{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:20:29Z","timestamp":1790018429459,"version":"4.0.1"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2015,6,15]]},"abstract":"\n Background<\/jats:title>\n \n No gold standard currently exists for quantification of mitral regurgitation (\n MR<\/jats:styled-content>\n ) severity. Classification by echocardiography is based on integrative criteria using color and spectral Doppler and anatomic measurements. We hypothesized that a simple Doppler left ventricular early inflow\u2013outflow index (\n LVEIO<\/jats:styled-content>\n ), based on flow velocity into the left ventricle (\n LV<\/jats:styled-content>\n ) in diastole and ejected from the\n LV<\/jats:styled-content>\n in systole, would add incrementally to current diagnostic criteria.\n LVEIO<\/jats:styled-content>\n was calculated by dividing the mitral E\u2010wave velocity by the\n LV<\/jats:styled-content>\n outflow velocity time integral.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Transthoracic echocardiography reports from Montefiore Medical Center and its referring clinics from July 1, 2011, to December 31, 2011 (n=11\u00a0235) were reviewed. The\n MR<\/jats:styled-content>\n severity reported by a cardiologist certified by the National Board of Echocardiography was used as a reference standard. Studies reporting moderate or severe\n MR<\/jats:styled-content>\n (n=550) were reanalyzed to measure effective regurgitant orifice area by the proximal isovelocity surface area method, vena contracta width,\n MR<\/jats:styled-content>\n jet area, and left\u2010sided chamber volumes.\n LVEIO<\/jats:styled-content>\n was 9.3\u00b13.9, 7.0\u00b13.2, and 4.2\u00b11.7 among those with severe, moderate, and insignificant\n MR<\/jats:styled-content>\n , respectively (\n ANOVA<\/jats:styled-content>\n P<\/jats:italic>\n <0.001). By receiver operating characteristic analysis, area under the curve for\n LVEIO<\/jats:styled-content>\n was 0.92 for severe\n MR<\/jats:styled-content>\n . Those with\n LVEIO<\/jats:styled-content>\n \u22658 were likely to have severe\n MR<\/jats:styled-content>\n (likelihood ratio 26.5), whereas those with\n LVEIO<\/jats:styled-content>\n \u22644 were unlikely to have severe\n MR<\/jats:styled-content>\n (likelihood ratio 0.11).\n LVEIO<\/jats:styled-content>\n performed better in those with normal\n LV ejection fraction<\/jats:styled-content>\n (\u226550%) compared with those with reduced\n LV ejection fraction<\/jats:styled-content>\n (<50%) (area under the curve 0.92 versus 0.80,\n P<\/jats:italic>\n <0.001). By multivariate logistic regression analysis,\n LVEIO<\/jats:styled-content>\n was independently associated with severe\n MR<\/jats:styled-content>\n when compared with\n vena contracta<\/jats:styled-content>\n width,\n MR<\/jats:styled-content>\n jet area, and\n effective regurgitant orifice area measured<\/jats:styled-content>\n by\n the proximal isovelocity surface area method<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n LVEIO<\/jats:styled-content>\n is a simple\u2010to\u2010use echocardiographic parameter that accurately identifies severe\n MR<\/jats:styled-content>\n , particularly in patients with normal\n LV ejection fraction<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.113.000781","type":"journal-article","created":{"date-parts":[[2015,6,13]],"date-time":"2015-06-13T03:05:56Z","timestamp":1434164756000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Left Ventricular Early Inflow\u2013Outflow Index: A Novel Echocardiographic Indicator of Mitral Regurgitation Severity"],"prefix":"10.1161","volume":"4","author":[{"given":"Ming\u2010Ming","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Medicine, Rhode Island Hospital, Brown University, Providence, RI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha","family":"Salahuddin","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario J.","family":"Garcia","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"Spevack","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-7317(03)00335-3"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jeq121"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2010.01.019"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2008.11.023"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780040112"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(86)80146-2"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.87.3.841"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8175.2007.00479.x"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-008-9362-9"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2012.10.011"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2009.11.008"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.05.028"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.95.3.636"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.84.2.712"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(93)90248-Y"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(88)92621-6"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)00434-R"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(95)00486-6"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.10.2951"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-7317(03)00509-1"},{"key":"e_1_3_2_22_2","first-page":"376","article-title":"How to measure severity of mitral regurgitation","volume":"94","author":"Grayburn PA","year":"2008","unstructured":"Grayburn PA. How to measure severity of mitral regurgitation. Heart. 2008;94:376\u2013383.","journal-title":"Heart"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2009.09.029"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(97)00454-3"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.113.000781","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:01:10Z","timestamp":1715594470000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.113.000781"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,6,15]]},"references-count":23,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2015,6,15]]}},"alternative-id":["10.1161\/JAHA.113.000781"],"URL":"https:\/\/doi.org\/10.1161\/jaha.113.000781","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,6,15]]},"assertion":[{"value":"2013-12-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-03-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-06-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e000781"}}