Mitral and tricuspid annuli in hemophilia—A detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

Q: What are the key findings of this study?

Hemophilia was associated with significant dilation of the mitral annulus, including increased end-diastolic area (10.70 vs 7.66 cm2) and reduced fractional area change, compared to matched controls.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hemophilia (n=43). Intervention: Hemophilia vs. Healthy age- and gender-matched controls. Primary outcome: End-diastolic mitral annulus area (cm2) (p=< 0.001).

Q: What does this research mean for the field?

Patients with hemophilia exhibit significant dilation and functional deterioration of the mitral annulus, along with less pronounced dilation of the tricuspid annulus, compared to healthy controls. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To characterize mitral and tricuspid annular dimensions and functional dynamics in patients with hemophilia using three-dimensional speckle-tracking echocardiography.

Attila Nemes; Nóra Ambrus; Zita Borbényi

doi:10.37349/emed.2026.1001427

September 13, 2026Exploration of MedicineOpen Access

Mitral and tricuspid annuli in hemophilia—A detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

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Key result

Hemophilia is linked to ~40% greater mitral annular end-diastolic area vs matched controls.

P<0.001
n=43

Why the study?

Does hemophilia alter mitral and tricuspid annular dimensions and functions compared to healthy controls?

Key Points

To characterize mitral and tricuspid annular dimensions and functional dynamics in patients with hemophilia using three-dimensional speckle-tracking echocardiography.
Evaluated 13 adult males with hemophilia (mean age: 40.8 ± 16.3 years; 11 hemophilia A, 2 hemophilia B) and 30 age- and gender-matched healthy controls (mean age: 40.4 ± 9.2 years).
Assessed valvular geometry via three-dimensional speckle-tracking echocardiography, excluding 4 of the original 17 hemophilia patients due to suboptimal image quality (76% feasibility rate).
Mitral annular dimensions were significantly enlarged in hemophilia at end-diastole (diameter: 2.79 ± 0.25 vs. 2.47 ± 0.35 cm, p = 0.006; area: 10.70 ± 2.55 vs. 7.66 ± 1.90 cm², p < 0.001) and end-systole (diameter: 2.19 ± 0.38 vs. 1.83 ± 0.40 cm, p = 0.010; area: 6.91 ± 2.31 vs. 4.02 ± 1.34 cm², p < 0.001).
Mitral annular fractional area change was significantly impaired in hemophilia patients compared with controls (35.57 ± 16.44% vs. 47.17 ± 15.91%, p = 0.042).
Tricuspid annular dilation was restricted to end-diastolic area (9.06 ± 2.32 vs. 7.68 ± 1.94 cm², p = 0.050) and perimeter (11.54 ± 1.32 vs. 10.68 ± 1.25 cm, p = 0.049), with preserved end-systolic dimensions and tricuspid fractional area change (23.75 ± 9.42% vs. 26.57 ± 12.01%, p = 0.420).

Study Design

Type

Cross-Sectional (n=43)

Multicenter

No

Structured PICO

Does hemophilia alter mitral and tricuspid annular dimensions and functions compared to healthy controls?

P

Population

13 males with hemophilia and 30 age-matched healthy male controls underwent 3D speckle-tracking echocardiography to assess valvular geometry.

C

Comparator

30 age- and gender-matched healthy males with no symptoms, cardiovascular risk factors, or medications.

O

Outcome

Mitral and tricuspid annular dimensions (diameter, area, perimeter) and functional properties (fractional shortening, fractional area change) measured via 3D speckle-tracking echocardiography.surrogate

Main Result

Absolute Event Rate: 10.7% vs 7.66%

p-value: p=< 0.001

Hemophilia is associated with significant dilation and functional deterioration of the mitral annulus, and to a lesser extent the tricuspid annulus, as assessed by 3D speckle-tracking echocardiography.

Limitations

3D echocardiography image quality is lower than 2D, leading to exclusion of 24% of the initial cohort.
Assessment of mitral and tricuspid annuli dimensions was based on 2D-projected images rather than their true 3D saddle-shape.
Quantitative determination of mitral and tricuspid valve regurgitations was not performed.
Small sample size of hemophilia patients.
Potential confounding effects of cardiovascular risk factors such as hypertension and hypercholesterolemia cannot be ruled out.
Image quality of 3D echocardiography is lower than 2D.
No comparison of 2D vs 3D echocardiography-derived MA/TA dimensions.
Assessment of MA/TA dimensions is based on 2D-projected image, not real 3D saddle-shape.
No simultaneous chamber quantifications or speckle-tracking derived analysis of MA/TA function.
No quantitative determination of mitral and tricuspid valve regurgitations (excluded visually).
Unknown if aortic and pulmonary valves show similar abnormalities.

Implication

Should not change practice; hypothesis-generating for subclinical mitral annular changes in hemophilia and needs larger prospective studies.

Abstract

Aim: Hypocoagulability and associated alterations in myocardial mechanics seen in hemophilia could theoretically impact valvular geometry. Therefore, the purpose of the present study was to characterize mitral and tricuspid annular dimensions and functions in patients with hemophilia via 3D speckle-tracking echocardiography. Methods: Of the 17 hemophilia patients originally assessed, four were excluded due to inadequate image quality. The remaining cohort consisted of 13 males with hemophilia (mean age: 40.8 ± 16.3 years; 11 with hemophilia A and 2 with hemophilia B). Thirty age- and gender-matched healthy males (mean age: 40.4 ± 9.2 years) served as the control group. Results: Hemophilia patients presented with significant dilation of end-diastolic and end-systolic mitral annulus (MA) dimensions (diameter, area, and perimeter), leading to a reduction in MA fractional area change (MAFAC) compared with control subjects. In contrast, among the tricuspid annulus (TA) parameters, dilation was confined to end-diastolic values, while end-systolic dimensions were preserved. Conclusions: Dilated MA, along with its functional deterioration, is present in patients with hemophilia compared to matched controls. TA dilation seems less pronounced.

Discussion

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Cite This Study

Nemes et al. (2026) conducted a cross-sectional in Hemophilia (n=43). Hemophilia vs. Healthy age- and gender-matched controls was evaluated on End-diastolic mitral annulus area (cm2) (p=< 0.001). Hemophilia was associated with significant dilation of the mitral annulus, including increased end-diastolic area (10.70 vs 7.66 cm2) and reduced fractional area change, compared to matched controls.

synapsesocial.com/papers/6aa7affb79e9260bc85aad39 https://doi.org/10.37349/emed.2026.1001427

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Mitral and tricuspid annuli in hemophilia—A detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Mitral and tricuspid annuli in hemophilia—A detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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