{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T16:50:13Z","timestamp":1764089413602,"version":"3.45.0"},"reference-count":176,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T00:00:00Z","timestamp":1763769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health, Ricerca Corrente IRCCS MultiMedica"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Primary mitral regurgitation (PMR) is the most common mitral valve disorder in clinical practice. Although several prognostic indicators derived from resting transthoracic echocardiography (TTE) and exercise stress echocardiography (ESE) are available, patient outcomes remain highly variable, with substantial differences in complication rates and mortality. Identifying individuals at lower cardiovascular risk is therefore clinically relevant, as they represent a large proportion of cases. Current guidelines recommend an integrative approach\u2014combining qualitative, semi-quantitative, and quantitative indices\u2014to determine the timing of intervention, but they do not specifically address risk stratification in low-risk PMR populations. Recent studies have highlighted the potential prognostic value of chest wall configuration, assessed noninvasively using the Modified Haller Index (MHI). Defined as the ratio of latero-lateral thoracic diameter to the antero-posterior (A-P) sternum\u2013spine distance, MHI appears to influence myocardial deformation indices obtained by speckle-tracking echocardiography (STE). Patients with PMR due to mitral valve prolapse (MVP) often show a reduced A-P thoracic diameter caused by sternal depression. Among these, those with an MHI &gt; 2.5 or A-P diameter \u2264 13.5 cm display greater impairment in global and basal strain, particularly in longitudinal and circumferential directions. These abnormalities likely reflect extrinsic geometric constraints and cardiac displacement leading to apparent dyssynchrony rather than intrinsic myocardial dysfunction. A reduced A-P diameter was also independently associated with mitral annular disjunction (MAD) in MVP and emerged as a determinant of impaired strain in this subgroup. In a retrospective cohort of 424 symptomatic MVP patients with moderate MR undergoing ESE, positive tests and exercise-induced severe MR were uncommon. Importantly, an MHI &gt; 2.5 or an A-P diameter \u2264 13.5 cm was associated with a favorable medium-term prognosis, with few adverse cardiovascular events. This narrative, non-systematic review, based on a structured but non-PRISMA literature search, summarizes current evidence on conventional and novel echocardiographic prognostic markers and their implications for risk stratification in PMR. As such, it carries inherent limitations, including potential selection bias, incomplete retrieval of unpublished or negative studies, and reliance on single-center observational data. The findings should therefore be interpreted cautiously and validated through larger, independent, multicenter investigations.<\/jats:p>","DOI":"10.3390\/jcm14238297","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T16:31:54Z","timestamp":1764088314000},"page":"8297","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Does Preliminary Chest Shape Assessment Improve the Prognostic Risk Stratification of Symptomatic Individuals with Primary Mitral Regurgitation? A Narrative Review of Traditional and Innovative Prognostic Indicators"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7641-8831","authenticated-orcid":false,"given":"Andrea","family":"Sonaglioni","sequence":"first","affiliation":[{"name":"Division of Cardiology, IRCCS MultiMedica, 20123 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2218-2808","authenticated-orcid":false,"given":"Gian Luigi","family":"Nicolosi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Policlinico San Giorgio, 33170 Pordenone, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Lombardo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, IRCCS MultiMedica, 20123 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Baravelli","sequence":"additional","affiliation":[{"name":"Division of Cardiology, IRCCS MultiMedica, 20123 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1161\/CIRCULATIONAHA.119.041080","article-title":"Contemporary Presentation and Management of Valvular Heart Disease: The EURObservational Research Programme Valvular Heart Disease II Survey","volume":"140","author":"Iung","year":"2019","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1136\/heartjnl-2020-318482","article-title":"Community Prevalence, Mechanisms and Outcome of Mitral or Tricuspid Regurgitation","volume":"107","author":"Cahill","year":"2021","journal-title":"Heart"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1161\/CIRCULATIONAHA.119.043391","article-title":"Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990\u20132017","volume":"141","author":"Yadgir","year":"2020","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2194","DOI":"10.1093\/eurheartj\/ehz314","article-title":"Causes and Mechanisms of Isolated Mitral Regurgitation in the Community: Clinical Context and Outcome","volume":"40","author":"Dziadzko","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1056\/NEJM199611073351902","article-title":"Clinical Outcome of Mitral Regurgitation Due to Flail Leaflet","volume":"335","author":"Ling","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/S0195-668X(03)00201-X","article-title":"A Prospective Survey of Patients with Valvular Heart Disease in Europe: The Euro Heart Survey on Valvular Heart Disease","volume":"24","author":"Iung","year":"2003","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Figlioli, G., Sticchi, A., Christodoulou, M.N., Hadjidemetriou, A., Amorim Moreira Alves, G., De Carlo, M., Praz, F., Caterina, R., Nikolopoulos, G.K., and Bonovas, S. (2025). Global Prevalence of Mitral Regurgitation: A Systematic Review and Meta-Analysis of Population-Based Studies. J. Clin. Med., 14.","DOI":"10.3390\/jcm14082749"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4635","DOI":"10.1093\/eurheartj\/ehaf194","article-title":"2025 ESC\/EACTS Guidelines for the Management of Valvular Heart Disease","volume":"46","author":"Praz","year":"2025","journal-title":"Eur. Heart J."},{"key":"ref_9","first-page":"e72","article-title":"2020 ACC\/AHA Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1093\/ehjci\/jeaa162","article-title":"Incremental Prognostic Value of Global Myocardial Work over Ejection Fraction and Global Longitudinal Strain in Patients with Heart Failure and Reduced Ejection Fraction","volume":"22","author":"Wang","year":"2021","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJM199907013410101","article-title":"Prevalence and Clinical Outcome of Mitral-Valve Prolapse","volume":"341","author":"Freed","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1161\/01.CIR.0000028933.34260.09","article-title":"Natural History of Asymptomatic Mitral Valve Prolapse in the Community","volume":"106","author":"Avierinos","year":"2002","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/S0140-6736(18)30473-2","article-title":"Outcome and Undertreatment of Mitral Regurgitation: A Community Cohort Study","volume":"391","author":"Dziadzko","year":"2018","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.12688\/f1000research.16066.1","article-title":"Recent Advances in Understanding and Managing Mitral Valve Disease","volume":"8","author":"Tsang","year":"2019","journal-title":"F1000Research"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1007\/s10554-018-1366-5","article-title":"A New Modified Anthropometric Haller Index Obtained without Radiological Exposure","volume":"34","author":"Sonaglioni","year":"2018","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1002\/jcu.23064","article-title":"Does Chest Wall Conformation Influence Myocardial Strain Parameters in Infants with Pectus Excavatum?","volume":"49","author":"Sonaglioni","year":"2021","journal-title":"J. Clin. Ultrasound"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1053\/j.semtcvs.2020.05.003","article-title":"Reduced Myocardial Strain Parameters in Subjects with Pectus Excavatum: Impaired Myocardial Function or Methodological Limitations Due to Chest Deformity?","volume":"33","author":"Sonaglioni","year":"2021","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1007\/s10554-020-02085-z","article-title":"Influence of Chest Conformation on Myocardial Strain Parameters in Healthy Subjects with Mitral Valve Prolapse","volume":"37","author":"Sonaglioni","year":"2021","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1007\/s11739-022-03026-5","article-title":"Modified Haller Index Validation and Correlation with Left Ventricular Strain in a Cohort of Subjects with Obesity and without Overt Heart Disease","volume":"17","author":"Sonaglioni","year":"2022","journal-title":"Intern. Emerg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"767","DOI":"10.2459\/JCM.0000000000001213","article-title":"Chest Conformation Spuriously Influences Strain Parameters of Myocardial Contractile Function in Healthy Pregnant Women","volume":"22","author":"Sonaglioni","year":"2021","journal-title":"J. Cardiovasc. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1111\/joa.12499","article-title":"The Measurement of the Normal Thorax Using the Haller Index Methodology at Multiple Vertebral Levels","volume":"229","author":"Archer","year":"2016","journal-title":"J. Anat."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"29","DOI":"10.4103\/jcecho.jcecho_71_21","article-title":"Impact of Chest Wall Conformation on the Outcome of Primary Mitral Regurgitation Due to Mitral Valve Prolapse","volume":"32","author":"Sonaglioni","year":"2022","journal-title":"J. Cardiovasc. Echogr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1093\/ehjci\/jet105","article-title":"Recommendations for the Echocardiographic Assessment of Native Valvular Regurgitation: An Executive Summary from the European Association of Cardiovascular Imaging","volume":"14","author":"Lancellotti","year":"2013","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.echo.2017.01.007","article-title":"Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance","volume":"30","author":"Zoghbi","year":"2017","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ahj.2018.05.001","article-title":"Long-Term Outcomes of Mitral Regurgitation by Type and Severity","volume":"203","author":"Samad","year":"2018","journal-title":"Am. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/S0022-5223(19)39144-5","article-title":"Cardiac Valve Surgery\u2014The \u201cFrench Correction\u201d","volume":"86","author":"Carpentier","year":"1983","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1093\/ehjci\/jeaa062","article-title":"Conceiving MitraClip as a Tool: Percutaneous Edge-to-Edge Repair in Complex Mitral Valve Anatomies","volume":"21","author":"Gavazzoni","year":"2020","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1093\/eurheartj\/ehx465","article-title":"The MIDA mortality risk score: Development and external validation of a prognostic model for early and late death in degenerative mitral regurgitation","volume":"39","author":"Grigioni","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1067\/mhj.2000.108242","article-title":"Echocardiographic Markers for Mitral Valve Surgery to Preserve Left Ventricular Performance in Mitral Regurgitation","volume":"140","author":"Flemming","year":"2000","journal-title":"Am. Heart J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1186\/s13019-020-01309-6","article-title":"Mitral Valve Repair for Degenerative Mitral Regurgitation in Patients with Left Ventricular Systolic Dysfunction: Early and Mid-Term Outcomes","volume":"15","author":"Li","year":"2020","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1016\/j.athoracsur.2011.02.055","article-title":"Echocardiographic Predictors of Left Ventricular Function and Clinical Outcomes After Successful Mitral Valve Repair: Conventional Two-Dimensional Versus Speckle-Tracking Parameters","volume":"91","author":"Song","year":"2011","journal-title":"Ann. Thorac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1016\/j.jacc.2009.06.047","article-title":"Survival Implication of Left Ventricular End-Systolic Diameter in Mitral Regurgitation Due to Flail Leaflets: A Long-Term Follow-Up Multicenter Study","volume":"54","author":"Tribouilloy","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/j.athoracsur.2018.05.011","article-title":"Benefits of Early Surgery on Clinical Outcomes after Degenerative Mitral Valve Repair","volume":"106","author":"Zhou","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1093\/ehjci\/jes155","article-title":"Global Longitudinal Strain Predicts Left Ventricular Dysfunction after Mitral Valve Repair","volume":"14","author":"Witkowski","year":"2013","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/j.echo.2012.04.009","article-title":"Predictive Value of Global Longitudinal Strain in a Surgical Population of Organic Mitral Regurgitation","volume":"25","author":"Mascle","year":"2012","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1161\/01.CIR.90.2.830","article-title":"Echocardiographic Prediction of Survival After Surgical Correction of Organic Mitral Regurgitation","volume":"90","author":"Tajik","year":"1994","journal-title":"Circulation"},{"key":"ref_37","first-page":"460","article-title":"Mortality and Morbidity After Mitral Valve Repair: The Importance of Left Ventricular Dysfunction","volume":"4","author":"Lee","year":"1995","journal-title":"J. Heart Valve Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1093\/ejechocard\/jer128","article-title":"Predicting Left Ventricular Dysfunction after Valve Repair for Mitral Regurgitation Due to Leaflet Prolapse: Additive Value of Left Ventricular End-Systolic Dimension to Ejection Fraction","volume":"12","author":"Tribouilloy","year":"2011","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.athoracsur.2020.06.017","article-title":"Timing of Valve Repair for Asymptomatic Mitral Regurgitation and Preserved Left Ventricular Function","volume":"111","author":"Hu","year":"2021","journal-title":"Ann. Thorac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1978","DOI":"10.1016\/j.jtcvs.2014.01.041","article-title":"Timing of Valve Repair for Severe Degenerative Mitral Regurgitation and Long-Term Left Ventricular Function","volume":"148","author":"Kitai","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1007\/s12055-021-01160-x","article-title":"Mitral Valve Repair in Chronic Severe Mitral Regurgitation: Short-Term Results and Analysis of Mortality Predictors","volume":"37","author":"Nair","year":"2021","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e004451","DOI":"10.1161\/CIRCIMAGING.115.004451","article-title":"Synergistic utility of brain natriuretic peptide and left ventricular global longitudinal strain in asymptomatic patients with significant primary mitral regurgitation and preserved systolic function undergoing mitral valve surgery","volume":"9","author":"Alashi","year":"2016","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"213","DOI":"10.4070\/kcj.2016.46.2.213","article-title":"Predicting left ventricular dysfunction after surgery in patients with chronic mitral regurgitation: Assessment of myocardial deformation by 2-dimensional multilayer speckle tracking echocardiography","volume":"46","author":"Cho","year":"2016","journal-title":"Korean Circ. J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1016\/j.jacc.2016.08.030","article-title":"Strain echocardiography and functional capacity in asymptomatic primary mitral regurgitation with preserved ejection fraction","volume":"68","author":"Mentias","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.jcmg.2019.03.024","article-title":"Prognostic value of global longitudinal strain and etiology after surgery for primary mitral regurgitation","volume":"13","author":"Hiemstra","year":"2020","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1093\/ehjci\/jes068","article-title":"Prediction of left ventricular ejection fraction 6 months after surgical correction of organic mitral regurgitation: The value of exercise echocardiography and deformation imaging","volume":"13","author":"Donal","year":"2012","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.athoracsur.2019.10.044","article-title":"Predictors of left ventricular dysfunction after surgery for degenerative mitral regurgitation","volume":"109","author":"Kislitsina","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.echo.2014.02.008","article-title":"Assessment of longitudinal myocardial mechanics in patients with degenerative mitral valve regurgitation predicts postoperative worsening of left ventricular systolic function","volume":"27","author":"Pandis","year":"2014","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1053\/j.semtcvs.2020.09.024","article-title":"Global longitudinal strain predicts survival and left ventricular function after mitral valve surgery: A meta-analysis","volume":"33","author":"Canessa","year":"2021","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.jtcvs.2019.08.040","article-title":"Preoperative Left Atrial Volume Index Is Associated with Postoperative Outcomes in Mitral Valve Repair for Chronic Mitral Regurgitation","volume":"160","author":"Balachandran","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.ijcard.2016.11.051","article-title":"Should Pre-Operative Left Atrial Volume Receive More Consideration in Patients with Degenerative Mitral Valve Disease Undergoing Mitral Valve Surgery?","volume":"227","author":"Mega","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1159\/000499577","article-title":"Impact of Preoperative Left Atrial Dimension on Outcome in Patients in Sinus Rhythm Undergoing Surgical Valve Repair for Severe Mitral Regurgitation Due to Mitral Valve Prolapse","volume":"142","author":"Szymanski","year":"2019","journal-title":"Cardiology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1016\/j.jacc.2019.06.032","article-title":"Prognostic Implications of Left Atrial Enlargement in Degenerative Mitral Regurgitation","volume":"74","author":"Essayagh","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1016\/j.jcmg.2018.03.016","article-title":"Myocardial Strain in Prediction of Outcomes after Surgery for Severe Mitral Regurgitation","volume":"11","author":"Kim","year":"2018","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ijcard.2020.10.003","article-title":"Left atrial systolic function by strain analysis\u2014A new useful prognostic tool in primary severe mitral regurgitation?","volume":"322","author":"Jensen","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1016\/j.echo.2013.05.019","article-title":"Left atrial function by two-dimensional speckle-tracking echocardiography in patients with severe organic mitral regurgitation: Association with guidelines-based surgical indication and postoperative (long-term) survival","volume":"26","author":"Debonnaire","year":"2013","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1007\/s10554-014-0433-9","article-title":"Atrial longitudinal strain parameters predict left atrial reverse remodeling after mitral valve surgery: A speckle tracking echocardiography study","volume":"30","author":"Candan","year":"2014","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.ijcard.2020.09.009","article-title":"Left atrial strain as a pre-operative prognostic marker for patients with severe mitral regurgitation","volume":"324","author":"Mandoli","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1093\/ehjci\/jeac058","article-title":"Prognostic value of left atrial reservoir function in patients with severe primary mitral regurgitation undergoing mitral valve repair","volume":"24","author":"Stassen","year":"2022","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1007\/s10554-019-01598-6","article-title":"Prognostic value of left atrial strain in patients with moderate asymptomatic mitral regurgitation","volume":"35","author":"Cameli","year":"2019","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1007\/s10554-018-1391-4","article-title":"Left heart longitudinal deformation analysis in mitral regurgitation","volume":"34","author":"Cameli","year":"2018","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12947-019-0158-y","article-title":"Left atrial strain reproducibility using vendor-dependent and vendor-independent software","volume":"17","author":"Wang","year":"2019","journal-title":"Cardiovasc. Ultrasound"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1136\/hrt.2009.186486","article-title":"Echocardiography Predictors and Prognostic Value of Pulmonary Artery Systolic Pressure in Chronic Organic Mitral Regurgitation","volume":"96","author":"Richardson","year":"2010","journal-title":"Heart"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e002268","DOI":"10.1136\/openhrt-2023-002268","article-title":"Prevalence of pulmonary hypertension in mitral regurgitation and its influence on outcomes","volume":"10","author":"Ratwatte","year":"2023","journal-title":"Open Heart"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1093\/eurheartj\/ehv512","article-title":"Left Ventricular Heart Failure and Pulmonary Hypertension","volume":"37","author":"Rosenkranz","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1016\/j.jtcvs.2011.08.030","article-title":"Pulmonary Hypertension Adversely Affects Short-and Long-Term Survival after Mitral Valve Operation for Mitral Regurgitation: Implications for Timing of Surgery","volume":"142","author":"Ghoreishi","year":"2011","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1111\/jocs.12026","article-title":"Prognostic Value of Pulmonary Hypertension in Patients Undergoing Surgery for Degenerative Mitral Valve Disease with Leaflet Prolapse","volume":"27","author":"Nozohoor","year":"2012","journal-title":"J. Card. Surg."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5761\/atcs.oa.13-00364","article-title":"The Impact of Preoperative and Postoperative Pulmonary Hypertension on Long-Term Surgical Outcome after Mitral Valve Repair for Degenerative Mitral Regurgitation","volume":"21","author":"Murashita","year":"2015","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e018394","DOI":"10.1161\/JAHA.120.018394","article-title":"Increased Mortality in Patients with Preoperative and Persistent Postoperative Pulmonary Hypertension Undergoing Mitral Valve Surgery for Mitral Regurgitation: A Cohort Study","volume":"10","author":"Genuardi","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1093\/ejcts\/ezu511","article-title":"Negative Impact of Atrial Fibrillation and Pulmonary Hypertension After Mitral Valve Surgery in Asymptomatic Patients with Severe Mitral Regurgitation: A 20-Year Follow-Up","volume":"48","author":"Coutinho","year":"2015","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2952","DOI":"10.1016\/j.jacc.2016.03.589","article-title":"Effect of Pulmonary Vascular Pressures on Long-Term Outcome in Patients with Primary Mitral Regurgitation","volume":"67","author":"Mentias","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1093\/eurheartj\/ehq294","article-title":"Prognostic and Therapeutic Implications of Pulmonary Hypertension Complicating Degenerative Mitral Regurgitation Due to Flail Leaflet: A Multicenter Long-Term International Study","volume":"32","author":"Barbieri","year":"2011","journal-title":"Eur. Heart J."},{"key":"ref_73","first-page":"386","article-title":"Forward Stroke Volume Is Predictor of Perioperative Course in Patients with Mitral Regurgitation Undergoing Mitral Valve Replacement","volume":"17","author":"Gackowski","year":"2010","journal-title":"Cardiol. J."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1016\/j.echo.2007.02.017","article-title":"Right Ventricular Myocardial Performance Index Predicts Perioperative Mortality or Circulatory Failure in High-Risk Valvular Surgery","volume":"20","author":"Haddad","year":"2007","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1161\/CIRCULATIONAHA.112.000999","article-title":"Right Ventricular Systolic Function in Organic Mitral Regurgitation: Impact of Biventricular Impairment","volume":"127","author":"Deswarte","year":"2013","journal-title":"Circulation"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1111\/j.1540-8175.2009.01001.x","article-title":"Preoperative Right Ventricular Function in Patients with Organic Mitral Regurgitation","volume":"27","author":"Chrustowicz","year":"2010","journal-title":"Echocardiography"},{"key":"ref_77","first-page":"I152","article-title":"Influence of Mitral Valve Surgery on Tricuspid Incompetence Concomitant with Mitral Valve Disease","volume":"62","author":"Simon","year":"1980","journal-title":"Circulation"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2288","DOI":"10.1253\/circj.CJ-13-0221","article-title":"Fate of functional tricuspid regurgitation after mitral valve repair for degenerative mitral regurgitation","volume":"77","author":"Murashita","year":"2013","journal-title":"Circ. J."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/j.athoracsur.2009.06.034","article-title":"Clinical and echocardiographic impact of functional tricuspid regurgitation repair at the time of mitral valve replacement","volume":"88","author":"Chan","year":"2009","journal-title":"Ann. Thorac. Surg."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/j.ijcard.2013.04.043","article-title":"Functional tricuspid regurgitation: An underestimated issue","volume":"168","author":"Bezante","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1111\/ans.12068","article-title":"Does moderate tricuspid regurgitation require attention during mitral valve surgery?","volume":"84","author":"Yeates","year":"2014","journal-title":"ANZ J. Surg."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.jtcvs.2016.12.046","article-title":"Tricuspid regurgitation is uncommon after mitral valve repair for degenerative diseases","volume":"154","author":"David","year":"2017","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1093\/eurheartj\/ehaa192","article-title":"Functional tricuspid regurgitation of degenerative mitral valve disease: A crucial determinant of survival","volume":"41","author":"Essayagh","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"101360","DOI":"10.1016\/j.cpcardiol.2022.101360","article-title":"Efficacy and safety of concomitant tricuspid repair in patients undergoing mitral valve surgery: A systematic review and meta-analysis","volume":"47","author":"Yasmin","year":"2022","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e007171","DOI":"10.1161\/CIRCIMAGING.117.007171","article-title":"Hemodynamic characteristics in significant symptomatic and asymptomatic primary mitral valve regurgitation at rest and during exercise","volume":"11","author":"Banke","year":"2018","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"e007282","DOI":"10.1161\/CIRCIMAGING.117.007282","article-title":"Exercise-stress echocardiography and effort intolerance in asymptomatic\/minimally symptomatic patients with degenerative mitral regurgitation: Combined invasive\u2013noninvasive hemodynamic monitoring","volume":"11","author":"Utsunomiya","year":"2018","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.1016\/j.jacc.2009.07.046","article-title":"The emerging role of exercise testing and stress echocardiography in valvular heart disease","volume":"54","author":"Picano","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e001010","DOI":"10.1161\/JAHA.114.001010","article-title":"Importance of exercise capacity in predicting outcomes and determining optimal timing of surgery in significant primary mitral regurgitation","volume":"3","author":"Naji","year":"2014","journal-title":"J. Am. Heart Assoc."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1016\/S0735-1097(96)00281-1","article-title":"Left ventricular function after valve repair for chronic mitral regurgitation: Predictive value of preoperative assessment of contractile reserve by exercise echocardiography","volume":"28","author":"Leung","year":"1996","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/j.echo.2008.09.023","article-title":"Importance of left ventricular longitudinal function and functional reserve in patients with degenerative mitral regurgitation: Assessment by two-dimensional speckle tracking","volume":"21","author":"Lancellotti","year":"2008","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1136\/heartjnl-2017-312097","article-title":"Right ventricular exercise contractile reserve and outcomes after early surgery for primary mitral regurgitation","volume":"104","author":"Vitel","year":"2018","journal-title":"Heart"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1136\/heartjnl-2014-306296","article-title":"Impact of exercise pulmonary hypertension on postoperative outcome in primary mitral regurgitation","volume":"101","author":"Magne","year":"2015","journal-title":"Heart"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1136\/hrt.2004.047613","article-title":"Functional and prognostic implications of left ventricular contractile reserve in patients with asymptomatic severe mitral regurgitation","volume":"91","author":"Lee","year":"2005","journal-title":"Heart"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1093\/eurheartj\/eht345","article-title":"Left ventricular contractile reserve in asymptomatic primary mitral regurgitation","volume":"35","author":"Magne","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jacc.2009.12.073","article-title":"Exercise-induced changes in degenerative mitral regurgitation","volume":"56","author":"Magne","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1161\/CIRCULATIONAHA.110.938241","article-title":"Exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation","volume":"122","author":"Magne","year":"2010","journal-title":"Circulation"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/j.echo.2011.04.003","article-title":"Prediction of exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation","volume":"24","author":"Magne","year":"2011","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1016\/j.echo.2014.08.013","article-title":"Diastolic stress echocardiography: The time has come for its integration into clinical practice","volume":"27","author":"Oh","year":"2014","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1016\/j.jacc.2006.02.042","article-title":"Diastolic stress echocardiography: Hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise","volume":"47","author":"Burgess","year":"2006","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.jcmg.2019.01.037","article-title":"Diastolic stress test: Invasive and noninvasive testing","volume":"13","author":"Ha","year":"2020","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/S0002-8703(03)00173-X","article-title":"Relationship of ventricular longitudinal function to contractile reserve in patients with mitral regurgitation","volume":"146","author":"Haluska","year":"2003","journal-title":"Am. Heart J."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1161\/CIRCIMAGING.112.000162","article-title":"Prognostic significance of exercise-induced right ventricular dysfunction in asymptomatic degenerative mitral regurgitation","volume":"6","author":"Kusunose","year":"2013","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"e001583","DOI":"10.1136\/openhrt-2021-001583","article-title":"Physiological and prognostic differences between types of exercise stress echocardiography for functional mitral regurgitation","volume":"8","author":"Kagiyama","year":"2021","journal-title":"Open Heart"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.amjcard.2023.05.039","article-title":"Clinical and prognostic implications of cardiopulmonary exercise stress echocardiography in asymptomatic degenerative mitral regurgitation","volume":"201","author":"Althunayyan","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1007\/s11886-022-01765-7","article-title":"The role of stress echocardiography in valvular heart disease","volume":"24","author":"Citro","year":"2022","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1093\/ehjci\/jeae245","article-title":"Implications of myocardial strain in primary mitral regurgitation\u2014A cardiovascular magnetic resonance study","volume":"26","author":"Romano","year":"2024","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/s12968-020-00674-4","article-title":"Myocardial fibrosis in asymptomatic and symptomatic chronic severe primary mitral regurgitation and relationship to tissue characterisation and left ventricular function on cardiovascular magnetic resonance","volume":"22","author":"Liu","year":"2020","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Badau Riebel, C.I., and Agoston-Coldea, L. (2024). Left ventricular fibrosis by cardiac magnetic resonance tissue characterization in chronic mitral regurgitation patients. J. Clin. Med., 13.","DOI":"10.3390\/jcm13133877"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s10554-017-1195-y","article-title":"Cardiovascular magnetic resonance imaging to assess myocardial fibrosis in valvular heart disease","volume":"34","author":"Podlesnikar","year":"2018","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1001\/jamacardio.2020.1555","article-title":"Hybrid positron emission tomography\/magnetic resonance imaging in arrhythmic mitral valve prolapse","volume":"5","author":"Miller","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"2280","DOI":"10.1016\/S0735-1097(03)00486-8","article-title":"Plasma natriuretic peptide levels increase with symptoms and severity of mitral regurgitation","volume":"41","author":"Sutton","year":"2003","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1161\/01.CIR.0000164269.80908.9D","article-title":"B-type natriuretic peptide in organic mitral regurgitation: Determinants and impact on outcome","volume":"111","author":"Detaint","year":"2005","journal-title":"Circulation"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1161\/CIRCIMAGING.110.961011","article-title":"Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets: Results from a large international multicenter study","volume":"4","author":"Rusinaru","year":"2011","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.jacc.2018.10.067","article-title":"Long-term implications of atrial fibrillation in patients with degenerative mitral regurgitation","volume":"73","author":"Grigioni","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1016\/j.amjcard.2015.02.027","article-title":"Usefulness of preoperative atrial fibrillation to predict outcome and left ventricular dysfunction after valve repair for mitral valve prolapse","volume":"115","author":"Szymanski","year":"2015","journal-title":"Am. J. Cardiol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1001\/jama.2013.8643","article-title":"Association between early surgical intervention vs watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets","volume":"310","author":"Suri","year":"2013","journal-title":"JAMA"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.amjcard.2018.10.024","article-title":"Meta-analysis comparing mitral valve repair versus replacement for degenerative mitral regurgitation across all ages","volume":"123","author":"Jung","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1161\/CIRCULATIONAHA.116.023340","article-title":"Twenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation: Analysis of a large, prospective, multicenter, international registry","volume":"135","author":"Lazam","year":"2017","journal-title":"Circulation"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1016\/j.jacc.2019.06.052","article-title":"Long-term results of mitral valve repair for regurgitation due to leaflet prolapse","volume":"74","author":"David","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1161\/CIRCULATIONAHA.119.040546","article-title":"Outcomes of patients with mediastinal radiation-associated mitral valve disease undergoing cardiac surgery","volume":"140","author":"Donnellan","year":"2019","journal-title":"Circulation"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1161\/CIRCULATIONAHA.118.035789","article-title":"Sex differences in the etiology of surgical mitral valve disease","volume":"138","author":"Vakamudi","year":"2018","journal-title":"Circulation"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1056\/NEJMoa1009355","article-title":"Percutaneous repair or surgery for mitral regurgitation","volume":"364","author":"Feldman","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1016\/j.jacc.2017.09.015","article-title":"Outcomes with transcatheter mitral valve repair in the United States: An STS\/ACC TVT Registry report","volume":"70","author":"Sorajja","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jacc.2017.10.062","article-title":"Beating-heart mitral valve repair using a novel ePTFE cordal implantation device: A prospective trial","volume":"71","author":"Gammie","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/S0140-6736(17)31600-8","article-title":"Compassionate use of the PASCAL transcatheter mitral valve repair system for patients with severe mitral regurgitation: A multicentre, prospective, observational, first-in-man study","volume":"390","author":"Praz","year":"2017","journal-title":"Lancet"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1161\/CIRCULATIONAHA.122.061495","article-title":"Current indications for transcatheter edge-to-edge repair in a patient with primary mitral regurgitation","volume":"146","author":"Hahn","year":"2022","journal-title":"Circulation"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1016\/j.jcmg.2018.05.014","article-title":"Long-term outcome of active surveillance in severe but asymptomatic primary mitral regurgitation","volume":"11","author":"Zilberszac","year":"2018","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"e005113","DOI":"10.1161\/CIRCIMAGING.115.005113","article-title":"Basal Left Ventricular Dilatation and Reduced Contraction in Patients with Mitral Valve Prolapse Can Be Secondary to Annular Dilatation: Preoperative and Postoperative Speckle-Tracking Echocardiographic Study on Left Ventricle and Mitral Valve Annulus Interaction","volume":"9","author":"Fukuda","year":"2016","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/0002-9343(75)90252-1","article-title":"Dilatation of the mitral anulus. A rare cause of mitral regurgitation","volume":"59","author":"Bulkley","year":"1975","journal-title":"Am. J. Med."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1161\/CIRCIMAGING.109.924332","article-title":"Characterization of degenerative mitral valve disease using morphologic analysis of real-time three-dimensional echocardiographic images: Objective insight into complexity and planning of mitral valve repair","volume":"4","author":"Chandra","year":"2011","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1161\/CIRCIMAGING.112.973834","article-title":"Global strain in severe aortic valve stenosis: Relation to clinical outcome after aortic valve replacement","volume":"5","author":"Dahl","year":"2012","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1016\/j.echo.2010.07.019","article-title":"Global longitudinal strain as a major predictor of cardiac events in patients with depressed left ventricular function: A multicenter study","volume":"23","author":"Mignot","year":"2010","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1161\/CIRCIMAGING.111.970434","article-title":"Global longitudinal strain predicts long-term survival in patients with chronic ischemic cardiomyopathy","volume":"5","author":"Bertini","year":"2012","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.echo.2017.03.003","article-title":"Maturational patterns of systolic ventricular deformation mechanics by two-dimensional speckle-tracking echocardiography in preterm infants over the first year of age","volume":"30","author":"Levy","year":"2017","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1093\/ejechocard\/jen323","article-title":"Velocity and deformation imaging for the assessment of myocardial dysfunction","volume":"10","author":"Bijnens","year":"2009","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.athoracsur.2017.08.017","article-title":"Effects of Pectus Excavatum Repair on Right and Left Ventricular Strain","volume":"105","author":"Chao","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_137","doi-asserted-by":"crossref","unstructured":"Truong, V.T., Li, C.Y., Brown, R.L., Moore, R.A., Garcia, V.F., Crotty, E.J., Taylor, M.D., Ngo, T.M.N., and Mazur, W. (2017). Occult RV systolic dysfunction detected by CMR derived RV circumferential strain in patients with pectus excavatum. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0189128"},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1007\/s00330-017-5042-2","article-title":"Differences in myocardial strain between pectus excavatum patients and healthy subjects assessed by cardiac MRI: A pilot study","volume":"28","author":"Lollert","year":"2018","journal-title":"Eur. Radiol."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1016\/j.jacc.2018.07.070","article-title":"The mitral annulus disjunction arrhythmic syndrome","volume":"72","author":"Dejgaard","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1136\/heartjnl-2017-312932","article-title":"Mitral valve prolapse and sudden cardiac death: A systematic review and meta-analysis","volume":"105","author":"Nalliah","year":"2019","journal-title":"Heart"},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"e010584","DOI":"10.1161\/JAHA.118.010584","article-title":"Mitral valve prolapse and sudden cardiac death: A systematic review","volume":"7","author":"Han","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.jacc.2020.06.029","article-title":"Presentation and outcome of arrhythmic mitral valve prolapse","volume":"76","author":"Essayagh","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1016\/j.echo.2005.06.013","article-title":"Mitral annular disjunction in advanced myxomatous mitral valve disease: Echocardiographic detection and surgical correction","volume":"18","author":"Eriksson","year":"2005","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/1476-7120-8-53","article-title":"Mitral annular disjunction in myxomatous mitral valve disease: A relevant abnormality recognizable by transthoracic echocardiography","volume":"8","author":"Carmo","year":"2010","journal-title":"Cardiovasc. Ultrasound"},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1016\/j.acvd.2023.08.004","article-title":"Mitral annular disjunction and Pickelhaube sign in children with mitral valve prolapse: A prospective cohort study","volume":"116","author":"Vaksmann","year":"2023","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1148\/radiol.220454","article-title":"Myocardial fibrosis at cardiac MRI helps predict adverse clinical outcome in patients with mitral valve prolapse","volume":"306","author":"Figliozzi","year":"2023","journal-title":"Radiology"},{"key":"ref_147","first-page":"101298","article-title":"Mitral annular disjunction; how accurate are we? A cardiovascular MRI study defining risk","volume":"49","author":"Hussain","year":"2023","journal-title":"Int. J. Cardiol. Heart Vasc."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.jacep.2023.12.007","article-title":"Determinants of ventricular arrhythmias in mitral valve prolapse","volume":"10","author":"Cecere","year":"2024","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_149","doi-asserted-by":"crossref","unstructured":"Blondeel, M., L\u2019Hoyes, W., Robyns, T., Verbrugghe, P., De Meester, P., Dresselaers, T., Masci, P.G., Willems, R., Bogaert, J., and Vandenberk, B. (2024). Serial cardiac magnetic resonance imaging in patients with mitral valve prolapse\u2014A single-center retrospective registry. J. Clin. Med., 13.","DOI":"10.3390\/jcm13092669"},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"101056","DOI":"10.1016\/j.jocmr.2024.101056","article-title":"Mitral annulus disjunction in consecutive patients undergoing cardiovascular magnetic resonance: Where is the boundary between normality and disease?","volume":"26","author":"Figliozzi","year":"2024","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s10554-022-02705-w","article-title":"The influence of chest wall conformation on myocardial strain parameters in a cohort of mitral valve prolapse patients with and without mitral annular disjunction","volume":"39","author":"Sonaglioni","year":"2023","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1016\/j.jcmg.2016.11.022","article-title":"Functional implication of mitral annular disjunction in mitral valve prolapse: A quantitative dynamic 3D echocardiographic study","volume":"10","author":"Lee","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.ijcard.2021.04.052","article-title":"Strain evaluation for mitral annular disjunction by echocardiography and magnetic resonance imaging: A case\u2013control study","volume":"334","author":"Wang","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1007\/s10554-020-01818-4","article-title":"Prevalence of mitral annular disjunction in patients with mitral valve prolapse and severe regurgitation","volume":"36","author":"Putnam","year":"2020","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1056\/NEJM198602273140902","article-title":"The association of floppy mitral valve with disjunction of the mitral annulus fibrosus","volume":"314","author":"Hutchins","year":"1986","journal-title":"N. Engl. J. Med."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"2278","DOI":"10.1016\/j.jcmg.2019.06.021","article-title":"Mitral annular disjunction in a large cohort of patients with mitral valve prolapse and significant regurgitation","volume":"12","author":"Mantegazza","year":"2019","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_157","doi-asserted-by":"crossref","unstructured":"Wunderlich, N.C., Ho, S.Y., Flint, N., and Siegel, R.J. (2021). Myxomatous mitral valve disease with mitral valve prolapse and mitral annular disjunction: Clinical and functional significance of the coincidence. J. Cardiovasc. Dev. Dis., 8.","DOI":"10.3390\/jcdd8020009"},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1161\/CIRCULATIONAHA.115.016291","article-title":"Arrhythmic mitral valve prolapse and sudden cardiac death","volume":"132","author":"Basso","year":"2015","journal-title":"Circulation"},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1111\/jce.12914","article-title":"Bileaflet mitral valve prolapse and risk of ventricular dysrhythmias and death","volume":"27","author":"Nordhues","year":"2016","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_160","first-page":"e005030","article-title":"Morphofunctional abnormalities of mitral annulus and arrhythmic mitral valve prolapse","volume":"9","author":"Basso","year":"2016","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1016\/j.jacc.2018.07.069","article-title":"Mitral annulus disjunction: Emerging role of myocardial mechanical stretch in arrhythmogenesis","volume":"72","author":"Basso","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1093\/icvts\/ivs045","article-title":"Pectus excavatum: History, hypotheses and treatment options","volume":"14","author":"Brochhausen","year":"2012","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_163","doi-asserted-by":"crossref","unstructured":"Nomura, K., Ajiro, Y., Nakano, S., Matsushima, M., Yamaguchi, Y., Hatakeyama, N., Ohata, M., Sakuma, M., Nonaka, T., and Harii, M. (2019). Characteristics of mitral valve leaflet length in patients with pectus excavatum: A single center cross-sectional study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0212165"},{"key":"ref_164","doi-asserted-by":"crossref","unstructured":"Sonaglioni, A., Nicolosi, G.L., Muti-Sch\u00fcnemann, G.E.U., Rispoli, G.A., Lombardo, M., and Muti, P. (2025). Does preliminary chest shape assessment improve the prognostic risk stratification of individuals with mitral annular disjunction? A case report and narrative review. J. Clin. Med., 14.","DOI":"10.20944\/preprints202502.1923.v1"},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"2917","DOI":"10.1007\/s10554-021-02274-4","article-title":"Appropriate use criteria implementation with modified Haller index for predicting stress echocardiographic results and outcome in a population of patients with suspected coronary artery disease","volume":"37","author":"Sonaglioni","year":"2021","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jcmg.2014.12.003","article-title":"Pulmonary hypertension in valvular disease: A comprehensive review on pathophysiology to therapy from the HAVEC Group","volume":"8","author":"Magne","year":"2015","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"e001348","DOI":"10.1161\/JAHA.114.001348","article-title":"Impact of duration of mitral regurgitation on outcomes in asymptomatic patients with myxomatous mitral valve undergoing exercise stress echocardiography","volume":"4","author":"Naji","year":"2015","journal-title":"J. Am. Heart Assoc."},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1056\/NEJMoa041451","article-title":"Quantitative determinants of the outcome of asymptomatic mitral regurgitation","volume":"352","author":"Avierinos","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_169","first-page":"e201703","article-title":"Primary mitral valve regurgitation: Update and review","volume":"2017","author":"Apostolidou","year":"2017","journal-title":"Glob. Cardiol. Sci. Pract."},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1007\/s11906-019-0928-9","article-title":"The role of arterial hypertension in mitral valve regurgitation","volume":"21","author":"Katsi","year":"2019","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_171","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1161\/CIRCULATIONAHA.111.055111","article-title":"Mitral valve prolapse with mid-late systolic mitral regurgitation: Pitfalls of evaluation and clinical outcome compared with holosystolic regurgitation","volume":"125","author":"Topilsky","year":"2012","journal-title":"Circulation"},{"key":"ref_172","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1161\/CIRCULATIONAHA.112.121590","article-title":"Quantitation of mitral regurgitation","volume":"126","author":"Grayburn","year":"2012","journal-title":"Circulation"},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1016\/j.amjcard.2007.01.032","article-title":"Effect of metoprolol on heart rate variability in symptomatic patients with mitral valve prolapse","volume":"99","author":"Arslan","year":"2007","journal-title":"Am. J. Cardiol."},{"key":"ref_174","doi-asserted-by":"crossref","first-page":"28","DOI":"10.3909\/ricm0835","article-title":"The role of medical therapy in moderate to severe degenerative mitral regurgitation","volume":"17","author":"Slipczuk","year":"2016","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"e297","DOI":"10.5114\/amsad.2020.103032","article-title":"The strain and strain rate imaging paradox in echocardiography: Overabundant literature in the last two decades but still uncertain clinical utility in an individual case","volume":"5","author":"Nicolosi","year":"2020","journal-title":"Arch. Med. Sci. Atheroscler. Dis."},{"key":"ref_176","doi-asserted-by":"crossref","first-page":"85","DOI":"10.4103\/jcecho.jcecho_141_20","article-title":"Prognostic value of modified Haller index in patients with suspected coronary artery disease referred for exercise stress echocardiography","volume":"31","author":"Sonaglioni","year":"2021","journal-title":"J. Cardiovasc. Echogr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8297\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T16:45:07Z","timestamp":1764089107000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8297"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,22]]},"references-count":176,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14238297"],"URL":"https:\/\/doi.org\/10.3390\/jcm14238297","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,11,22]]}}}