{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:10:40Z","timestamp":1791616240391,"version":"4.3.4"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,2,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Mitral annular calcification (MAC) is common and associated with increased cardiovascular risk and, when severe, mitral stenosis (MS). MAC\u2010related MS differs anatomically and hemodynamically from rheumatic MS (RMS), challenging standard diagnostic methods. This study compares structural and flow characteristics, including \u00a0kinetic energy losses, across MAC\u2010related MS, RMS, and normal mitral valves, and evaluates the applicability of conventional diagnostic metrics in MAC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Three\u2010dimensional transesophageal echocardiographic data sets from 70 patients (22 normal mitral valves, 26 RMS valves, 22 MAC valves) were used to obtain linear, area, and volumetric measurements for valve comparison. Representative valves from each group were converted into 3\u2010dimensional silicone models for in\u00a0vitro testing in a heart flow simulator. Transmitral flow was assessed with particle image velocimetry, flow energetics were quantified, and coefficients of contraction were derived from geometric and effective orifice areas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Compared with RMS, MAC\u2010related MS had smaller anteroposterior dimensions, reduced valve volume, and lower coefficients of contraction. MAC demonstrated the highest transmitral velocities and energy dissipation in\u00a0vitro. Unlike the normal model, neither MAC nor RMS produced a consistent transmitral vortex ring. Despite having a larger geometric orifice, MAC MS produced a greater pressure drop than RMS, likely due to increased flow disruption and lower coefficients of contraction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">MAC\u2010related MS represents a unique pathophysiological entity, characterized by distinct structural and hemodynamic features. These findings underscore the necessity for disease\u2010specific diagnostic frameworks and multimodality imaging strategies to inform clinical decision making and guide emerging therapeutic approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.045018","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T13:29:12Z","timestamp":1769002152000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Two Faces of Mitral Stenosis: Uncovering Structural and Hemodynamic Signatures of Rheumatic and Mitral Annular Calcification\u2013Induced Disease"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0436-6088","authenticated-orcid":false,"given":"Mohammad S.","family":"Hashemi","sequence":"first","affiliation":[{"name":"University of California Irvine","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7677-9610","authenticated-orcid":false,"given":"Peter","family":"Abdelmaseeh","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atif","family":"Nehvi","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0992-1805","authenticated-orcid":false,"given":"Gregg S.","family":"Pressman","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3864-1359","authenticated-orcid":false,"given":"Arash","family":"Kheradvar","sequence":"additional","affiliation":[{"name":"University of California Irvine","place":["USA"]},{"name":"University of California Irvine","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.08.872"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.15420\/ecr.2021.25"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.030540"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/echo.14861"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2024.06.017"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.05.032"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2013.06.014"},{"key":"e_1_3_2_9_2","unstructured":"Bhargav R Pressman GS. 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