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Aremu OO, Samuels P, Jermy S, Lumngwena EN, Mutithu D, Cupido BJ, Skatulla S, Ntusi NAB. Cardiovascular imaging modalities in the diagnosis and management of rheumatic heart disease. Int J Cardiol 2020; 325:176-185. [PMID: 32980432 DOI: 10.1016/j.ijcard.2020.09.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/09/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
Rheumatic heart disease (RHD) is prevalent in sub-Saharan Africa, where the capacity for diagnosis and evaluation of disease severity and complications is not always optimal. While the medical history and physical examination are important in the assessment of patients suspected to have RHD, cardiovascular imaging techniques are useful for confirmation of the diagnosis. Echocardiography is the workhorse modality for initial evaluation and diagnosis of RHD. Cardiovascular magnetic resonance is complementary and may provide additive information, including tissue characteristics, where echocardiography is inadequate or non-diagnostic. There is emerging evidence on the role of computed tomography, particularly following valve replacement surgery, in the monitoring and management of RHD. This article summarises the techniques used in imaging RHD patients, considers the evidence base for their utility, discusses their limitations and recognises the clinical contexts in which indications and imaging with various modalities are expanding.
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Affiliation(s)
- Olukayode O Aremu
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Petronella Samuels
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Stephen Jermy
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Evelyn N Lumngwena
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; Centre for the Study of Emerging and Ee-emerging Infections (CREMER), Institute for Medical Research and Medicinal Plant studies (IMPM), Ministry of Scientific Research and Innovation, Cameroon
| | - Daniel Mutithu
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Blanche J Cupido
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sebastian Skatulla
- Division of Structural Engineering and Mechanics, Department of Civil Engineering, University of Cape Town, South Africa; Department of Civil Engineering, Centre for Research in Computational and Applied Mechanics (CERECAM), University of Cape Town, South Africa
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa; Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, South Africa.
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Quien MM, Vainrib AF, Freedberg RS, Bamira DG, Benenstein RJ, Williams MR, Saric M. Advanced Imaging Techniques for Mitral Regurgitation. Prog Cardiovasc Dis 2018; 61:390-396. [PMID: 30321560 DOI: 10.1016/j.pcad.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/16/2022]
Abstract
Mitral regurgitation (MR) is one of the most commonly encountered valvular lesions in clinical practice. MR can be either primary (degenerative) or secondary (functional) depending on the etiology of MR and the pathology of the mitral valve (MV). Echocardiography is the primary diagnostic tool for MR and is key in determining this etiology as well as MR severity. While clinicians usually turn to 2 Dimensional echocardiography as first-line imaging, 3 Dimensional echocardiography (3DE) has continually shown to be superior in terms of describing MV anatomy and pathology. This review article elaborates on 3DE techniques, modalities, and advances in software. Furthermore, the article demonstrates how 3DE has reformed MR evaluation and has played a vital role in determining patient management.
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Affiliation(s)
- Mary M Quien
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016
| | - Robin S Freedberg
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016
| | - Daniel G Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016
| | - Ricardo J Benenstein
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016
| | - Mathew R Williams
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, 560 First Avenue, New York, NY 10016.
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Gao H, Qi N, Feng L, Ma X, Danton M, Berry C, Luo X. Modelling mitral valvular dynamics-current trend and future directions. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2017; 33:e2858. [PMID: 27935265 PMCID: PMC5697636 DOI: 10.1002/cnm.2858] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/30/2016] [Accepted: 11/26/2016] [Indexed: 05/19/2023]
Abstract
Dysfunction of mitral valve causes morbidity and premature mortality and remains a leading medical problem worldwide. Computational modelling aims to understand the biomechanics of human mitral valve and could lead to the development of new treatment, prevention and diagnosis of mitral valve diseases. Compared with the aortic valve, the mitral valve has been much less studied owing to its highly complex structure and strong interaction with the blood flow and the ventricles. However, the interest in mitral valve modelling is growing, and the sophistication level is increasing with the advanced development of computational technology and imaging tools. This review summarises the state-of-the-art modelling of the mitral valve, including static and dynamics models, models with fluid-structure interaction, and models with the left ventricle interaction. Challenges and future directions are also discussed.
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Affiliation(s)
- Hao Gao
- School of Mathematics and StatisticsUniversity of GlasgowUK
| | - Nan Qi
- School of Mathematics and StatisticsUniversity of GlasgowUK
| | - Liuyang Feng
- School of Mathematics and StatisticsUniversity of GlasgowUK
| | | | - Mark Danton
- Department of Cardiac SurgeryRoyal Hospital for ChildrenGlasgowUK
| | - Colin Berry
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUK
| | - Xiaoyu Luo
- School of Mathematics and StatisticsUniversity of GlasgowUK
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Chandrasekhar J, Dangas G, Mehran R. Valvular Heart Disease in Women, Differential Remodeling, and Response to New Therapies. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:74. [DOI: 10.1007/s11936-017-0573-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Wu S, Duan B, Qin X, Butcher JT. Living nano-micro fibrous woven fabric/hydrogel composite scaffolds for heart valve engineering. Acta Biomater 2017; 51:89-100. [PMID: 28110071 DOI: 10.1016/j.actbio.2017.01.051] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/27/2016] [Accepted: 01/17/2017] [Indexed: 02/07/2023]
Abstract
Regeneration and repair of injured or diseased heart valves remains a clinical challenge. Tissue engineering provides a promising treatment approach to facilitate living heart valve repair and regeneration. Three-dimensional (3D) biomimetic scaffolds that possess heterogeneous and anisotropic features that approximate those of native heart valve tissue are beneficial to the successful in vitro development of tissue engineered heart valves (TEHV). Here we report the development and characterization of a novel composite scaffold consisting of nano- and micro-scale fibrous woven fabrics and 3D hydrogels by using textile techniques combined with bioactive hydrogel formation. Embedded nano-micro fibrous scaffolds within hydrogel enhanced mechanical strength and physical structural anisotropy of the composite scaffold (similar to native aortic valve leaflets) and also reduced its compaction. We determined that the composite scaffolds supported the growth of human aortic valve interstitial cells (HAVIC), balanced the remodeling of heart valve ECM against shrinkage, and maintained better physiological fibroblastic phenotype in both normal and diseased HAVIC over single materials. These fabricated composite scaffolds enable the engineering of a living heart valve graft with improved anisotropic structure and tissue biomechanics important for maintaining valve cell phenotypes. STATEMENT OF SIGNIFICANCE Heart valve-related disease is an important clinical problem, with over 300,000 surgical repairs performed annually. Tissue engineering offers a promising strategy for heart valve repair and regeneration. In this study, we developed and tissue engineered living nano-micro fibrous woven fabric/hydrogel composite scaffolds by using textile technique combined with bioactive hydrogel formation. The novelty of our technique is that the composite scaffolds can mimic physical structure anisotropy and the mechanical strength of natural aortic valve leaflet. Moreover, the composite scaffolds prevented the matrix shrinkage, which is major problem that causes the failure of TEHV, and better maintained physiological fibroblastic phenotype in both normal and diseased HAVIC. This work marks the first report of a combination composite scaffold using 3D hydrogel enhanced by nano-micro fibrous woven fabric, and represents a promising tissue engineering strategy to treat heart valve injury.
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Echocardiographic assessment of long-term hemodynamic characteristics of mechanical mitral valve prostheses with different mitral valvular diseases. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2017; 40:259-266. [PMID: 28105540 DOI: 10.1007/s13246-016-0521-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 12/28/2016] [Indexed: 02/05/2023]
Abstract
Mitral stenosis (MS) and mitral insufficiency (MI) have different pre-operative hemodynamic characteristics. However, it is unclear if there are differences in long-term echocardiographic characteristics of MS and MI patients after mechanical mitral valve replacement. This study is to compare long-term echocardiographic results of mechanical mitral valve prostheses between MS and MI patients. From January 2003 to January 2009, a total of 199 consecutive patients were recruited in this study. Patients were classified as group MS (n = 123) and MI (n = 76) according to the manifestation of mitral valvular disease. The mean age for patients was 50.1 ± 10.5 years and follow-up time was 7.2 ± 2.0 years. The MS after operation were more likely to experience atrial fibrillation (p = 0.002). The New York Heart Association (NYHA) class in MI showed a greater improvement (p = 0.006) than in MS. The left ventricular end-diastolic dimension (LVEDD) (p = 0.010) and stroke volume (SV) (p = 0.000) in MI were still larger than that in MS patients. These differences did not disappear with time after operation. The long-term echocardiographic results of mechanical mitral valve prostheses between MS and MI patients are significantly different. Over a long-term follow up, MI patients still have a larger LVEDD and SV than MS, and associated with a greater improvement of NYHA class.
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Jolobe O. Recognition of the distinction between primary and secondary mitral regurgitation is also important. QJM 2016; 109:699. [PMID: 27289110 DOI: 10.1093/qjmed/hcw084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- O Jolobe
- From the Manchester Medical Society, Manchester, UK.
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Kenzaka T, Kusano S. Response: "Recognition of the distinction between primary and secondary mitral regurgitation is also important". QJM 2016; 109:700. [PMID: 27289115 DOI: 10.1093/qjmed/hcw086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/02/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Kenzaka
- From the Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Internal Medicine, Hyogo Prefectural Kaibara Hospital, Tamba, Japan
| | - S Kusano
- Department of Internal Medicine, Hyogo Prefectural Kaibara Hospital, Tamba, Japan
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Popa MO, Irimia AM, Papagheorghe MN, Vasile EM, Tircol SA, Negulescu RA, Toader C, Adam R, Dorobantu L, Caldararu C, Alexandrescu M, Onciul S. The mechanisms, diagnosis and management of mitral regurgitation in mitral valve prolapse and hypertrophic cardiomyopathy. Discoveries (Craiova) 2016; 4:e61. [PMID: 32309580 PMCID: PMC7159827 DOI: 10.15190/d.2016.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Valvular disease is a frequent cardiac pathology leading to heart failure and, ultimately, death. Mitral regurgitation, defined as the inability of the two mitral leaflets to coapt, is a common valvular disease and a self sustained pathology. A better understanding of the mitral valve histological layers provides a better understanding of the leaflet and chordae changes in mitral valve prolapse.
Mitral valve prolapse may occur in myxomatous degenerative abnormalities, connective tissue disorders or in sporadic isolated cases. It is the most common mitral abnormality of non-ischemic cause leading to severe surgery-requiring mitral regurgitation. In addition to standard echocardiographic investigations, newly implemented three-dimensional techniques are being used and they permit a better visualisation, from the so-called ‘surgical view’, and an improved evaluation of the mitral valve.
Hypertrophic cardiomyopathy is the most frequent inherited myocardial disease caused by mutations in various genes encoding proteins of the cardiac sarcomere, leading to a marked left ventricular hypertrophy unexplained by other comorbidities. The pathological echocardiographic hallmarks of hypertrophic cardiomyopathy are left ventricular hypertrophy, left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve. The systolic anterior motion of the mitral valve contributes to the development of mitral regurgitation and further narrows the left ventricular outflow tract, leading to more severe symptomatology. Cardiac magnetic resonance imaging accurately measures the left ventricular mass, the degree of diastolic function and it may also be used to distinguish phenotypic variants.
The clinical outcome of patients with these pathologies is mostly determined by the selected option of treatment. The purpose of surgical correction regarding mitral valve involvement is to restore valvular competence. Surgery has proven to be the only useful treatment in preventing heart failure, improving symptomatology and reducing mortality. Our approach wishes to enhance the understanding of the mitral valve’s involvement in hypertrophic cardiomyopathy and mitral valve prolapse from genetic, haemodynamic and clinical perspectives, as well as to present novelties in the grand field of treatment.
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Affiliation(s)
| | - Ana Maria Irimia
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | | | | | - Catalina Toader
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Robert Adam
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Lucian Dorobantu
- Department of Cardiovascular Surgery, Monza Hospital, Bucharest, Romania
| | | | - Maria Alexandrescu
- Department of Radiology and Imaging Sciences, Monza Hospital, Bucharest, Romania
| | - Sebastian Onciul
- Department of Cardiology, Floreasca Clinical Emergency Hospital, Bucharest, Romania
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Tarkiainen M, Sipola P, Jalanko M, Heliö T, Laine M, Järvinen V, Häyrinen K, Lauerma K, Kuusisto J. Cardiovascular magnetic resonance of mitral valve length in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2016; 18:33. [PMID: 27259862 PMCID: PMC4893285 DOI: 10.1186/s12968-016-0250-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Previous data suggest that mitral valve leaflets are elongated in hypertrophic cardiomyopathy (HCM), and mitral valve leaflet elongation may constitute a primary phenotypic expression of HCM. Our objective was to measure the length of mitral valve leaflets by cardiovascular magnetic resonance (CMR) in subjects with HCM caused by a Finnish founder mutation in the myosin-binding protein C gene (MYBPC3-Q1061X), carriers of the same mutation without left ventricular hypertrophy, as well as in unselected consecutive patients with HCM, and respective controls. METHODS Anterior mitral valve leaflet (AML) and posterior mitral valve leaflet (PML) lengths were measured by CMR in 47 subjects with the Q1061X mutation in the gene encoding MYBPC3 and in 20 healthy relatives without the mutation. In addition, mitral valve leaflet lengths were measured by CMR in 80 consecutive non-genotyped patients with HCM in CMR and 71 age- and gender-matched healthy subjects. RESULTS Of the subjects with the MYBPC-Q1016X mutation, 32 had left ventricular hypertrophy (LVH, LV maximal wall thickness ≥ 13 mm in CMR) and 15 had no hypertrophy. PML was longer in patients with the MYBPC3-Q1061X mutation and LVH than in controls of the MYBPC group (12.8 ± 2.8 vs 10.6 ± 1.9 mm, P = 0.013), but the difference between the groups was not statistically significant when PML was indexed for BSA (P = 0.066), or when PML length was adjusted for BSA, age, gender, LV mass and ejection fraction (P = 0.195). There was no significant difference in the PML length in mutation carriers without LVH and controls (11.1 ± 3.4 vs 10.6 ± 1.9, P = 0.52). We found no difference in AML lengths between the MYBPC mutation carriers with or without hypertrophy and controls. In 80 consecutive non-genotyped patients with HCM, there was no difference either in AML or PML lengths in subjects with HCM compared to respective control subjects. CONCLUSIONS In subjects with HCM caused by the Q1061X mutation in the MYBPC3 gene, the posterior mitral valve leaflets may be elongated, but mitral valve elongation does not constitute primary phenotypic expression of the disease. Instead, elongated mitral valve leaflets seem to be associated with body size and left ventricular remodeling.
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Affiliation(s)
- Mika Tarkiainen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Petri Sipola
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Mikko Jalanko
- Heart and Lung Center, Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Tiina Heliö
- Heart and Lung Center, Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Laine
- Heart and Lung Center, Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Vesa Järvinen
- HUS Medical Imaging Center, Clinical Physiology and Nuclear Medicine, Hyvinkää Hospital, Hyvinkää, Finland
| | | | - Kirsi Lauerma
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Johanna Kuusisto
- Centre for Medicine and Clinical Research, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
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Use of strain and strain rate echocardiographic imaging to predict the progression of mitral stenosis: a 5-year follow-up study the progression of mitral stenosis: a 5-year follow-up study. Anatol J Cardiol 2016; 16:772-777. [PMID: 27182618 PMCID: PMC5324938 DOI: 10.14744/anatoljcardiol.2015.6590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: Little information is available about echocardiographic progression of mitral stenosis (MS). The aim of this study was to investigate whether the left ventricular (LV) strain is a favorable method predicting the progression of MS. Methods: Forty-eight patients with isolated mild-to-moderate MS were enrolled in this prospective cohort study. LV global longitudinal strain (GLS) and strain rate (GLSR) were measured by two-dimensional echocardiography (2-DE) at the baseline. Mitral valve area (MVA) was evaluated during the 5-year follow-up. The change in MVA from the beginning to the end of the surveillance period was determined as an indicator of progression. Pearson’s correlation test was used, and significant differences between the groups were analyzed using the Student’s t-test or the Mann–Whitney U test. At the end of follow-up, we evaluated the correlation between the change in MVA and both GLS-GLSR. GLS and GLSR are predictive factors for MS progression, whether or not it has been tested according to the receiver operating characteristics curve analysis. Results: A meaningful correlation was detected between the change in MVA with both GLS and GLSR (r=0.924 and r=0.980, respectively, p<0.001). The cut-off value for GLS was identified as –16.98 (sensitivity 81%, specificity 96%, p<0.001) and for GLSR as –1.45 (sensitivity 95%, specificity 100%, p<0.001). Patients with MS having a value under (mathematically above) these cut-off values showed more rapid progression. Conclusion: The progression of MS can be predicted by GLS and GLSR measurements, which are evaluated via strain echocardiography. (Anatol J Cardiol 2016; 16: 772-7)
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