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Vamvakidou A, Jin W, Danylenko O, Papasozomenos G, Chahal N, Khattar R, Senior R. FLOW RATE NOT STROKE VOLUME IS A SUPERIOR PROGNOSTIC MARKER OF TRANSORTIC FLOW AND FLOW RESERVE IN PATIENTS WITH LOW-FLOW LOW-GRADIENT AORTIC STENOSIS UNDERGOING LOW-DOSE DOBUTAMINE ECHOCARDIOGRAPHY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31999-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Porter TR, Mulvagh SL, Abdelmoneim SS, Becher H, Belcik JT, Bierig M, Choy J, Gaibazzi N, Gillam LD, Janardhanan R, Kutty S, Leong-Poi H, Lindner JR, Main ML, Mathias W, Park MM, Senior R, Villanueva F. Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr 2018; 31:241-274. [DOI: 10.1016/j.echo.2017.11.013] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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103
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Ahmadvazir S, Shah BN, Zacharias K, Senior R. Incremental Prognostic Value of Stress Echocardiography With Carotid Ultrasound for Suspected CAD. JACC Cardiovasc Imaging 2018; 11:173-180. [DOI: 10.1016/j.jcmg.2016.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/07/2016] [Accepted: 12/12/2016] [Indexed: 10/19/2022]
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104
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Shah BN, MacNab A, Lynch J, Hampson R, Senior R, Steeds RP. Stress echocardiography in contemporary clinical cardiology: practical considerations and accreditation. Echo Res Pract 2018; 5:E1-E6. [PMID: 29358185 PMCID: PMC5795358 DOI: 10.1530/erp-17-0032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 01/09/2018] [Indexed: 11/20/2022] Open
Abstract
Stress echocardiography is a widely utilised test in patients with known or suspected coronary artery disease (CAD), valvular heart disease and cardiomyopathies. Its advantages include the ubiquitous availability of echocardiography, lack of ionising radiation, choice of physiological or pharmacological stressors, good diagnostic accuracy and robust supporting evidence base. SE has evolved significantly as a technique over the past three decades and has benefitted considerably from improvements in overall image quality (superior resolution), machine technology (e.g. digital cine-loop acquisition and side-by-side image display) and development of second-generation ultrasound contrast agents that have improved reader confidence and diagnostic accuracy. The purpose of this article is to review the breadth of SE in contemporary clinical cardiology and discuss the recently launched British Society of Echocardiography (BSE) Stress Echocardiography accreditation scheme.
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Nam M, Meneses A, Anstey C, Askew C, Hickman I, Bailey T, Quah J, Senior R, Cox S, Poulter R, Butterly S, Fryer M, Russell A, Stanton T, Greaves K. An Experimental Series Investigating the Effects of Euglycaemic Hyperinsulinaemia on Myocardial Blood Flow Reserve in Healthy Individuals and Perfusion Defect Size in Patients Presenting With Acute Myocardial Infarction. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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106
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Gurunathan S, Ahmed A, Vamvakidou A, Ramzy IS, Akhtar M, Ali A, Karogiannis N, Zidros S, Balaji G, Young G, Elghamaz A, Senior R. Diagnostic Concordance and Clinical Outcomes in Patients Undergoing Fractional Flow Reserve and Stress Echocardiography for the Assessment of Coronary Stenosis of Intermediate Severity. J Am Soc Echocardiogr 2017; 31:180-186. [PMID: 29246509 DOI: 10.1016/j.echo.2017.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The ischemic consequences of coronary artery stenosis can be assessed by invasive fractional flow reserve (FFR) or by noninvasive imaging. We sought to determine (1) the concordance between wall thickening assessment during clinically indicated stress echocardiography (SE) and FFR measurements and (2) the factors associated with hard events in these patients. METHODS Two hundred twenty-three consecutive patients who underwent SE and invasive FFR measurements in close succession were analyzed retrospectively for diagnostic concordance and clinical outcomes. RESULTS At the vessel level, the sensitivity, specificity, positive predictive value, and negative predictive value of SE for identifying significant disease as assessed by FFR was 68%, 75%, 43%, and 89%, respectively. The greatest discordance was seen in patients with wall thickening abnormalities (WTAs) and negative FFR. During a follow-up of 3.6 ± 2.2 years, there were 23 cardiovascular (CV) events (death and nonfatal myocardial infarction). The number of wall segments with inducible WTAs emerged as the strongest factor associated with CV events (hazard ratio, 1.18 [1.05-1.34]; P = .008). FFR was not associated with outcome. There was a significant increase in event rate in patients with WTA/negative FFR versus no WTA/negative FFR (P = .01), but no significant difference versus WTA/positive FFR (P = .85). CONCLUSIONS In a patient population with significant CV risk factors, a normal SE had a high negative predictive value for excluding abnormal FFR. WTAs were associated with outcomes regardless of FFR value, suggesting that this is a superior marker of ischemia to FFR.
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107
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Toulemonde MEG, Corbett R, Papadopoulou V, Chahal N, Li Y, Leow CH, Cosgrove DO, Eckersley RJ, Duncan N, Senior R, Tang MX. High Frame-Rate Contrast Echocardiography: In-Human Demonstration. JACC Cardiovasc Imaging 2017; 11:923-924. [PMID: 29248652 DOI: 10.1016/j.jcmg.2017.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/15/2017] [Accepted: 09/21/2017] [Indexed: 11/29/2022]
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108
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Abstract
PURPOSE OF REVIEW Stress echocardiography (SE) is a well-established technique for the diagnosis and risk stratification of patients with known or suspected coronary artery disease (CAD). This review article summarizes the status of SE in CAD, including testing protocols, clinical efficacy and current use of newer technologies: myocardial perfusion, strain imaging, three-dimensional echocardiography and adjunctive carotid ultrasonography. RECENT FINDINGS Recent major findings in SE include the clinical value of myocardial perfusion imaging in multicentre studies, as well as when added to left ventricular (LV) wall motion assessment in clinical service. Additionally, SE has been shown to be more cost-effective than exercise ECG in patients with low-intermediate pre-test probability of CAD. Adjunctive atherosclerosis imaging by carotid ultrasonography (CU) to ischaemia testing by SE provides synergistic prognostic value, equivalent to hybrid imaging by PET-CT. Despite the development of newer and more expensive imaging modalities, SE remains the cornerstone for the assessment of CAD and has excellent clinical efficacy, is safe and is cost-effective.
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109
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Li Y, Chahal N, Senior R, Tang MX. Reproducible Computer-Assisted Quantification of Myocardial Perfusion with Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2235-2246. [PMID: 28693906 DOI: 10.1016/j.ultrasmedbio.2017.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 04/02/2017] [Accepted: 05/01/2017] [Indexed: 06/07/2023]
Abstract
Myocardial perfusion can be quantified by myocardial contrast echocardiography (MCE) and is used for the diagnosis of coronary artery disease (CAD). However, existing MCE quantification software is highly operator dependent and has poor reproducibility and ease of usage. The aim of this study was to develop robust and easy-to-use software that can perform MCE quantification accurately, reproducibly and rapidly. The developed software has the following features: (i) semi-automatic segmentation of the myocardium; (ii) automatic rejection of MCE data with poor image quality; (iii) automatic computation of perfusion parameters such as myocardial blood flow (MBF). MCE sequences of 18 individuals (9 normal, 9 with CAD) undergoing vasodilator stress with dipyridamole were analysed quantitatively using the software. When evaluated against coronary angiography, the software achieved a sensitivity of 71% and a specificity of 91% for hyperemic MBF. With the automatic rejection algorithm, the sensitivity and specificity further improved to 77% and 94%, respectively. For MBF reproducibility, the percentage agreement is 85% (κ = 0.65) for inter-observer variability and 88% (κ = 0.72) for intra-observer variability. The intra-class correlation coefficients are 0.94 (inter-observer) and 0.96 (intra-observer). The time taken to analyse one MCE sequence using the software is about 3 min on a PC. The software has exhibited good diagnostic performance and reproducibility for CAD detection and is rapid and user-friendly.
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Steffel J, Ruff CT, Hamershock RA, Murphy SA, Senior R, Roy D, Lanz HJ, Mercuri MF, Antman EM, Giugliano RP. First experience with edoxaban and atrial fibrillation ablation – Insights from the ENGAGE AF-TIMI 48 trial. Int J Cardiol 2017. [DOI: 10.1016/j.ijcard.2017.05.098] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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111
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Steeds RP, Cowie MR, Rana BS, Chambers JB, Ray S, Srinivasan J, Schwarz K, Neil CJ, Scally C, Horowitz JD, Frenneaux MP, Pislaru C, Dawson DK, Rothwell OJ, George K, Somauroo JD, Lord R, Stembridge M, Shave R, Hoffman M, Ashley EA, Haddad F, Eijsvogels TMH, Oxborough D, Hampson R, Kinsey CD, Gurunathan S, Vamvakidou A, Karogiannis N, Senior R, Ahmadvazir S, Shah BN, Zacharias K, Bowen D, Robinson S, Ihekwaba U, Parker K, Boyd J, Densem CG, Atkinson C, Hinton J, Gaisie EB, Rakhit DJ, Yue AM, Roberts PR, Thomas D, Phen P, Sibley J, Fergey S, Russhard P. Report from the Annual Conference of the British Society of Echocardiography, November 2016, Queen Elizabeth II Conference Centre, London. Echo Res Pract 2017; 4:M1. [PMID: 30390608 PMCID: PMC8693153 DOI: 10.1530/erp-17-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 11/16/2022] Open
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112
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Cazzoli I, Larsen S, Kempny A, Dimopoulos K, Uebing A, Diller G, West C, Senior R, Babu-Narayan S, Gatzoulis M, Li W. P733Echocardiographic predictors of outcome in repaired Tetralogy of Fallot patients over 40 years old. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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113
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Venneri L, Danylenko O, Calicchio F, Manivarmane R, Tadic M, Baksi J, Rosen S, Senior R, Lyon A, Khattar R. P6119Cancer and myocardial dysfunction: observations from myocardial strain imaging in a dedicated cardio-oncology clinic. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gurunathan S, Zacharias K, Akhtar M, Ahmed A, Mehta V, Karogiannis N, Vamvakidou A, Khattar R, Senior R. P6025A management strategy based on exercise echocardiography is more cost-effective than exercise ecg in patients presenting with suspected angina during long term follow up: a randomised study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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115
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Kouranos V, Minz M, Danylenko O, Teoh H, Bronis K, Baksi J, Wechalekar K, Sharma R, Wells A, Senior R, Khattar R. P6124Diagnostic value of baseline characteristics and echocardiography in patients with suspected cardiac sarcoidosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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116
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Saeed S, Senior R, Chahal NS, Lønnebakken MT, Chambers JB, Bahlmann E, Gerdts E. Lower Transaortic Flow Rate Is Associated With Increased Mortality in Aortic Valve Stenosis. JACC Cardiovasc Imaging 2017; 10:912-920. [DOI: 10.1016/j.jcmg.2017.05.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/15/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
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117
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Gurunathan S, Ahmed A, Karogiannis N, Ramzy I, Vamvakidou A, Young G, Zidros S, Akhtar M, Elghamaz A, Senior R. P6026Diagnostic concordance and clinical outcomes in patients undergoing fractional flow reserve and stress echocardiography for the assessment of coronary stenosis of intermediate severity. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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118
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Karogiannis N, Pabla J, Gurunathan S, Vamvakidou A, Young G, Senior R. 1245Long term prognostic value of dipyridamole stress myocardial contrast echocardiography in comparison with single photon emission tomography in patients with known or suspected coronary artery disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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119
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Pires N, Li W, Senior R, Khattar RS. Incidental finding of a double orifice mitral valve in an elderly patient: value of 3D imaging. Echo Res Pract 2017; 4:K21-K24. [PMID: 28743714 PMCID: PMC5574279 DOI: 10.1530/erp-17-0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 07/25/2017] [Indexed: 11/08/2022] Open
Abstract
A rare isolated double orifice mitral valve (DOMV) was diagnosed in a 77-year-old male patient, being assessed for surgical repair of the ascending aorta. This is a rare congenital abnormality, usually discovered as an incidental finding during investigation of other congenital heart defects. This case shows that a detailed assessment of all cardiac structures is necessary, not only in young patients, but also in the elderly population, to minimise the under-diagnosis of such rare anomalies. The use of 3D transthoracic echocardiography (TTE) has an increasingly significant role in establishing the diagnosis and extending the morphological and functional understanding of the anomaly.
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Vamvakidou A, Chahal N, Hampson R, Gurunathan S, Karogiannis N, Li W, Banfield A, Khattar R, Senior R. 124 Stroke volume determined flow reserve does not predict the true severity of low-flow low-gradient aortic stenosis and is not a robust marker of contractile reserve in patients undergoing low-dose dobutamine echocardiography. BRITISH HEART JOURNAL 2017. [DOI: 10.1136/heartjnl-2017-311726.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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121
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Gurunathan S, Elghamaz A, Ahmed A, Young G, Vamvakidou A, Karogiannis N, Ramzy I, Senior R. 115 Diagnostic concordance and clinical outcomes in patients undergoing fractional flow reserve and stress echocardiography for the assessment of coronary stenosis of intermediate severity. BRITISH HEART JOURNAL 2017. [DOI: 10.1136/heartjnl-2017-311726.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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122
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Karogiannis N, Zacharias K, Vamvakidou A, Gurunathan S, Senior R. 108 Clinical outcome and cost-effectiveness of performing cardiac investigations in a very low likehood of coronary artery disease population according to nice and esc risk prediction models. BRITISH HEART JOURNAL 2017. [DOI: 10.1136/heartjnl-2017-311726.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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123
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Karogiannis N, Pabla J, Gurunathan S, Vamvakidou A, Young G, Senior R. 107 The long term prognostic value of dipyridamole stress myocardial contrast echocardiography in comparison with single photon emission tomography in patients with known or suspected coronary artery disease. BRITISH HEART JOURNAL 2017. [DOI: 10.1136/heartjnl-2017-311726.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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124
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Senior R, Khattar RS. Cardiac investigation for prognosis in coronary artery disease: where negative is positive. Eur Heart J Cardiovasc Imaging 2017; 18:988-989. [DOI: 10.1093/ehjci/jex053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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125
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Vamvakidou A, Chahal N, Senior R. Lack of Stroke Volume Determined Flow Reserve Does Not Always Preclude Assessment of Severity of Aortic Stenosis in Low-Flow Low-Gradient State During Dobutamine Echocardiography. JACC Cardiovasc Imaging 2017; 10:491-493. [DOI: 10.1016/j.jcmg.2016.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/18/2016] [Accepted: 04/16/2016] [Indexed: 11/25/2022]
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