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    "titulo" => "Mitral annulus is dilated with preserved function in acromegaly regardless of its activity&#58; Insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Images from the three-dimensional full-volume dataset showing the mitral annulus in a patient with acromegaly including apical 4-chamber &#40;A&#41; and 4-chamber &#40;B&#41; long-axis views and a cross-sectional view at the level of the mitral annulus &#40;C7&#41; optimized in long-axis views&#46; Area&#58; mitral annular area&#59; Circ&#58; mitral annular perimeter&#59; Dist&#58; mitral annular diameter&#59; LA&#58; left atrium&#44; LV&#58; left ventricle&#44; RA&#58; right atrium&#44; RV&#58; right ventricle&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acromegaly is a rare&#44; chronic and slowly developing endocrine disorder caused by hypersecretion of human growth hormone &#40;hGH&#41; and consequently of insulin-like growth factor-1 &#40;IGF-1&#41; during adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> Acromegalic cardiomyopathy is reported to be one of the most important complications of acromegaly and cardiovascular events may be linked to these hormones&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#8211;4</span></a> The saddle-shaped mitral annulus &#40;MA&#41; plays an important role in the filling and emptying of the left heart chambers&#46; Perturbations of MA geometry and function can be seen in a number of diseases&#44; particularly in valvular disorders and atrial fibrillation&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> However&#44; some non-valvular disorders have also been found to be associated with MA morphological and functional alterations&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6&#8211;8</span></a> The present study was conducted to compare MA size and functional properties between acromegalic patients and age- and gender-matched healthy controls by three-dimensional speckle-tracking echocardiography &#40;3D-STE&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient population</span><p id="par0010" class="elsevierStylePara elsevierViewall">The study included 27 patients with acromegaly&#44; three of whom were excluded due to inferior image quality&#46; The mean age of the remaining 24 patients was 55&#46;7&#177;14&#46;0 years and seven were male&#46; Their results were compared to 38 healthy controls &#40;mean age&#58; 53&#46;4&#177;4&#46;4 years&#44; 16 male&#41;&#46; For all patients and controls&#44; 3D-STE was performed in addition to routine two-dimensional Doppler echocardiography&#46; The diagnosis of acromegaly was based on and its activity was defined in accordance with current guidelines&#44; as detailed previously&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> All acromegalic patients were included in the Motion Analysis of the heart and Great vessels bY three-dimensionAl speckle-tRacking echocardiography in Pathological cases &#40;MAGYAR-Path Study&#41;&#46; All patients gave their informed consent&#46; The study was approved by the human research committee at the University of Szeged and followed the ethical guidelines of the 1975 Declaration of Helsinki&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Two-dimensional Doppler echocardiography</span><p id="par0015" class="elsevierStylePara elsevierViewall">A Toshiba Artida&#8482; echocardiograph &#40;Toshiba Medical Systems&#44; Tokyo&#44; Japan&#41; with a PST-30SBP phased-array transducer &#40;1-5 MHz&#41; was used to perform standard two-dimensional &#40;2D&#41; Doppler transthoracic echocardiographic examinations following recent guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> A qualitative &#40;0-4&#41; scale was used to grade mitral regurgitation&#44; where 0 represents no regurgitation and 4 stands for the most severe regurgitation possible&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Three-dimensional speckle-tracking echocardiography</span><p id="par0020" class="elsevierStylePara elsevierViewall">3D-STE was performed with the same Toshiba Artida&#8482; echocardiograph &#40;Toshiba Medical Systems&#44; Tokyo&#44; Japan&#41; attached to a PST-25SX matrix-array transducer&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> An apical window was used for 3D-STE data acquisition&#44; in which six wedge-shaped subvolumes were acquired during a single breath-hold in sinus rhythm&#44; from which a full-volume 3D dataset was created automatically&#46; Offline analysis of the 3D datasets was carried out using 3D Wall Motion Tracking software&#44; version 2&#46;7 &#40;Toshiba Medical Systems&#44; Tokyo&#44; Japan&#41;&#46; Apical 2-chamber and 4-chamber views and three short-axis views &#8211; basal &#40;C7&#41;&#44; midventricular and apical left ventricular &#40;LV&#41; levels &#8211; were selected at end-diastole by the software&#46; Following optimization of imaging planes in apical 4- and 2-chamber views on the edges of the MA&#44; several MA morphological parameters were measured in the C7 short-axis view&#46; The following morphological parameters were measured at end-diastole &#40;just before mitral valve closure&#41; and end-systole &#40;just before mitral valve opening&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6&#8211;8</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0025" class="elsevierStylePara elsevierViewall">MA diameter &#40;MAD&#41;&#44; defined as the perpendicular line drawn from the peak of MA curvature to the middle of the straight MA border &#40;anteroposterior diameter&#41;&#59;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">MA area &#40;MAA&#41; measured by planimetry&#59;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">MA perimeter &#40;MAP&#41; measured by planimetry&#46;</p></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Using the above parameters&#44; the following MA functional properties were calculated&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">MA fractional shortening &#40;MAFS&#41;&#44; defined as &#40;&#91;end-diastolic MAD&#8722;end-systolic MAD&#93;&#47;end-diastolic MAD&#41;&#215;100&#44;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">MA fractional area change &#40;MAFAC&#41;&#44; defined as &#40;&#91;end-diastolic MAA&#8722;end-systolic MAA&#93;&#47;end-diastolic MAA&#41;&#215;100&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">All data were presented as number &#40;percentage&#41; or mean &#177; standard deviation&#46; Differences in values were considered to be statistically significant with p&#60;0&#46;05&#46; Pearson&#39;s coefficient was used for correlation between variables&#46; Bland and Altman&#39;s method was used for studying intra- and interobserver agreement&#46; Data analyses were performed using RStudio Team statistical software &#40;RStudio&#58; Integrated Development for R&#46; RStudio&#44; Inc&#46;&#44; Boston&#44; MA&#44; 2015&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Clinical&#44; laboratory&#44; therapeutic and two-dimensional echocardiographic data</span><p id="par0060" class="elsevierStylePara elsevierViewall">Significant differences were demonstrated in most echocardiographic parameters between all acromegalic patients and healthy control subjects&#46; Differences between active and inactive acromegalic patients and controls are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; IGF-1 levels and indices and early transmitral flow velocity differed significantly between active and inactive acromegalic subjects &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Three-dimensional speckle-tracking echocardiography-derived mitral annular parameters</span><p id="par0065" class="elsevierStylePara elsevierViewall">Significantly increased MA dimensions were demonstrated in acromegalic patients&#46; MA functional properties did not differ between patients with acromegaly and age- and gender-matched controls&#46; No differences in MA data were seen according to the activity of acromegaly &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Correlations</span><p id="par0070" class="elsevierStylePara elsevierViewall">No significant correlations were detected between MA parameters and different hormone levels&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Reproducibility measurements</span><p id="par0075" class="elsevierStylePara elsevierViewall">The differences &#40;mean &#177; standard deviation&#41; measured by two observers for end-diastolic MAD&#44; MAA and MAP were 0&#46;01&#177;0&#46;18 cm&#44; -0&#46;04&#177;0&#46;79 cm<span class="elsevierStyleSup">2</span> and &#8211;0&#46;19&#177;0&#46;98 cm&#44; respectively&#44; with correlation coefficients between these independent measurements of 0&#46;97 &#40;p&#60;0&#46;0001&#41;&#44; 0&#46;96 &#40;p&#60;0&#46;0001&#41; and 0&#46;97 &#40;p&#60;0&#46;0001&#41;&#44; respectively &#40;interobserver variability&#41; at rest&#46; The corresponding values for intraobserver variability including values obtained by two measurements by observer 1 were -0&#46;03&#177;0&#46;19 cm&#44; 0&#46;03&#177;1&#46;04 cm<span class="elsevierStyleSup">2</span> and -0&#46;01&#177;0&#46;95 cm&#44; respectively&#44; with correlation coefficients between these independent measurements of 0&#46;98 &#40;p&#60;0&#46;0001&#41;&#44; 0&#46;96 &#40;p&#60;0&#46;0001&#41; and 0&#46;96 &#40;p&#60;0&#46;0001&#41;&#44; respectively&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The corresponding values for end-systolic MAD&#44; MAA and MAP were 0&#46;03&#177;0&#46;21 cm&#44; -0&#46;03&#177;0&#46;39 cm<span class="elsevierStyleSup">2</span> and 0&#46;03&#177;0&#46;43 cm&#44; with correlation coefficients of 0&#46;97 &#40;p&#60;0&#46;0001&#41;&#44; 0&#46;98 &#40;p&#60;0&#46;0001&#41; and 0&#46;98 &#40;p&#60;0&#46;0001&#41;&#44; respectively &#40;interobserver variability&#41;&#46; The corresponding parameters for intraobserver variability including two measurements by observer 1 were -0&#46;02&#177;0&#46;21 cm&#44; -0&#46;01&#177;0&#46;34 cm<span class="elsevierStyleSup">2</span> and 0&#46;03&#177;0&#46;53 cm&#44; respectively&#44; with correlation coefficients between these independent measurements of 0&#46;98 &#40;p&#60;0&#46;0001&#41;&#44; 0&#46;98 &#40;p&#60;0&#46;0001&#41; and 0&#46;97 &#40;p&#60;0&#46;0001&#41;&#44; respectively&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">In the early stages of acromegaly&#44; excess hGH and IGF-1 induce a hyperkinetic syndrome&#46; Subsequently concentric hypertrophy develops&#44; together with LV diastolic dysfunction and eventually impaired systolic function&#44; ending in heart failure unless the excess hGH&#47;IGF-1 is treated&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> Hypertension&#44; arrhythmias&#44; atherosclerosis&#44; coronary artery disease and heart valve disease are also frequent findings in acromegaly&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Acromegaly has been found to be associated with an increased prevalence of regurgitant valvular heart disease&#44; which is dependent on the duration of exposure to increased hGH concentrations&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> Aortic valve regurgitation &#40;&#8805;trace severity&#41; was present in 30&#37; of acromegalic patients&#44; and mitral regurgitation &#40;&#8805;moderate severity&#41; was present in 5&#37; of individuals with acromegaly&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> The overall prevalence of valve abnormalities is higher in both active and cured acromegalic patients&#46; The persistence of valve disease in patients with cured acromegaly is likely to correlate with the persistence of LV hypertrophy&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Under normal&#44; healthy conditions&#44; the contractile function of the myocardium in the basal regions of the left atrium and ventricle adjacent to the mitral annulus results in a sphincter-like motion of the annulus&#44; which is an innervated fibrous ring&#46; This sphincter-like narrowing follows the cardiac cycle&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> The circumferential fibers in the basal segment of the left atrium are positioned so that their contraction creates a centripetal force on the inner segment of the adjacent fibrous MA ring&#44; leading to an inward motion during late diastole&#46; The superficial oblique fibers of the LV inlet generate a torsional force on the outer segment of the mitral annulus&#44; causing it to move inwards in systole&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> Myocardial contraction of the left atrium and ventricle following the cardiac cycle and occurring at the appropriate time are required for proper contraction of the mitral annulus&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In the present study&#44; MA dilation with preserved function was demonstrated in acromegalic patients with no significant mitral regurgitation and with no relationship to the disease&#39;s activity&#46; In 3D-STE studies for deeper insights into acromegaly-associated abnormalities&#44; impaired LV rotational mechanics has been found&#44; with reduced apical LV rotation and LV twist and 20&#37; incidence of absence of LV twist &#40;LV rigid body rotation&#41; in acromegalic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> Moreover&#44; increased LV radial strains have been demonstrated&#44; together with changes in LA functional parameters&#44; suggesting compensatory increases in LV and LA contractility to maintain LV pumping function&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">16&#8211;18</span></a> These results could explain both the MA dilation and its normal function&#44; helping to elucidate these particular features of acromegalic cardiomyopathy&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">These results highlight the need for reliable non-invasive assessment of MA dimensions in clinical practice&#46; Although true MA diameter is underestimated by routine 2D echocardiography&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> transthoracic real-time 3D echocardiography &#40;RT3DE&#41; had been validated by magnetic resonance imaging for the assessment of MA dimensions and offers superior accuracy to 2D echocardiography&#44; but its main limitation is that it measures the 2D-projected annulus&#44; not its real 3D-shape&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6&#8211;8</span></a> Transesophageal RT3DE &#40;RT-3DE&#41; using special software is able to create a virtual 3D model of the mitral valve and its annulus&#44; but due to its semi-invasive nature its usefulness is limited&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> Although 3D-STE is optimal for simultaneous assessment of strain&#44; rotational and volumetric parameters of the heart chambers using the same acquired 3D echocardiographic dataset&#44; transthoracic 3D-STE has a similar ability to transesophageal RT-3DE to visualize the annulus&#46; It is easy to use&#44; the learning curve is short&#44; there is no radiation&#44; its cost is relatively low&#44; and it can be used in asymptomatic non-cardiac patients such as individuals with acromegaly&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a></p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Study limitations</span><p id="par0110" class="elsevierStylePara elsevierViewall">In our patients&#44; acromegalic cardiomyopathy was present in both early and later stages&#44; which could affect the results&#46; 3D-STE is a new methodology with limited spatial &#40;due to the limited number of piezoelectric crystals&#41; and temporal resolution &#40;mean 25&#177;5 frames per second&#41;&#44; which could affect image resolution and quality&#46; With the presented 3D-STE-derived MA analysis&#44; the 3D saddle shape of the annulus cannot be analyzed&#44; only its 2D projection&#44; which could theoretically affect the measurements&#46; The present study did not aim to assess and compare 3D-STE-derived LV&#44; left or right atrial volumetric and strain parameters between acromegalic patients and matched controls&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0115" class="elsevierStylePara elsevierViewall">MA dilation was seen in acromegaly regardless of its activity&#46; Acromegaly is not associated with MA functional impairment&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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              "titulo" => "Two-dimensional Doppler echocardiography"
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              "titulo" => "Three-dimensional speckle-tracking echocardiography"
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              "titulo" => "Clinical&#44; laboratory&#44; therapeutic and two-dimensional echocardiographic data"
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              "titulo" => "Three-dimensional speckle-tracking echocardiography-derived mitral annular parameters"
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              "titulo" => "Correlations"
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          "titulo" => "Reproducibility measurements"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2020-04-21"
    "fechaAceptado" => "2020-07-08"
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            0 => "Acromegaly"
            1 => "Mitral annulus"
            2 => "Three-dimensional"
            3 => "Echocardiography"
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          "clase" => "keyword"
          "titulo" => "Palavras-chave"
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          "palabras" => array:4 [
            0 => "Acromegalia"
            1 => "Anel mitral"
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            3 => "Ecocardiografia"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Acromegaly is a rare&#44; chronic and slowly developing endocrine disorder caused by hypersecretion of human growth hormone and consequently of insulin-like growth factor-1 during adulthood&#46; The present study was conducted to assess mitral annular &#40;MA&#41; size and function between acromegalic patients and age- and gender-matched healthy controls by three-dimensional speckle-tracking echocardiography &#40;3D-STE&#41;&#46; It also aimed to examine whether activity of the disease has any effect on MA parameters&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This study included 27 patients with acromegaly&#44; three of whom were excluded due to inferior image quality&#46; The mean age of the remaining 24 patients was 55&#46;7&#177;14&#46;0 years and seven were male&#46; Complete two-dimensional Doppler echocardiography and 3D-STE were performed in all cases&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Significantly increased end-diastolic and end-systolic MA diameter &#40;2&#46;81&#177;0&#46;36 cm vs&#46; 2&#46;44&#177;0&#46;34 cm and 2&#46;00&#177;0&#46;32 cm vs&#46; 1&#46;65&#177;0&#46;37 cm&#44; respectively&#41;&#44; area &#40;9&#46;67&#177;2&#46;33 cm<span class="elsevierStyleSup">2</span> vs&#46; 7&#46;38&#177;1&#46;93 cm<span class="elsevierStyleSup">2</span> and 5&#46;14&#177;1&#46;62 cm<span class="elsevierStyleSup">2</span> vs&#46; 3&#46;74&#177;1&#46;19 cm<span class="elsevierStyleSup">2</span>&#44; respectively&#41; and perimeter &#40;11&#46;76&#177;1&#46;42 cm vs&#46; 10&#46;27&#177;1&#46;33 cm and 8&#46;61&#177;1&#46;23 cm vs&#46; 7&#46;36&#177;1&#46;10 cm&#44; respectively&#41; were demonstrated in acromegalic patients compared with control subjects&#46; MA functional parameters were not significantly altered compared to those of healthy individuals&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">MA dilation could be seen in acromegaly regardless of its activity&#46; Acromegaly is not associated with MA functional impairment&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
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            "titulo" => "Results"
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            "titulo" => "Conclusions"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e Objectivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A acromegalia &#233; uma doen&#231;a end&#243;crina rara&#44; cr&#243;nica e de desenvolvimento lento&#44; causada pela hipersecre&#231;&#227;o da hormona do crescimento humano e&#44; consequentemente&#44; do fator de crescimento semelhante &#224; insulina-1 durante a idade adulta&#46; O presente estudo foi conduzido para avaliar o tamanho e a fun&#231;&#227;o do anel mitral &#40;MA&#41; nos doentes com acromegalia e controles saud&#225;veis emparelhados por idade e sexo&#44; por meio de ecocardiografia tridimensional com <span class="elsevierStyleItalic">speckle-tracking</span> &#40;3DSTE&#41;&#46; O objetivo foi tamb&#233;m examinar se a atividade da doen&#231;a tem algum efeito nos par&#226;metros da MA&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este estudo incluiu 27 pacientes com acromegalia&#44; tr&#234;s dos quais tiveram de ser exclu&#237;dos devido &#224; qualidade inferior de imagem&#46; A m&#233;dia de idade dos 24 pacientes restantes foi de 55&#44;7 &#177; 14&#44;0 anos &#40;7 homens&#41;&#46; Foram realizados em todos os casos uma ecocardiografia Doppler bidimensional completa e um 3DSTE&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Quando comparados com os controlos&#44; os doentes acromeg&#225;licos apresentaram di&#226;metros diast&#243;lico e sist&#243;lico finais significativamente dilatados &#40;2&#44;81 &#177; 0&#44;36<span class="elsevierStyleHsp" style=""></span>cm <span class="elsevierStyleItalic">versus</span> 2&#44;44 &#177; 0&#44;34<span class="elsevierStyleHsp" style=""></span>cm e 2&#44;00 &#177; 0&#44;32<span class="elsevierStyleHsp" style=""></span>cm <span class="elsevierStyleItalic">versus</span> 1&#44;65 &#177; 0&#44;37<span class="elsevierStyleHsp" style=""></span>cm&#44; respetivamente&#41;&#44; assim como a &#225;rea valvular &#40;9&#44;67 &#177; 2&#44;33<span class="elsevierStyleHsp" style=""></span>cm2 <span class="elsevierStyleItalic">versus</span> 7&#44;38 &#177; 1&#44;93<span class="elsevierStyleHsp" style=""></span>cm2 e 5&#44;14 &#177; 1&#44;62<span class="elsevierStyleHsp" style=""></span>cm2 <span class="elsevierStyleItalic">versus</span> 3&#44;74 &#177; 1&#44;19<span class="elsevierStyleHsp" style=""></span>cm2&#44; respetivamente&#41; e o per&#237;metro &#40;11&#44;76 &#177; 1&#44;42<span class="elsevierStyleHsp" style=""></span>cm <span class="elsevierStyleItalic">versus</span> 10&#44;27 &#177; 1&#44;33<span class="elsevierStyleHsp" style=""></span>cm e 8&#44;61 &#177; 1&#44;23<span class="elsevierStyleHsp" style=""></span>cm <span class="elsevierStyleItalic">versus</span> 7&#44;36 &#177; 1&#44;10<span class="elsevierStyleHsp" style=""></span>cm&#44; respetivamente&#41; Os par&#226;metros funcionais da MA n&#227;o estavam significativamente alterados em compara&#231;&#227;o com indiv&#237;duos saud&#225;veis&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A dilata&#231;&#227;o do MA pode ser observada na acromegalia&#44; independentemente de sua atividade&#46; A acromegalia n&#227;o est&#225; associada ao comprometimento funcional da MA&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Images from the three-dimensional full-volume dataset showing the mitral annulus in a patient with acromegaly including apical 4-chamber &#40;A&#41; and 4-chamber &#40;B&#41; long-axis views and a cross-sectional view at the level of the mitral annulus &#40;C7&#41; optimized in long-axis views&#46; Area&#58; mitral annular area&#59; Circ&#58; mitral annular perimeter&#59; Dist&#58; mitral annular diameter&#59; LA&#58; left atrium&#44; LV&#58; left ventricle&#44; RA&#58; right atrium&#44; RV&#58; right ventricle&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">E&#47;A&#58; ratio of early and late diastolic transmitral flow velocity&#59; hGH&#58; human growth hormone&#59; IGF-1&#58; insulin-like growth factor-1&#59; IVS&#58; interventricular septum&#59; LA&#58; left atrial&#59; LV&#58; left ventricular&#59; LVEDD&#58; end-diastolic diameter&#59; LVEDV&#58; end-diastolic volume&#59; LVEF&#58; left ventricular ejection fraction&#59; LVESD&#58; end-systolic diameter&#59; LVESV&#58; end-systolic volume&#59; MR&#58; mitral regurgitation&#59; PW&#58; posterior wall&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypercholesterolemia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Laboratory findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum hHG&#44; ng&#47;ml&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;0&#177;6&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;4&#177;3&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;4&#177;8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum IGF-1&#44; ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">313&#177;200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">425&#177;199&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179&#177;92<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum IGF-1 index&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;34&#177;0&#46;90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;83&#177;0&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;74&#177;0&#46;40<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Somatostatin analogue&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bromocriptine&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pegvisomant&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypophysectomy&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Two-dimensional echocardiography</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LA diameter&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;0&#177;4&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;1&#177;5&#46;6<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;2&#177;6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;3&#177;4&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LVEDD&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;3&#177;4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;1&#177;5&#46;4<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;9&#177;5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;8&#177;5&#46;6<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LVEDV&#44; ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">111&#46;3&#177;36&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128&#46;3&#177;28&#46;6<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">122&#46;6&#177;24&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  """
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Original Article
Mitral annulus is dilated with preserved function in acromegaly regardless of its activity: Insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study
Dimensões e função do anel mitral na acromegalia: dados do estudo MAGYAR-Path por ecocardiografia tridimensional de speckle tracking
Attila Nemesa,
Autor para correspondência
nemes@in2nd.szote.u-szeged.hu

Corresponding author.
, Árpád Kormányosa, Péter Domsika, Anita Kalaposa, Csaba Lengyelb, Nóra Ambrusa, Zsuzsanna Valkuszb
a 2nd Department of Medicine and Cardiology Centre, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
b 1st Department of Medicine, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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    "titulo" => "Mitral annulus is dilated with preserved function in acromegaly regardless of its activity&#58; Insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Images from the three-dimensional full-volume dataset showing the mitral annulus in a patient with acromegaly including apical 4-chamber &#40;A&#41; and 4-chamber &#40;B&#41; long-axis views and a cross-sectional view at the level of the mitral annulus &#40;C7&#41; optimized in long-axis views&#46; Area&#58; mitral annular area&#59; Circ&#58; mitral annular perimeter&#59; Dist&#58; mitral annular diameter&#59; LA&#58; left atrium&#44; LV&#58; left ventricle&#44; RA&#58; right atrium&#44; RV&#58; right ventricle&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acromegaly is a rare&#44; chronic and slowly developing endocrine disorder caused by hypersecretion of human growth hormone &#40;hGH&#41; and consequently of insulin-like growth factor-1 &#40;IGF-1&#41; during adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> Acromegalic cardiomyopathy is reported to be one of the most important complications of acromegaly and cardiovascular events may be linked to these hormones&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#8211;4</span></a> The saddle-shaped mitral annulus &#40;MA&#41; plays an important role in the filling and emptying of the left heart chambers&#46; Perturbations of MA geometry and function can be seen in a number of diseases&#44; particularly in valvular disorders and atrial fibrillation&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> However&#44; some non-valvular disorders have also been found to be associated with MA morphological and functional alterations&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6&#8211;8</span></a> The present study was conducted to compare MA size and functional properties between acromegalic patients and age- and gender-matched healthy controls by three-dimensional speckle-tracking echocardiography &#40;3D-STE&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient population</span><p id="par0010" class="elsevierStylePara elsevierViewall">The study included 27 patients with acromegaly&#44; three of whom were excluded due to inferior image quality&#46; The mean age of the remaining 24 patients was 55&#46;7&#177;14&#46;0 years and seven were male&#46; Their results were compared to 38 healthy controls &#40;mean age&#58; 53&#46;4&#177;4&#46;4 years&#44; 16 male&#41;&#46; For all patients and controls&#44; 3D-STE was performed in addition to routine two-dimensional Doppler echocardiography&#46; The diagnosis of acromegaly was based on and its activity was defined in accordance with current guidelines&#44; as detailed previously&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> All acromegalic patients were included in the Motion Analysis of the heart and Great vessels bY three-dimensionAl speckle-tRacking echocardiography in Pathological cases &#40;MAGYAR-Path Study&#41;&#46; All patients gave their informed consent&#46; The study was approved by the human research committee at the University of Szeged and followed the ethical guidelines of the 1975 Declaration of Helsinki&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Two-dimensional Doppler echocardiography</span><p id="par0015" class="elsevierStylePara elsevierViewall">A Toshiba Artida&#8482; echocardiograph &#40;Toshiba Medical Systems&#44; Tokyo&#44; Japan&#41; with a PST-30SBP phased-array transducer &#40;1-5 MHz&#41; was used to perform standard two-dimensional &#40;2D&#41; Doppler transthoracic echocardiographic examinations following recent guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> A qualitative &#40;0-4&#41; scale was used to grade mitral regurgitation&#44; where 0 represents no regurgitation and 4 stands for the most severe regurgitation possible&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Three-dimensional speckle-tracking echocardiography</span><p id="par0020" class="elsevierStylePara elsevierViewall">3D-STE was performed with the same Toshiba Artida&#8482; echocardiograph &#40;Toshiba Medical Systems&#44; Tokyo&#44; Japan&#41; attached to a PST-25SX matrix-array transducer&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> An apical window was used for 3D-STE data acquisition&#44; in which six wedge-shaped subvolumes were acquired during a single breath-hold in sinus rhythm&#44; from which a full-volume 3D dataset was created automatically&#46; Offline analysis of the 3D datasets was carried out using 3D Wall Motion Tracking software&#44; version 2&#46;7 &#40;Toshiba Medical Systems&#44; Tokyo&#44; Japan&#41;&#46; Apical 2-chamber and 4-chamber views and three short-axis views &#8211; basal &#40;C7&#41;&#44; midventricular and apical left ventricular &#40;LV&#41; levels &#8211; were selected at end-diastole by the software&#46; Following optimization of imaging planes in apical 4- and 2-chamber views on the edges of the MA&#44; several MA morphological parameters were measured in the C7 short-axis view&#46; The following morphological parameters were measured at end-diastole &#40;just before mitral valve closure&#41; and end-systole &#40;just before mitral valve opening&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6&#8211;8</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0025" class="elsevierStylePara elsevierViewall">MA diameter &#40;MAD&#41;&#44; defined as the perpendicular line drawn from the peak of MA curvature to the middle of the straight MA border &#40;anteroposterior diameter&#41;&#59;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">MA area &#40;MAA&#41; measured by planimetry&#59;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">MA perimeter &#40;MAP&#41; measured by planimetry&#46;</p></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Using the above parameters&#44; the following MA functional properties were calculated&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">MA fractional shortening &#40;MAFS&#41;&#44; defined as &#40;&#91;end-diastolic MAD&#8722;end-systolic MAD&#93;&#47;end-diastolic MAD&#41;&#215;100&#44;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">MA fractional area change &#40;MAFAC&#41;&#44; defined as &#40;&#91;end-diastolic MAA&#8722;end-systolic MAA&#93;&#47;end-diastolic MAA&#41;&#215;100&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">All data were presented as number &#40;percentage&#41; or mean &#177; standard deviation&#46; Differences in values were considered to be statistically significant with p&#60;0&#46;05&#46; Pearson&#39;s coefficient was used for correlation between variables&#46; Bland and Altman&#39;s method was used for studying intra- and interobserver agreement&#46; Data analyses were performed using RStudio Team statistical software &#40;RStudio&#58; Integrated Development for R&#46; RStudio&#44; Inc&#46;&#44; Boston&#44; MA&#44; 2015&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Clinical&#44; laboratory&#44; therapeutic and two-dimensional echocardiographic data</span><p id="par0060" class="elsevierStylePara elsevierViewall">Significant differences were demonstrated in most echocardiographic parameters between all acromegalic patients and healthy control subjects&#46; Differences between active and inactive acromegalic patients and controls are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; IGF-1 levels and indices and early transmitral flow velocity differed significantly between active and inactive acromegalic subjects &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Three-dimensional speckle-tracking echocardiography-derived mitral annular parameters</span><p id="par0065" class="elsevierStylePara elsevierViewall">Significantly increased MA dimensions were demonstrated in acromegalic patients&#46; MA functional properties did not differ between patients with acromegaly and age- and gender-matched controls&#46; No differences in MA data were seen according to the activity of acromegaly &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Correlations</span><p id="par0070" class="elsevierStylePara elsevierViewall">No significant correlations were detected between MA parameters and different hormone levels&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Reproducibility measurements</span><p id="par0075" class="elsevierStylePara elsevierViewall">The differences &#40;mean &#177; standard deviation&#41; measured by two observers for end-diastolic MAD&#44; MAA and MAP were 0&#46;01&#177;0&#46;18 cm&#44; -0&#46;04&#177;0&#46;79 cm<span class="elsevierStyleSup">2</span> and &#8211;0&#46;19&#177;0&#46;98 cm&#44; respectively&#44; with correlation coefficients between these independent measurements of 0&#46;97 &#40;p&#60;0&#46;0001&#41;&#44; 0&#46;96 &#40;p&#60;0&#46;0001&#41; and 0&#46;97 &#40;p&#60;0&#46;0001&#41;&#44; respectively &#40;interobserver variability&#41; at rest&#46; The corresponding values for intraobserver variability including values obtained by two measurements by observer 1 were -0&#46;03&#177;0&#46;19 cm&#44; 0&#46;03&#177;1&#46;04 cm<span class="elsevierStyleSup">2</span> and -0&#46;01&#177;0&#46;95 cm&#44; respectively&#44; with correlation coefficients between these independent measurements of 0&#46;98 &#40;p&#60;0&#46;0001&#41;&#44; 0&#46;96 &#40;p&#60;0&#46;0001&#41; and 0&#46;96 &#40;p&#60;0&#46;0001&#41;&#44; respectively&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The corresponding values for end-systolic MAD&#44; MAA and MAP were 0&#46;03&#177;0&#46;21 cm&#44; -0&#46;03&#177;0&#46;39 cm<span class="elsevierStyleSup">2</span> and 0&#46;03&#177;0&#46;43 cm&#44; with correlation coefficients of 0&#46;97 &#40;p&#60;0&#46;0001&#41;&#44; 0&#46;98 &#40;p&#60;0&#46;0001&#41; and 0&#46;98 &#40;p&#60;0&#46;0001&#41;&#44; respectively &#40;interobserver variability&#41;&#46; The corresponding parameters for intraobserver variability including two measurements by observer 1 were -0&#46;02&#177;0&#46;21 cm&#44; -0&#46;01&#177;0&#46;34 cm<span class="elsevierStyleSup">2</span> and 0&#46;03&#177;0&#46;53 cm&#44; respectively&#44; with correlation coefficients between these independent measurements of 0&#46;98 &#40;p&#60;0&#46;0001&#41;&#44; 0&#46;98 &#40;p&#60;0&#46;0001&#41; and 0&#46;97 &#40;p&#60;0&#46;0001&#41;&#44; respectively&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">In the early stages of acromegaly&#44; excess hGH and IGF-1 induce a hyperkinetic syndrome&#46; Subsequently concentric hypertrophy develops&#44; together with LV diastolic dysfunction and eventually impaired systolic function&#44; ending in heart failure unless the excess hGH&#47;IGF-1 is treated&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> Hypertension&#44; arrhythmias&#44; atherosclerosis&#44; coronary artery disease and heart valve disease are also frequent findings in acromegaly&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Acromegaly has been found to be associated with an increased prevalence of regurgitant valvular heart disease&#44; which is dependent on the duration of exposure to increased hGH concentrations&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> Aortic valve regurgitation &#40;&#8805;trace severity&#41; was present in 30&#37; of acromegalic patients&#44; and mitral regurgitation &#40;&#8805;moderate severity&#41; was present in 5&#37; of individuals with acromegaly&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> The overall prevalence of valve abnormalities is higher in both active and cured acromegalic patients&#46; The persistence of valve disease in patients with cured acromegaly is likely to correlate with the persistence of LV hypertrophy&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Under normal&#44; healthy conditions&#44; the contractile function of the myocardium in the basal regions of the left atrium and ventricle adjacent to the mitral annulus results in a sphincter-like motion of the annulus&#44; which is an innervated fibrous ring&#46; This sphincter-like narrowing follows the cardiac cycle&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> The circumferential fibers in the basal segment of the left atrium are positioned so that their contraction creates a centripetal force on the inner segment of the adjacent fibrous MA ring&#44; leading to an inward motion during late diastole&#46; The superficial oblique fibers of the LV inlet generate a torsional force on the outer segment of the mitral annulus&#44; causing it to move inwards in systole&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> Myocardial contraction of the left atrium and ventricle following the cardiac cycle and occurring at the appropriate time are required for proper contraction of the mitral annulus&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In the present study&#44; MA dilation with preserved function was demonstrated in acromegalic patients with no significant mitral regurgitation and with no relationship to the disease&#39;s activity&#46; In 3D-STE studies for deeper insights into acromegaly-associated abnormalities&#44; impaired LV rotational mechanics has been found&#44; with reduced apical LV rotation and LV twist and 20&#37; incidence of absence of LV twist &#40;LV rigid body rotation&#41; in acromegalic patients&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> Moreover&#44; increased LV radial strains have been demonstrated&#44; together with changes in LA functional parameters&#44; suggesting compensatory increases in LV and LA contractility to maintain LV pumping function&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">16&#8211;18</span></a> These results could explain both the MA dilation and its normal function&#44; helping to elucidate these particular features of acromegalic cardiomyopathy&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">These results highlight the need for reliable non-invasive assessment of MA dimensions in clinical practice&#46; Although true MA diameter is underestimated by routine 2D echocardiography&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> transthoracic real-time 3D echocardiography &#40;RT3DE&#41; had been validated by magnetic resonance imaging for the assessment of MA dimensions and offers superior accuracy to 2D echocardiography&#44; but its main limitation is that it measures the 2D-projected annulus&#44; not its real 3D-shape&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6&#8211;8</span></a> Transesophageal RT3DE &#40;RT-3DE&#41; using special software is able to create a virtual 3D model of the mitral valve and its annulus&#44; but due to its semi-invasive nature its usefulness is limited&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> Although 3D-STE is optimal for simultaneous assessment of strain&#44; rotational and volumetric parameters of the heart chambers using the same acquired 3D echocardiographic dataset&#44; transthoracic 3D-STE has a similar ability to transesophageal RT-3DE to visualize the annulus&#46; It is easy to use&#44; the learning curve is short&#44; there is no radiation&#44; its cost is relatively low&#44; and it can be used in asymptomatic non-cardiac patients such as individuals with acromegaly&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a></p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Study limitations</span><p id="par0110" class="elsevierStylePara elsevierViewall">In our patients&#44; acromegalic cardiomyopathy was present in both early and later stages&#44; which could affect the results&#46; 3D-STE is a new methodology with limited spatial &#40;due to the limited number of piezoelectric crystals&#41; and temporal resolution &#40;mean 25&#177;5 frames per second&#41;&#44; which could affect image resolution and quality&#46; With the presented 3D-STE-derived MA analysis&#44; the 3D saddle shape of the annulus cannot be analyzed&#44; only its 2D projection&#44; which could theoretically affect the measurements&#46; The present study did not aim to assess and compare 3D-STE-derived LV&#44; left or right atrial volumetric and strain parameters between acromegalic patients and matched controls&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0115" class="elsevierStylePara elsevierViewall">MA dilation was seen in acromegaly regardless of its activity&#46; Acromegaly is not associated with MA functional impairment&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction and Objective"
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              "titulo" => "Methods"
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        1 => array:2 [
          "identificador" => "xpalclavsec1353314"
          "titulo" => "Keywords"
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          "titulo" => "Resumo"
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            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introdu&#231;&#227;o e Objectivo"
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              "titulo" => "M&#233;todos"
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              "titulo" => "Resultados"
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              "titulo" => "Conclus&#245;es"
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          "titulo" => "Palavras-chave"
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            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Patient population"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Two-dimensional Doppler echocardiography"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Three-dimensional speckle-tracking echocardiography"
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              "titulo" => "Statistical analysis"
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              "titulo" => "Clinical&#44; laboratory&#44; therapeutic and two-dimensional echocardiographic data"
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              "identificador" => "sec0045"
              "titulo" => "Three-dimensional speckle-tracking echocardiography-derived mitral annular parameters"
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              "identificador" => "sec0050"
              "titulo" => "Correlations"
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          ]
        ]
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          "identificador" => "sec0055"
          "titulo" => "Reproducibility measurements"
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          "titulo" => "Discussion"
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            0 => array:2 [
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              "titulo" => "Study limitations"
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          "titulo" => "Conclusions"
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          "titulo" => "Conflicts of interest"
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          "titulo" => "References"
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    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-04-21"
    "fechaAceptado" => "2020-07-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1353314"
          "palabras" => array:4 [
            0 => "Acromegaly"
            1 => "Mitral annulus"
            2 => "Three-dimensional"
            3 => "Echocardiography"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec1353315"
          "palabras" => array:4 [
            0 => "Acromegalia"
            1 => "Anel mitral"
            2 => "Tridimensional"
            3 => "Ecocardiografia"
          ]
        ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Acromegaly is a rare&#44; chronic and slowly developing endocrine disorder caused by hypersecretion of human growth hormone and consequently of insulin-like growth factor-1 during adulthood&#46; The present study was conducted to assess mitral annular &#40;MA&#41; size and function between acromegalic patients and age- and gender-matched healthy controls by three-dimensional speckle-tracking echocardiography &#40;3D-STE&#41;&#46; It also aimed to examine whether activity of the disease has any effect on MA parameters&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This study included 27 patients with acromegaly&#44; three of whom were excluded due to inferior image quality&#46; The mean age of the remaining 24 patients was 55&#46;7&#177;14&#46;0 years and seven were male&#46; Complete two-dimensional Doppler echocardiography and 3D-STE were performed in all cases&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Significantly increased end-diastolic and end-systolic MA diameter &#40;2&#46;81&#177;0&#46;36 cm vs&#46; 2&#46;44&#177;0&#46;34 cm and 2&#46;00&#177;0&#46;32 cm vs&#46; 1&#46;65&#177;0&#46;37 cm&#44; respectively&#41;&#44; area &#40;9&#46;67&#177;2&#46;33 cm<span class="elsevierStyleSup">2</span> vs&#46; 7&#46;38&#177;1&#46;93 cm<span class="elsevierStyleSup">2</span> and 5&#46;14&#177;1&#46;62 cm<span class="elsevierStyleSup">2</span> vs&#46; 3&#46;74&#177;1&#46;19 cm<span class="elsevierStyleSup">2</span>&#44; respectively&#41; and perimeter &#40;11&#46;76&#177;1&#46;42 cm vs&#46; 10&#46;27&#177;1&#46;33 cm and 8&#46;61&#177;1&#46;23 cm vs&#46; 7&#46;36&#177;1&#46;10 cm&#44; respectively&#41; were demonstrated in acromegalic patients compared with control subjects&#46; MA functional parameters were not significantly altered compared to those of healthy individuals&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">MA dilation could be seen in acromegaly regardless of its activity&#46; Acromegaly is not associated with MA functional impairment&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e Objectivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A acromegalia &#233; uma doen&#231;a end&#243;crina rara&#44; cr&#243;nica e de desenvolvimento lento&#44; causada pela hipersecre&#231;&#227;o da hormona do crescimento humano e&#44; consequentemente&#44; do fator de crescimento semelhante &#224; insulina-1 durante a idade adulta&#46; O presente estudo foi conduzido para avaliar o tamanho e a fun&#231;&#227;o do anel mitral &#40;MA&#41; nos doentes com acromegalia e controles saud&#225;veis emparelhados por idade e sexo&#44; por meio de ecocardiografia tridimensional com <span class="elsevierStyleItalic">speckle-tracking</span> &#40;3DSTE&#41;&#46; O objetivo foi tamb&#233;m examinar se a atividade da doen&#231;a tem algum efeito nos par&#226;metros da MA&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este estudo incluiu 27 pacientes com acromegalia&#44; tr&#234;s dos quais tiveram de ser exclu&#237;dos devido &#224; qualidade inferior de imagem&#46; A m&#233;dia de idade dos 24 pacientes restantes foi de 55&#44;7 &#177; 14&#44;0 anos &#40;7 homens&#41;&#46; Foram realizados em todos os casos uma ecocardiografia Doppler bidimensional completa e um 3DSTE&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Quando comparados com os controlos&#44; os doentes acromeg&#225;licos apresentaram di&#226;metros diast&#243;lico e sist&#243;lico finais significativamente dilatados &#40;2&#44;81 &#177; 0&#44;36<span class="elsevierStyleHsp" style=""></span>cm <span class="elsevierStyleItalic">versus</span> 2&#44;44 &#177; 0&#44;34<span class="elsevierStyleHsp" style=""></span>cm e 2&#44;00 &#177; 0&#44;32<span class="elsevierStyleHsp" style=""></span>cm <span class="elsevierStyleItalic">versus</span> 1&#44;65 &#177; 0&#44;37<span class="elsevierStyleHsp" style=""></span>cm&#44; respetivamente&#41;&#44; assim como a &#225;rea valvular &#40;9&#44;67 &#177; 2&#44;33<span class="elsevierStyleHsp" style=""></span>cm2 <span class="elsevierStyleItalic">versus</span> 7&#44;38 &#177; 1&#44;93<span class="elsevierStyleHsp" style=""></span>cm2 e 5&#44;14 &#177; 1&#44;62<span class="elsevierStyleHsp" style=""></span>cm2 <span class="elsevierStyleItalic">versus</span> 3&#44;74 &#177; 1&#44;19<span class="elsevierStyleHsp" style=""></span>cm2&#44; respetivamente&#41; e o per&#237;metro &#40;11&#44;76 &#177; 1&#44;42<span class="elsevierStyleHsp" style=""></span>cm <span class="elsevierStyleItalic">versus</span> 10&#44;27 &#177; 1&#44;33<span class="elsevierStyleHsp" style=""></span>cm e 8&#44;61 &#177; 1&#44;23<span class="elsevierStyleHsp" style=""></span>cm <span class="elsevierStyleItalic">versus</span> 7&#44;36 &#177; 1&#44;10<span class="elsevierStyleHsp" style=""></span>cm&#44; respetivamente&#41; Os par&#226;metros funcionais da MA n&#227;o estavam significativamente alterados em compara&#231;&#227;o com indiv&#237;duos saud&#225;veis&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A dilata&#231;&#227;o do MA pode ser observada na acromegalia&#44; independentemente de sua atividade&#46; A acromegalia n&#227;o est&#225; associada ao comprometimento funcional da MA&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o e Objectivo"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
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    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Images from the three-dimensional full-volume dataset showing the mitral annulus in a patient with acromegaly including apical 4-chamber &#40;A&#41; and 4-chamber &#40;B&#41; long-axis views and a cross-sectional view at the level of the mitral annulus &#40;C7&#41; optimized in long-axis views&#46; Area&#58; mitral annular area&#59; Circ&#58; mitral annular perimeter&#59; Dist&#58; mitral annular diameter&#59; LA&#58; left atrium&#44; LV&#58; left ventricle&#44; RA&#58; right atrium&#44; RV&#58; right ventricle&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">E&#47;A&#58; ratio of early and late diastolic transmitral flow velocity&#59; hGH&#58; human growth hormone&#59; IGF-1&#58; insulin-like growth factor-1&#59; IVS&#58; interventricular septum&#59; LA&#58; left atrial&#59; LV&#58; left ventricular&#59; LVEDD&#58; end-diastolic diameter&#59; LVEDV&#58; end-diastolic volume&#59; LVEF&#58; left ventricular ejection fraction&#59; LVESD&#58; end-systolic diameter&#59; LVESV&#58; end-systolic volume&#59; MR&#58; mitral regurgitation&#59; PW&#58; posterior wall&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypercholesterolemia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Laboratory findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum hHG&#44; ng&#47;ml&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;0&#177;6&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;4&#177;3&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;4&#177;8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum IGF-1&#44; ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">313&#177;200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">425&#177;199&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">179&#177;92<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Serum IGF-1 index&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;34&#177;0&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;83&#177;0&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;74&#177;0&#46;40<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Somatostatin analogue&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bromocriptine&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pegvisomant&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypophysectomy&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Two-dimensional echocardiography</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LA diameter&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;0&#177;4&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;1&#177;5&#46;6<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;2&#177;6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;3&#177;4&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LVEDD&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">48&#46;3&#177;4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51&#46;1&#177;5&#46;4<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">49&#46;9&#177;5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;8&#177;5&#46;6<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LVEDV&#44; ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">111&#46;3&#177;36&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128&#46;3&#177;28&#46;6<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">122&#46;6&#177;24&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">136&#46;1&#177;33&#46;1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LVESD&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#46;4&#177;4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32&#46;0&#177;5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">30&#46;6&#177;4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33&#46;9&#177;4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controls &#40;n&#61;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">All acromegalic patients &#40;n&#61;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Active acromegalic patients &#40;n&#61;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inactive acromegalic patients &#40;n&#61;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">MA morphological parameters</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MAD-D&#44; cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#46;44&#177;0&#46;34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#46;81&#177;0&#46;36<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;86&#177;0&#46;41<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;76&#177;0&#46;32<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MAA-D&#44; cm2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;38&#177;1&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9&#46;67&#177;2&#46;33<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;12&#177;2&#46;58<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;22&#177;2&#46;05<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">10&#46;27&#177;1&#46;33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&#46;76&#177;1&#46;42<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&#46;96&#177;1&#46;59<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&#46;56&#177;1&#46;27<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MAD-S&#44; cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;65&#177;0&#46;37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#46;00&#177;0&#46;32<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#46;08&#177;0&#46;31<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;91&#177;0&#46;31<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MAA-S&#44; cm2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#46;74&#177;1&#46;19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;14&#177;1&#46;62<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;43&#177;1&#46;45<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#46;85&#177;1&#46;79<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7&#46;36&#177;1&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8&#46;61&#177;1&#46;23<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8&#46;87&#177;1&#46;10<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8&#46;35&#177;1&#46;34<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">MA functional parameters</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MAFAC&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48&#46;3&#177;16&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46&#46;4&#177;11&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MAFS&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#46;3&#177;11&#46;3&nbsp;\t\t\t\t\t\t\n
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