medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-1479medvis-1479Research ArticleСЕРДЦЕ И СОСУДЫHEART AND VESSELSКонкретизация роли эхокардиографического пособия при проведении баллонной митральной вальвулопластикиSpecification of the role of echocardiographic guidance during balloon mitral valvuloplastyhttps://orcid.org/0000-0003-4822-3193ЗуфаровМ. М.ZufarovM. M.

Зуфаров Миржамол Мирумарович – доктор мед. наук, профессор, руководитель отделения интервенционной кардиологии, аритмологии и эндоваскулярной хирургии ГУ “Республиканский специализированный научно-практический медицинский центр хирургии имени академика В. Вахидова”, Ташкентhttps://orcid.org/0000-0003-4822-3193

Mirjamol M. Zufarov – Doct. of Sci. (Med.), Professor, Head of the Department of Interventional Cardiology, Arrhythmology and Endovascular Surgery, Republican Specialized Scientific and Practical Medical Center for Surgery named after academician V. Vakhidov, Tashkenthttps://orcid.org/0000-0003-4822-3193

m_zufarov@mail.ruИмВ. М.ImV. M.

Им Вадим Мухасанович – канд. мед. наук, старший научный сотрудник отделения интервенционной кардиологии, аритмологии и эндоваскулярной хирургии ГУ “Республиканский специализированный научно-практический медицинский центр хирургии имени академика В. Вахидова”, Ташкентhttps://orcid.org/0000-0003-3397-8956E-mail: dr.vadim.im@gmail.com

Vadim M. Im – Cand. of Sci. (Med.), Senior Research Fellow of the Department of Interventional Cardiology, Arrhythmology and Endovascular Surgery, Republican Specialized Scientific and Practical Medical Center for Surgery named after academician V. Vakhidov, Tashkenthttps://orcid.org/0000-0003-3397-8956

dr.vadim.im@gmail.comХамдамовС. К.KhamdamovS. K.

Хамдамов Санжар Камалович – заведующий отделением ультразвуковой диагностики ГУ “Республиканский специализированный научно-практический медицинский центр хирургии имени академика В. Вахидова”, Ташкент

Sanzhar K. Khamdamov – Head of the Department of Ultrasound Diagnostics, Republican Specialized Scientific and Practical Medical Center for Surgery named after academician V. Vakhidov, Tashkent

dr.vadim.im@gmail.comГУ “Республиканский специализированный научно-практический медицинский центр хирургии имени академика В. Вахидова”УзбекистанState Institution “Republican Specialized Scientific and Practical Medical Center for Surgery named after academician V. Vakhidov”Uzbekistan2025300420252921019Copyright © Зуфаров М.М., Им В.М., Хамдамов С.К., 20252025Зуфаров М.М., Им В.М., Хамдамов С.К.Zufarov M.M., Im V.M., Khamdamov S.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/1479Цель исследования

Цель исследования: оценка результатов баллонной митральной вальвулопластики (БМВ) стеноза митрального клапана под ультразвуковым контролем, обобщение роли эхокардиографии (ЭхоКГ) в диагностике, лечении митрального стеноза (МС) ревматической этиологии.

Материал и методы

Материал и методы. В исследование включено 47 пациентов с МС, которым была выполнена БМВ по методике Inoue с включением ЭхоКГ как дополнительного метода контроля при проведении этапов вмешательства. Большинство пациентов составили женщины – 39 (82,9%). Средний возраст пациентов 49,8 ± 6,14 года. Синусовый ритм был у 35 (74,5%) пациентов, у оставшихся 12 (25,5%) была фибрилляция предсердий.

Результаты

Результаты. Среднее время, затраченное на процедуру (включающее момент от пункции вены до удаления катетера), составило 48,76 ± 6,48 мин. Размер баллонного катетера 26,3 ± 0,91 мм. Средний трансмитральный градиент снизился с 14,15 ± 2,75 мм рт.ст. до 6,1 ± 1,15 мм рт.ст. (p < 0,05). Среднее давление в легочной артерии снизилось с 28,48 ± 2,26 мм рт.ст. до 15,2 ± 3,68 мм рт.ст. (p < 0,05). Давление в левом предсердии снизилось с 27,86 ± 3,87 мм рт.ст. до 13,4 ± 2,75 мм рт.ст. (p < 0,05) после БМВ. Площадь митрального отверстия до БМВ в среднем составляла 0,95 ± 0,14 см2, а после БМВ увеличилась до 1,89 ± 0,25 см2 (p < 0,05). Осложнений во время и после процедуры не было. Средняя длительность наблюдения после операции составила 11,35 ± 1,14 мес.

Заключение

Заключение. БМВ является эффективным и безопасным методом лечения МС у отобранных для данной процедуры пациентов. ЭхоКГ является не только основным методом при диагностике МС, но и должна использоваться на всех этапах БМВ. Совершенствование использования ЭхоКГ во время эндоваскулярного вмешательства позволяет значительно снизить рентгеноблучение, а в дальнейшем и полностью избежать его применения.

Objective

Objective: To evaluate the outcomes of balloon mitral valvuloplasty (BMV) for mitral valve stenosis (MVS) performed under ultrasound guidance, and to summarize the role of echocardiography (EchoCG) in the diagnosis and treatment of rheumatic mitral stenosis (MS).

Materials and Methods

Materials and Methods: This study included 47 patients with MS who underwent BMV using the Inoue technique, with echocardiography employed as an auxiliary method for procedural guidance. The majority of patients were women—39 (82.9%). The mean age was 49.8 ± 6.14 years. Sinus rhythm was present in 35 (74.5%) patients, while atrial fibrillation (AF) was observed in 12 (25.5%).

Results

Results: The mean duration of the procedure (from venous puncture to catheter removal) was 48.76 ± 6.48 minutes. The average size of the balloon catheter was 26.3 ± 0.91 mm. The mean transmitral pressure gradient decreased significantly from 14.15 ± 2.75 mmHg to 6.1 ± 1.15 mmHg (p < 0.05). The mean pulmonary artery pressure (PAP) was reduced from 28.48 ± 2.26 mmHg to 15.2 ± 3.68 mmHg (p < 0.05). Left atrial (LA) pressure dropped from 27.86 ± 3.87 mmHg to 13.4 ± 2.75 mmHg (p < 0.05) after BMV. The mitral valve area (MVA) increased from 0.95 ± 0.14 cm² to 1.89 ± 0.25 cm² (p < 0.05). No intraoperative or postoperative complications were observed. The mean follow-up duration was 11.35 ± 1.14 months.

Conclusion

Conclusion: BMV is an effective and safe treatment option for selected patients with MS. Echocardiography not only plays a central role in diagnosing MS but should also be integrated into all stages of the BMV procedure. Enhancing the use of echocardiographic guidance during endovascular intervention can significantly reduce radiation exposure, and potentially eliminate its need altogether in the future.

ревматизммитральный стенозбаллонная митральная вальвулопластикаэхокардиографиялучевая нагрузкаrheumatic fevermitral stenosisballoon mitral valvuloplastyechocardiographyradiation exposureReferencesIung B., Vahanian A. Epidemiology of valvular heart disease in the adult. Nat. Rev. Cardiol. 2011; 8 (3): 162–172. http://doi.org/10.1038/nrcardio.2010.202Iung B., Vahanian A. Epidemiology of valvular heart disease in the adult. Nat. Rev. Cardiol. 2011; 8 (3): 162–172. http://doi.org/10.1038/nrcardio.2010.202Roth G.A., Johnson C., Abajobir A. et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J. Am. Coll. Cardiol. 2017; 70 (1): 1–25. http://doi.org/10.1016/j.jacc.2017.04.052.Roth G.A., Johnson C., Abajobir A. et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J. Am. Coll. Cardiol. 2017; 70 (1): 1–25. http://doi.org/10.1016/j.jacc.2017.04.052.Passeri J.J., Dal-Bianco J.P. Percutaneous Balloon Mitral Valvuloplasty: Echocardiographic Eligibility and Procedural Guidance. Interv. Cardiol. Clin. 2018; 7 (3): 405–413. http://doi.org/10.1016/j.iccl.2018.04.003Passeri J.J., Dal-Bianco J.P. Percutaneous Balloon Mitral Valvuloplasty: Echocardiographic Eligibility and Procedural Guidance. Interv. Cardiol. Clin. 2018; 7 (3): 405–413. http://doi.org/10.1016/j.iccl.2018.04.003Nobuyoshi M., Arita T., Shirai S. et al. Percutaneous balloon mitral valvuloplasty: a review. Circulation. 2009; 119 (8): e211–9. http://doi.org/10.1161/CIRCULATIONAHA.108.792952Nobuyoshi M., Arita T., Shirai S. et al. Percutaneous balloon mitral valvuloplasty: a review. Circulation. 2009; 119 (8): e211–9. http://doi.org/10.1161/CIRCULATIONAHA.108.792952Wilson J.K., Greenwood W.F. The natural history of mitral stenosis. Can. Med. Assoc. J. 1954; 71 (4): 323–331.Wilson J.K., Greenwood W.F. The natural history of mitral stenosis. Can. Med. Assoc. J. 1954; 71 (4): 323–331.Harb S.C., Griffin B.P. Mitral Valve Disease: a Comprehensive Review. Curr. Cardiol. Rep. 2017; 19 (8): 73. http://doi.org/10.1007/s11886-017-0883-5Harb S.C., Griffin B.P. Mitral Valve Disease: a Comprehensive Review. Curr. Cardiol. Rep. 2017; 19 (8): 73. http://doi.org/10.1007/s11886-017-0883-5Inoue K., Owaki T., Nakamura T. et al. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J. Thorac. Cardiovasc. Surg. 1984; 87 (3): 394–402.Inoue K., Owaki T., Nakamura T. et al. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J. Thorac. Cardiovasc. Surg. 1984; 87 (3): 394–402.Arora R., Nair M., Kalra G.S. et al. Immediate and long-term results of balloon and surgical closed mitral valvotomy: a randomized comparative study. Am. Heart J. 1993; 125 (4): 1091–1094. http://doi.org/10.1016/0002-8703(93)90118-sArora R., Nair M., Kalra G.S. et al. Immediate and long-term results of balloon and surgical closed mitral valvotomy: a randomized comparative study. Am. Heart J. 1993; 125 (4): 1091–1094. http://doi.org/10.1016/0002-8703(93)90118-sde Souza J.A., Martinez E.E. Jr., Ambrose J.A. et al. Percutaneous balloon mitral valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy. J. Am. Coll. Cardiol. 2001; 37 (3): 900–903. http://doi.org/10.1016/s0735-1097(00)01184-0de Souza J.A., Martinez E.E. Jr., Ambrose J.A. et al. Percutaneous balloon mitral valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy. J. Am. Coll. Cardiol. 2001; 37 (3): 900–903. http://doi.org/10.1016/s0735-1097(00)01184-0Turi Z.G. The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status. Struct. Heart. 2022; 6 (5): 100087. http://doi.org/10.1016/j.shj.2022.100087Turi Z.G. The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status. Struct. Heart. 2022; 6 (5): 100087. http://doi.org/10.1016/j.shj.2022.100087Iung B., Nicoud-Houel A., Fondard O. et al. Temporal trends in percutaneous mitral commissurotomy over a 15-year period. Eur. Heart J. 2004; 25 (8): 701–707. http://doi.org/10.1016/j.ehj.2004.02.026Iung B., Nicoud-Houel A., Fondard O. et al. Temporal trends in percutaneous mitral commissurotomy over a 15-year period. Eur. Heart J. 2004; 25 (8): 701–707. http://doi.org/10.1016/j.ehj.2004.02.026Singh A.D., Mian A., Devasenapathy N. et al. Percutaneous mitral commissurotomy versus surgical commissurotomy for rheumatic mitral stenosis: a systematic review and meta-analysis of randomised controlled trials. Heart. 2020; 106 (14): 1094–1101. http://doi.org/10.1136/heartjnl-2019-315906Singh A.D., Mian A., Devasenapathy N. et al. Percutaneous mitral commissurotomy versus surgical commissurotomy for rheumatic mitral stenosis: a systematic review and meta-analysis of randomised controlled trials. Heart. 2020; 106 (14): 1094–1101. http://doi.org/10.1136/heartjnl-2019-315906Harb S.C., Griffin B.P. Mitral Valve Disease: a Comprehensive Review. Curr. Cardiol. Rep. 2017; 19 (8): 73. http://doi.org/10.1007/s11886-017-0883-5Harb S.C., Griffin B.P. Mitral Valve Disease: a Comprehensive Review. Curr. Cardiol. Rep. 2017; 19 (8): 73. http://doi.org/10.1007/s11886-017-0883-5Wilkins G.T., Weyman A.E., Abascal V.M. et al. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br. Heart J. 1988; 60 (4): 299–308. http://doi.org/10.1136/hrt.60.4.299Wilkins G.T., Weyman A.E., Abascal V.M. et al. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. Br. Heart J. 1988; 60 (4): 299–308. http://doi.org/10.1136/hrt.60.4.299Chmielak Z., Klopotowski M., Kruk M. et al. Repeat percutaneous mitral balloon valvuloplasty for patients with mitral valve restenosis. Catheter Cardiovasc. Interv. 2010; 76 (7): 986–992. http://doi.org/10.1002/ccd.22608Chmielak Z., Klopotowski M., Kruk M. et al. Repeat percutaneous mitral balloon valvuloplasty for patients with mitral valve restenosis. Catheter Cardiovasc. Interv. 2010; 76 (7): 986–992. http://doi.org/10.1002/ccd.22608Turi Z.G. The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status. Struct. Heart. 2022; 6 (5): 100087. http://doi.org/10.1016/j.shj.2022.100087Turi Z.G. The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status. Struct. Heart. 2022; 6 (5): 100087. http://doi.org/10.1016/j.shj.2022.100087Livingstone R.S., Chandy S., Peace B.S. et al. Audit of radiation dose during balloon mitral valvuloplasty procedure. J. Radiol. Prot. 2006; 26 (4): 397–404. http://doi.org/10.1088/0952-4746/26/4/004Livingstone R.S., Chandy S., Peace B.S. et al. Audit of radiation dose during balloon mitral valvuloplasty procedure. J. Radiol. Prot. 2006; 26 (4): 397–404. http://doi.org/10.1088/0952-4746/26/4/004Meinel F.G., Nance J.W. Jr., Harris B.S. et al. Radiation risks from cardiovascular imaging tests. Circulation. 2014; 130 (5): 442–445. http://doi.org/10.1161/CIRCULATIONAHA.113.005340Meinel F.G., Nance J.W. Jr., Harris B.S. et al. Radiation risks from cardiovascular imaging tests. Circulation. 2014; 130 (5): 442–445. http://doi.org/10.1161/CIRCULATIONAHA.113.005340Hussein A., Eid M., Mahmoud S.E.D. et al. The Outcomes of PBMV in Pregnancy, and When is the Best Time? Vasc. Health. Risk. Manag. 2023; 19: 13–20. http://doi.org/10.2147/VHRM.S388754Hussein A., Eid M., Mahmoud S.E.D. et al. The Outcomes of PBMV in Pregnancy, and When is the Best Time? Vasc. Health. Risk. Manag. 2023; 19: 13–20. http://doi.org/10.2147/VHRM.S388754Sreerama D., Surana M., Moolchandani K. et al. Percutaneous balloon mitral valvotomy during pregnancy: A systematic review and meta-analysis. Acta Obstet. Gynecol. Scand. 2021; 100 (4): 666–675. http://doi.org/10.1111/aogs.14029Sreerama D., Surana M., Moolchandani K. et al. Percutaneous balloon mitral valvotomy during pregnancy: A systematic review and meta-analysis. Acta Obstet. Gynecol. Scand. 2021; 100 (4): 666–675. http://doi.org/10.1111/aogs.14029Broadhead D.A., Chapple C.L., Faulkner K. et al. The impact of cardiology on the collective effective dose in the North of England. Br. J. Radiol. 1997; 70 (833): 492–497. http://doi.org/10.1259/bjr.70.833.9227231Broadhead D.A., Chapple C.L., Faulkner K. et al. The impact of cardiology on the collective effective dose in the North of England. Br. J. Radiol. 1997; 70 (833): 492–497. http://doi.org/10.1259/bjr.70.833.9227231Vañó E., González L., Fernández J.M., Guibelalde E. Patient dose values in interventional radiology. Br. J. Radiol. 1995; 68 (815): 1215–1220. http://doi.org/10.1259/0007-1285-68-815-1215Vañó E., González L., Fernández J.M., Guibelalde E. Patient dose values in interventional radiology. Br. J. Radiol. 1995; 68 (815): 1215–1220. http://doi.org/10.1259/0007-1285-68-815-1215Pan X., Ouyang W., Li S. et al. Safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance. Zhonghua Xin Xue Guan Bing Za Zhi. 2015; 43 (1): 31–33. PMID: 25876719 (In Chinese)Pan X., Ouyang W., Li S. et al. Safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance. Zhonghua Xin Xue Guan Bing Za Zhi. 2015; 43 (1): 31–33. PMID: 25876719 (In Chinese)Liu Y., Guo G.L., Wen B. et al. Feasibility and effectiveness of percutaneous balloon mitral valvuloplasty under echocardiographic guidance only. Echocardiography. 2018; 35 (10): 1507–1511. http://doi.org/10.1111/echo.14055Liu Y., Guo G.L., Wen B. et al. Feasibility and effectiveness of percutaneous balloon mitral valvuloplasty under echocardiographic guidance only. Echocardiography. 2018; 35 (10): 1507–1511. http://doi.org/10.1111/echo.14055Pan X.B., Ou-Yang W.B., Pang K.J. et al. Percutaneous Closure of Atrial Septal Defects Under Transthoracic Echocardiography Guidance Without Fluoroscopy or Intubation in Children. J. Interv. Cardiol. 2015; 28 (4): 390–395. http://doi.org/10.1111/joic.12214Pan X.B., Ou-Yang W.B., Pang K.J. et al. Percutaneous Closure of Atrial Septal Defects Under Transthoracic Echocardiography Guidance Without Fluoroscopy or Intubation in Children. J. Interv. Cardiol. 2015; 28 (4): 390–395. http://doi.org/10.1111/joic.12214Wang S.Z., Ou-Yang W.B., Hu S.S. et al. First-in-Human Percutaneous Balloon Pulmonary Valvuloplasty Under Echocardiographic Guidance Only. Congenit. Heart Dis. 2016; 11 (6): 716–720. http://doi.org/10.1111/chd.12380Wang S.Z., Ou-Yang W.B., Hu S.S. et al. First-in-Human Percutaneous Balloon Pulmonary Valvuloplasty Under Echocardiographic Guidance Only. Congenit. Heart Dis. 2016; 11 (6): 716–720. http://doi.org/10.1111/chd.12380Rajvanshi S., Nath R.K., Bharadwaj R. Mitral valve assessment and scoring before balloon mitral valvuloplasty. Heart India. 2020; 8 (3): 121–126. http://doi.org/10.4103/heartindia.heartindia_22_20Rajvanshi S., Nath R.K., Bharadwaj R. Mitral valve assessment and scoring before balloon mitral valvuloplasty. Heart India. 2020; 8 (3): 121–126. http://doi.org/10.4103/heartindia.heartindia_22_20Gajjala O.R., Durgaprasad R., Velam V. et al. New integrated approach to percutaneous mitral valvuloplasty combining Wilkins score with commissural calcium score and commissural area ratio. Echocardiography. 2017; 34 (9): 1284–1291. http://doi.org/10.1111/echo.13635Gajjala O.R., Durgaprasad R., Velam V. et al. New integrated approach to percutaneous mitral valvuloplasty combining Wilkins score with commissural calcium score and commissural area ratio. Echocardiography. 2017; 34 (9): 1284–1291. http://doi.org/10.1111/echo.13635Cannan C.R., Nishimura R.A., Reeder G.S. et al. Echocardiographic assessment of commissural calcium: a simple predictor of outcome after percutaneous mitral balloon valvotomy. J. Am. Coll. Cardiol. 1997; 29 (1): 175–180. http://doi.org/10.1016/s0735-1097(96)00422-6Cannan C.R., Nishimura R.A., Reeder G.S. et al. Echocardiographic assessment of commissural calcium: a simple predictor of outcome after percutaneous mitral balloon valvotomy. J. Am. Coll. Cardiol. 1997; 29 (1): 175–180. http://doi.org/10.1016/s0735-1097(96)00422-6Padial L.R., Freitas N., Sagie A. et al. Echocardiography can predict which patients will develop severe mitral regurgitation after percutaneous mitral valvulotomy. J. Am. Coll. Cardiol. 1996; 27 (5): 1225–1231. http://doi.org/10.1016/0735-1097(95)00594-3Padial L.R., Freitas N., Sagie A. et al. Echocardiography can predict which patients will develop severe mitral regurgitation after percutaneous mitral valvulotomy. J. Am. Coll. Cardiol. 1996; 27 (5): 1225–1231. http://doi.org/10.1016/0735-1097(95)00594-3Nunes M.C., Tan T.C., Elmariah S. et al. The echo score revisited: Impact of incorporating commissural morphology and leaflet displacement to the prediction of outcome for patients undergoing percutaneous mitral valvuloplasty. Circulation. 2014; 129 (8): 886–895. http://doi.org/10.1161/CIRCULATIONAHA.113.001252Nunes M.C., Tan T.C., Elmariah S. et al. The echo score revisited: Impact of incorporating commissural morphology and leaflet displacement to the prediction of outcome for patients undergoing percutaneous mitral valvuloplasty. Circulation. 2014; 129 (8): 886–895. http://doi.org/10.1161/CIRCULATIONAHA.113.001252Sanati H.R., Kiavar M., Salehi N. et al. Percutaneous mitral valvuloplasty--a new method for balloon sizing based on maximal commissural diameter to improve procedural results. Am. Heart Hosp. J. 2010; 8 (1): 29–32. http://doi.org/10.15420/ahhj.2010.8.1.29Sanati H.R., Kiavar M., Salehi N. et al. Percutaneous mitral valvuloplasty--a new method for balloon sizing based on maximal commissural diameter to improve procedural results. Am. Heart Hosp. J. 2010; 8 (1): 29–32. http://doi.org/10.15420/ahhj.2010.8.1.29Mohan J.C., Shukla M. Mitral Regurgitation Following Balloon Mitral Valvuloplasty: A New Twist on an Old Problem. JACC Cardiovasc. Imaging. 2020; 13 (12): 2527–2529. http://doi.org/10.1016/j.jcmg.2020.07.044Mohan J.C., Shukla M. Mitral Regurgitation Following Balloon Mitral Valvuloplasty: A New Twist on an Old Problem. JACC Cardiovasc. Imaging. 2020; 13 (12): 2527–2529. http://doi.org/10.1016/j.jcmg.2020.07.044Nunes M.C.P., Levine R.A., Braulio R. et al. Mitral Regurgitation After Percutaneous Mitral Valvuloplasty: Insights Into Mechanisms and Impact on Clinical Outcomes. JACC Cardiovasc. Imaging. 2020; 13 (12): 2513–2526. http://doi.org/10.1016/j.jcmg.2020.07.020Nunes M.C.P., Levine R.A., Braulio R. et al. Mitral Regurgitation After Percutaneous Mitral Valvuloplasty: Insights Into Mechanisms and Impact on Clinical Outcomes. JACC Cardiovasc. Imaging. 2020; 13 (12): 2513–2526. http://doi.org/10.1016/j.jcmg.2020.07.020

The authors declare that there are no conflicts of interest present.