{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T04:57:31Z","timestamp":1766120251190,"version":"3.48.0"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,11,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The double helical direction of myocardial fibers allows for left ventricular (LV) twist. This led to the hypothesis that principal strain angles determine LV functional recovery after mitral valve repair in patients with primary mitral regurgitation (PMR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Controls (n=52) and patients with PMR with regurgitant volume defined as mild (&lt;30 mL, n=16), moderate (30\u201350 mL, n=38), and severe (50 mL, n=55) had cardiac magnetic resonance with tissue tagging and 3\u2010dimensional analysis. Fifty\u2010four patients with PMR had presurgery and 6 (n=46), 12 (n=44), and 24 (n=25) month studies. Longitudinal, circumferential, and maximal shortening were computed along with principal strain angles (circumferential, longitudinal, and radial directions) at base, mid, and distal LV levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">LV ejection fraction did not differ in mild, moderate, and severe PMR with similar increases in mid LV 3\u2010dimensional radius\u2010to\u2010wall thickness and decrease in LV mass to volume and sphericity index versus controls. Radial longitudinal shear strain and LV mid and distal LV circumferential and longitudinal angles increased in all groups with PMR. Postsurgery LV end\u2010diastolic volume, LV end\u2010diastolic mass to volume and 3\u2010dimensional radius\u2010to\u2010wall thickness returned to normal at 6, 12, and 24 months; however, mid LV circumferential, longitudinal, and maximal shortening decreased below normal. LV circumferential and longitudinal angles and LV sphericity index did not change from presurgery whereas LV ejection fraction post surgery correlated with decrease in LV twist at 6, 12, and 24 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Changes in principle strain angles occur early in PMR. The extent to which they persist after surgery may underlie the decrease in LV ejection fraction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.043558","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T11:12:35Z","timestamp":1763377955000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent Shift in Principal Strain Angles and Postsurgical Decline in Left Ventricular Ejection Fraction in Patients With Primary Mitral Regurgitation"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6654-0665","authenticated-orcid":false,"given":"Louis J.","family":"Dell\u2019Italia","sequence":"first","affiliation":[{"name":"Birmingham Veterans Affairs Health Care System","place":["Birmingham, USA"]},{"name":"University of Alabama at Birmingham","place":["Birmingham, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariame Selma","family":"Kane","sequence":"additional","affiliation":[{"name":"Birmingham Veterans Affairs Health Care System","place":["Birmingham, USA"]},{"name":"University of Alabama at Birmingham","place":["Birmingham, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0393-0997","authenticated-orcid":false,"given":"Jingyi","family":"Zheng","sequence":"additional","affiliation":[{"name":"Auburn University","place":["Auburn, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shao\u2010Wei","family":"Huang","sequence":"additional","affiliation":[{"name":"Auburn University","place":["Auburn, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betty","family":"Pat","sequence":"additional","affiliation":[{"name":"Birmingham Veterans Affairs Health Care System","place":["Birmingham, USA"]},{"name":"University of Alabama at Birmingham","place":["Birmingham, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6695-4777","authenticated-orcid":false,"suffix":"Jr","given":"Thomas S.","family":"Denney","sequence":"additional","affiliation":[{"name":"Auburn University","place":["Auburn, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1055"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.24811"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2023.1112797"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2024.1410859"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.12.027"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacbts.2022.04.014"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.073239"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(80)90471-4"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.06.083"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.11.025"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.1995.269.2.H571"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00484.2008"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00261.2001"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.1999.276.2.H595"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.res.24.3.339"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-2828(74)90074-1"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2010.05.004"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2007.126284"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jer003"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.108.785923"},{"key":"e_1_3_1_22_2","first-page":"39","article-title":"Torsion dynamics in the evolution from acute to chronic mitral regurgitation","volume":"11","author":"Tibayan FA","year":"2002","unstructured":"Tibayan FA, Yun KL, Fann JI, Lai DT, Timek TA, Daughters GT, Ingels NB, Miller DC. 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