":{"date-parts":[[2014,1,7]],"date-time":"2014-01-07T03:16:41Z","timestamp":1389064601000},"page":"1310-1319","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":55,"title":["Predictors of Long-Term Outcomes in Patients With Significant Myxomatous Mitral Regurgitation Undergoing Exercise Echocardiography"],"prefix":"10.1161","volume":"129","author":[{"given":"Peyman","family":"Naji","sequence":"first","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian P.","family":"Griffin","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi","family":"Asfahan","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Barr","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Leonardo","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Grimm","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shikhar","family":"Agarwal","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Stewart","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomislav","family":"Mihaljevic","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Marc","family":"Gillinov","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milind Y.","family":"Desai","sequence":"additional","affiliation":[{"name":"From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69208-8"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-668X(03)00201-X"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199611073351902"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.0000072274.12041.ff"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/12.suppl_B.5"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2010.10.004"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.03.079"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.599175"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.802314"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.05.007"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm095"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.3.400"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041451"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.06.047"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/circimaging.110.961011"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi272"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)01922-8"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq294"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.90.2.830"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.2459\/JCM.0b013e3283515c70"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.02.043"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.938241"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.12.073"},{"key":"e_1_3_2_25_2","first-page":"e269","article-title":"2011 ACCF\/AHA\/HRS focused updates incorporated into the ACC\/AHA\/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines.","volume":"123","author":"Fuster V","unstructured":"Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS, Smith SC, Priori SG, Estes NA, Ezekowitz MD, Jackman WM, January CT, Page RL, Slotwiner DJ, Stevenson WG, Tracy CM, Jacobs AK, Anderson JL, Albert N, Buller CE, Creager MA, Ettinger SM, Guyton RA, Hochman JS, Kushner FG, Ohman EM, Tarkington LG, Yancy CW. 2011 ACCF\/AHA\/HRS focused updates incorporated into the ACC\/AHA\/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines. Circulation.123:e269\u2013e367.","journal-title":"Circulation"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2005.10.005"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-7317(03)00335-3"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199910283411804"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(93)90832-L"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044154"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.08.003"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2007.07.003"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(96)00281-1"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(93)90840-W"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2011.09.002"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2009.03.046"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(98)00450-4"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2003.406"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1161\/hc37t1.094813"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)90150-3"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.11.1392"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.113.005287","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:39:15Z","timestamp":1715582355000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.005287"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,3,25]]},"references-count":40,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2014,3,25]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.113.005287"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.113.005287","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,3,25]]},"assertion":[{"value":"2013-07-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-12-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-01-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}