{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T20:37:11Z","timestamp":1790368631152,"version":"4.1.0"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Left ventricular (LV) end\u2010systolic enlargement in severe degenerative mitral\u2010regurgitation (MR) is a class I surgical trigger. Whether it occurs disproportionately to less\u2010than\u2010severe MR due to mitral valve prolapse and is associated with mortality are unknown. We aimed to analyze prevalence and association with survival of disproportionate LV enlargement in less\u2010than\u2010severe MR.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">A multicenter cohort international study enrolled 2848 consecutive patients (52% women, 69\u00b116\u2009years) with degenerative MR prospectively quantified and graded mild or moderate. Primary end point was survival under medical management. Secondary outcome was survival throughout follow\u2010up stratified by performance of early mitral surgery within 3\u2009months postdiagnosis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Among LV remodeling parameters (abnormal end\u2010diastolic diameter, LV end\u2010systolic diameter [LVESD] absolute and indexed), LVESD \u226540\u2009mm (present in 12.4%) was the sole independent associate of reduced survival (5\u2010year 70\u00b13 versus 76\u00b19%;\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.009). LVESD \u226540\u2009mm was independently linked to larger body surface area, effective regurgitant orifice, and left atrium, and to male sex and diabetes. With multivariable comprehensive adjustment, LVESD \u226540\u2009mm (adjusted hazard ratio [aHR], 1.25 [95% CI, 1.005\u20131.53];\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.04) remained associated with excess mortality under medical management, even after adjustment for lowered ejection fraction (aHR, 1.49 [95% CI, 1.13\u20131.95];\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.004) and in all patient subsets. Among patients with moderate degenerative MR and LVESD \u226540\u2009mm, 22% underwent mitral surgery within 3\u2009months, which was associated with superior survival, even after comprehensive adjustment (aHR, 0.11 [95% CI, 0.005\u20130.51];\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.002).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Disproportionate LV enlargement in patients with less\u2010than\u2010severe degenerative MR is common, particularly with larger bodies, regurgitation, and overall cardiac remodeling. LVESD \u226540\u2009mm is associated with worse survival independent of all baseline characteristics, even lowered ejection fraction, and represents a marker for risk stratification of patients who are generally not yet considered for medical or surgical\/interventional treatment.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.040868","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T12:05:14Z","timestamp":1752753914000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Disproportionate Left Ventricular Enlargement in Mitral Valve Prolapse: Prevalence, Predictors, and Association With Outcomes"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6101-8242","authenticated-orcid":false,"given":"Yan","family":"Topilsky","sequence":"first","affiliation":[{"name":"Tel Aviv Medical Center and Sackler Faculty of Medicine","place":["Tel Aviv, 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