{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:17:15Z","timestamp":1793215035549,"version":"4.5.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Effective orifice area (EOA) \u22650.2\u00a0cm\n              <jats:sup>2<\/jats:sup>\n              or regurgitant volume (Rvol) \u226530\u00a0mL predicts prognostic significance in functional mitral regurgitation (FMR). Both volumetric and proximal isovelocity surface area (PISA) methods enable calculation of these metrics. To determine their clinical value, we compared EOA and Rvol derived by volumetric and PISA quantitation upon outcome of patients with FMR.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We examined the outcome of patients with left ventricular ejection fraction &lt;35% and moderate to severe FMR. All had a complete echocardiogram including EOA and Rvol by both standard PISA and volumetric quantitation using total stroke volume calculated by left ventricular end\u2010diastolic volume\u00d7left ventricular ejection fraction and forward flow by Doppler method: EOA=Rvol\/mitral regurgitation velocity time integral. Primary outcome was all\u2010cause mortality or heart transplantation. We examined 177 patients: mean left ventricular ejection fraction 25.2% and 34.5% with ischemic cardiomyopathy. Echo measurements were greater by PISA than volumetric quantitation: EOA (0.18 versus 0.11 cm\n              <jats:sup>2<\/jats:sup>\n              ), Rvol (24.7 versus 16.9\u00a0mL), and regurgitant fraction (61 versus 37 %) respectively (all\n              <jats:italic>P<\/jats:italic>\n              value &lt;0.001). During 3.6\u00b12.3\u00a0years\u2019 follow\u2010up, patients with EOA \u22650.2\u00a0cm\n              <jats:sup>2<\/jats:sup>\n              or Rvol \u226530\u00a0mL had a worse outcome than those with EOA &lt;0.2\u00a0cm\n              <jats:sup>2<\/jats:sup>\n              or Rvol &lt;30\u00a0mL only by volumetric (log rank\n              <jats:italic>P<\/jats:italic>\n              =0.003 and 0.004) but not PISA quantitation (log rank\n              <jats:italic>P<\/jats:italic>\n              =0.984 and 0.544), respectively.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Volumetric and PISA methods yield different measurements of EOA and Rvol in FMR; volumetric values exhibit greater prognostic significance. The echo method of quantifying FMR may affect the management of this disorder.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.018553","type":"journal-article","created":{"date-parts":[[2021,5,22]],"date-time":"2021-05-22T09:38:24Z","timestamp":1621676304000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Optimal Quantification of Functional Mitral Regurgitation: Comparison of Volumetric and Proximal Isovelocity Surface Area Methods to Predict Outcome"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9709-583X","authenticated-orcid":false,"given":"Sachiyo","family":"Igata","sequence":"first","affiliation":[{"name":"The Division of Cardiology Department of Medicine University of California, San DiegoSulpizio Cardiovascular Center San Diego CA"},{"name":"The Division of Cardiovascular Medicine Department of Medicine Kurume University School of Medicine Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno R.","family":"Cotter","sequence":"additional","affiliation":[{"name":"The Division of Cardiology Department of Medicine University of California, San DiegoSulpizio Cardiovascular Center San Diego CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calvin T.","family":"Hang","sequence":"additional","affiliation":[{"name":"The Division of Cardiology Department of Medicine University of California, San DiegoSulpizio Cardiovascular Center San Diego CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagisa","family":"Morikawa","sequence":"additional","affiliation":[{"name":"The Division of Cardiovascular Medicine Department of Medicine Kurume University School of Medicine Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monet","family":"Strachan","sequence":"additional","affiliation":[{"name":"The Division of Cardiology Department of Medicine University of California, San DiegoSulpizio Cardiovascular Center San Diego CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajit","family":"Raisinghani","sequence":"additional","affiliation":[{"name":"The Division of Cardiology Department of Medicine University of California, San DiegoSulpizio Cardiovascular Center San Diego CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel G.","family":"Blanchard","sequence":"additional","affiliation":[{"name":"The Division of Cardiology Department of Medicine University of California, San DiegoSulpizio Cardiovascular Center San Diego CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8944-397X","authenticated-orcid":false,"given":"Anthony N.","family":"DeMaria","sequence":"additional","affiliation":[{"name":"The Division of Cardiology Department of Medicine University of California, San DiegoSulpizio Cardiovascular Center San Diego CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2011.10.004"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2011.04.001"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8175.2010.01204.x"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.euje.2004.03.001"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jeq121"},{"key":"e_1_3_2_7_2","first-page":"207","article-title":"Ischemic mitral regurgitation: mechanisms and echocardiographic classification","volume":"9","author":"Agricola E","year":"2008","unstructured":"Agricola E, Oppizzi M, Pisani M, Meris A, Maisano F, Margonato A. 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