Exploration of Medicine

Table 2. Mitral annular data as assessed by three-dimensional echocardiography between hemophilia patients and controls.

Data	Controls (n = 30)	Hemophilia patients (n = 13)	p value
Morphological parameters
End-diastolic MA diameter (MAD-D) (cm)	2.47 ± 0.35	2.79 ± 0.25	0.006
End-diastolic MA area (MAA-D) (cm²)	7.66 ± 1.90	10.70 ± 2.55	< 0.001
End-diastolic MA perimeter (MAP-D) (cm)	10.46 ± 1.22	11.30 ± 3.33	< 0.001
End-systolic MA diameter (MAD-S) (cm)	1.83 ± 0.40	2.19 ± 0.38	0.010
End-systolic MA area (MAA-S) (cm²)	4.02 ± 1.34	6.91 ± 2.31	< 0.001
End-systolic MA perimeter (MAP-S) (cm)	7.48 ± 1.28	9.99 ± 1.71	< 0.001
Functional parameters
MAFAC (%)	47.17 ± 15.91	35.57 ± 16.44	0.042
MAFS (%)	26.18 ± 15.87	21.75 ± 10.19	0.368

Return to article view

MA: mitral annulus; MAFAC: mitral annular fractional area change; MAFS: mitral annular fractional shortening.

Declarations

Author contributions

AN: Conceptualization, Investigation, Visualization, Formal analysis, Writing—original draft, Writing—review & editing. NA: Validation, Writing—review & editing. ZB: Supervision, Resources. All authors read and approved the submitted version.

Conflicts of interest

Attila Nemes, who is the Editorial Board Member and Guest Editor of Exploration of Medicine, had no involvement in the decision-making or the review process of this manuscript. The other authors declare no conflicts of interest.

Ethical approval

The study was approved by the Institutional and Regional Biomedical Research Committee of the University of Szeged (number: 71/2011, latest approval 17th March 2025). The study conformed to the ethical guidelines of the Declaration of Helsinki.

Consent to participate

All subjects gave their informed consent.

Consent to publication

Not applicable.

Availability of data and materials

The datasets for this manuscript are not publicly available due to local restrictions. Requests for accessing the datasets should be directed to the corresponding author.

Funding

No funding.

Copyright

Publisher’s note

Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

References

Zimmerman B, Valentino LA. Hemophilia: In Review. Pediatr Rev. 2013;34:289–95. [DOI]

Iorio A, Stonebraker JS, Chambost H, Makris M, Coffin D, Herr C, et al.; Data and Demographics Committee of the World Federation of Hemophilia. Establishing the Prevalence and Prevalence at Birth of Hemophilia in Males: A Meta-analytic Approach Using National Registries. Ann Intern Med. 2019;171:540–6. [DOI] [PubMed]

Böhmert S, Schubert R, Fichtlscherer S, Alesci S, Miesbach W. Endothelial Function in Patients with Severe and Moderate Haemophilia A and B. Hämostaseologie. 2019;39:195–202. [DOI] [PubMed]

Nemes A, Kormányos Á, Domsik P, Ambrus N, Gyenes N, Vezendi K, et al. Left ventricular rotational abnormalities in hemophilia—insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study. Quant Imaging Med Surg. 2022;12:886–93. [DOI] [PubMed] [PMC]

Nemes A, Kormányos Á, Vezendi K, Marton I, Borbényi Z. Left ventricular deformation in hemophilia (from the MAGYAR-Path Study). Rev Port Cardiol. 2022;41:441–43. [DOI] [PubMed]

Nemes A, Kormányos Á, Vezendi K, Marton I, Borbényi Z. Left Atrial Volumetric and Functional Properties in Hemophilia – Insights from a Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Path Study. J Cardiovasc Echogr. 2022;32:148–53. [DOI] [PubMed] [PMC]

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc. Echocardiogr. 2015;28:1–39.e14. [DOI]

Ammar KA, Paterick TE, Khandheria BK, Jan MF, Kramer C, Umland MM, et al. Myocardial Mechanics: Understanding and Applying Three‐Dimensional Speckle Tracking Echocardiography in Clinical Practice. Echocardiography. 2012;29:861–72. [DOI] [PubMed]

Urbano-Moral JA, Patel AR, Maron MS, Arias-Godinez JA, Pandian NG. Three-Dimensional Speckle-Tracking Echocardiography: Methodological Aspects and Clinical Potential. Echocardiography. 2012;29:997–1010. [DOI] [PubMed]

10.

Muraru D, Niero A, Rodriguez-Zanella H, Cherata D, Badano L. Three-dimensional speckle-tracking echocardiography: benefits and limitations of integrating myocardial mechanics with three-dimensional imaging. Cardiovasc Diagn Ther. 2018;8:101–17. [DOI] [PubMed] [PMC]

11.

Seo Y, Ishizu T, Atsumi A, Kawamura R, Aonuma K. Three-Dimensional Speckle Tracking Echocardiography. Circ J. 2014;78:1290–301. [DOI] [PubMed]

12.

Nemes A, Kovács Z, Kormányos Á, Domsik P, Kalapos A, Piros GÁ, et al. The mitral annulus in lipedema: Insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study. Echocardiography. 2019;36:1482–91. [DOI] [PubMed]

13.

Nemes A, Kormányos Á, Domsik P, Kalapos A, Gyenes N, Lengyel C. Normal reference values of three-dimensional speckle-tracking echocardiography-derived mitral annular dimensions and functional properties in healthy adults: Insights from the MAGYAR-Healthy Study. J Clin Ultrasound. 2021;49:234–9. [DOI] [PubMed]

14.

Nemes A, Rácz G, Kormányos Á. Tricuspid Annular Abnormalities in Isolated Left Ventricular Non-compaction—Insights From the Three-dimensional Speckle-Tracking Echocardiographic MAGYAR-Path Study. Front Cardiovasc Med. 2022;9:694616. [DOI] [PubMed] [PMC]

15.

Nemes A, Kormányos Á, Rácz G, Ruzsa Z, Ambrus N, Lengyel C. Normal reference values of tricuspid annular dimensions and functional properties in healthy adults using three-dimensional speckle-tracking echocardiography (insights from the MAGYAR-Healthy Study). Quant Imaging Med Surg. 2023;13:121–32. [DOI] [PubMed] [PMC]

16.

Santagata D, Abenante A, Squizzato A, Dentali F, Donadini MP, Ageno W, et al. Rates of venous thromboembolism and use of thromboprophylaxis after major orthopedic surgery in patients with congenital hemophilia A or B: a systematic review. J Thromb Haemost. 2024;22:1117–31. [DOI] [PubMed]

17.

Ghosh K, Shetty S. Anticoagulation in haemophilia patients with prosthetic valve replacement. Haemophilia. 2004;10:743. [DOI] [PubMed]

18.

Badescu MC, Badulescu OV, Costache AD, Mitu O, Lupu VV, Dmour BA, et al. Atherosclerosis in Patients with Congenital Hemophilia: A Focus on Peripheral Artery Disease. Life (Basel). 2023;13:2221. [DOI] [PubMed] [PMC]

19.

Franchini M, Focosi D, Mannucci PM. How we manage cardiovascular disease in patients with hemophilia. Haematologica. 2023;108:1748–57. [DOI] [PubMed] [PMC]

20.

Amoozgar H, Fath M, Jooya P, Karimi M. Evaluation of Heart Function in Patients With Hemophilia. Clin Appl Thromb Hemost. 2017;23:374–8. [DOI] [PubMed]

21.

Özdemir ZC, Köşger P, Uçar B, Bör Ö. Myocardial functions, blood pressure changes, and arterial stiffness in children with severe hemophilia A. Thromb Res. 2020;189:102–7. [DOI] [PubMed]

22.

Nemes A, Kormányos Á, Rácz G, Ruzsa Z, Achim A, Ambrus N, et al. Tricuspid annular and right atrial volume changes are associated in healthy adults—insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study. Front Cardiovasc Med. 2023;10:1140599. [DOI] [PubMed] [PMC]

23.

Nemes A, Kormányos Á, Ambrus N, Lengyel C. Associations between Mitral Annular and Left Atrial Volume Changes in Healthy Adults–Detailed Analysis from the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Healthy Study. Rev Cardiovasc Med. 2022;23:194. [DOI] [PubMed] [PMC]

24.

Nemes A, Kormányos Á, Ruzsa Z, Achim A, Ambrus N, Lengyel C. Three-Dimensional Speckle-Tracking Echocardiography-Derived Tricuspid Annular Dimensions and Right Atrial Strains in Healthy Adults—Is There a Relationship? (Insights from the MAGYAR-Healthy Study). J Clin Med. 2023;12:4240. [DOI] [PubMed] [PMC]