{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T07:46:03Z","timestamp":1791186363832,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,1,21]],"date-time":"2018-01-21T00:00:00Z","timestamp":1516492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Determining severity of mitral stenosis (<jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content>) by planimetry of mitral valve orifice area (<jats:styled-content style=\"fixed-case\">MVA<\/jats:styled-content>) has been a challenging issue in clinical practice, especially for less experienced cardiologists. Mitral leaflet separation (<jats:styled-content style=\"fixed-case\">MLS<\/jats:styled-content>) has shown a good correlation with <jats:styled-content style=\"fixed-case\">MVA<\/jats:styled-content> measurements. However, it has never been validated against multiplane 3<jats:styled-content style=\"fixed-case\">DTEE<\/jats:styled-content> planimetry (<jats:styled-content style=\"fixed-case\">MVA<\/jats:styled-content><jats:sub>3D<\/jats:sub>). We aimed to evaluate the accuracy of <jats:styled-content style=\"fixed-case\">MLS<\/jats:styled-content> index (<jats:styled-content style=\"fixed-case\">MLSI<\/jats:styled-content><jats:sub>2D<\/jats:sub>) in predicting <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content> severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively enrolled 144 patients with <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content> who underwent clinically indicated 2<jats:styled-content style=\"fixed-case\">DTTE<\/jats:styled-content> and 3<jats:styled-content style=\"fixed-case\">DTEE<\/jats:styled-content>. <jats:styled-content style=\"fixed-case\">MLSI<\/jats:styled-content><jats:sub>2D<\/jats:sub> was yield by averaging the maximal leaflet tip distance in diastole, in parasternal long\u2010axis and apical four\u2010chamber views. <jats:styled-content style=\"fixed-case\">MVA<\/jats:styled-content><jats:sub>3D<\/jats:sub> was used as the reference method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">MLSI<\/jats:styled-content><jats:sub>2D<\/jats:sub> showed an excellent discriminatory ability between different grades of <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content> (<jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>.001). There was a significant positive correlation between <jats:styled-content style=\"fixed-case\">MLSI<\/jats:styled-content><jats:sub>2D<\/jats:sub> and <jats:styled-content style=\"fixed-case\">MVA<\/jats:styled-content><jats:sub>3D<\/jats:sub> (<jats:italic>r<\/jats:italic>\u00a0=\u00a0.93, <jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>.001) irrespective of concurrent mitral regurgitation (<jats:italic>r<\/jats:italic>\u00a0=\u00a0.94, <jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>.001) and\/or atrial fibrillation (<jats:italic>r<\/jats:italic>\u00a0=\u00a0.92, <jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>.001). By receiver operating characteristic (<jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content>) curves, <jats:styled-content style=\"fixed-case\">MLSI<\/jats:styled-content><jats:sub>2D<\/jats:sub>\u00a0\u2264\u00a08.6\u00a0mm showed 100% sensitivity and 76% specificity for very severe <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content>. <jats:styled-content style=\"fixed-case\">MLSI<\/jats:styled-content><jats:sub>2D<\/jats:sub>\u00a0\u2265\u00a011.2\u00a0mm determined progressive <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content> with 100% sensitivity and 82% specificity. The study population was then divided into a derivation group and a validation group. A regression equation for <jats:styled-content style=\"fixed-case\">MVA<\/jats:styled-content> by <jats:styled-content style=\"fixed-case\">MLSI<\/jats:styled-content><jats:sub>2D<\/jats:sub> was derived in first group. Then, the <jats:styled-content style=\"fixed-case\">MVA<\/jats:styled-content> was calculated by this equation in validation group and was not significantly different from <jats:styled-content style=\"fixed-case\">MVA<\/jats:styled-content><jats:sub>3D<\/jats:sub>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">MLSI<\/jats:styled-content><jats:sub>2D<\/jats:sub> showed an excellent ability to assess <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content> severity and correlates well with planimetered <jats:styled-content style=\"fixed-case\">MVA<\/jats:styled-content> measured by 3<jats:styled-content style=\"fixed-case\">DTEE<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.13805","type":"journal-article","created":{"date-parts":[[2018,1,22]],"date-time":"2018-01-22T15:09:08Z","timestamp":1516633748000},"page":"361-367","source":"Crossref","is-referenced-by-count":11,"title":["Mitral 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Medical Sciences  Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lida","family":"Jarahi","sequence":"additional","affiliation":[{"name":"Department of Community Medicine Faculty of Medicine Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fereshteh","family":"Ghaderi","sequence":"additional","affiliation":[{"name":"Division of Atherosclerosis Vascular Surgery Research Center Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afsoon","family":"Fazlinejad","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Vascular Surgery Research Center Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hedieh","family":"Alimi","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Vascular Surgery Research 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