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Geng L, Huang S, Zhang T, Li J, Wang L, Zhou J, Gao L, Wang Y, Li J, Guo W, Li Y, Zhang Q. The association between O 2-pulse slope ratio and functional severity of coronary stenosis: A combined cardiopulmonary exercise testing and quantitative flow ratio study. IJC HEART & VASCULATURE 2024; 52:101409. [PMID: 38646188 PMCID: PMC11033149 DOI: 10.1016/j.ijcha.2024.101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/23/2024]
Abstract
Background The role of cardiopulmonary exercise testing (CPET) parameters in evaluating the functional severity of coronary disease remains unclear. The aim of this study was to quantify the O2-pulse morphology and investigate its relevance in predicting the functional severity of coronary stenosis, using Murray law-based quantitative flow ratio (μQFR) as the reference. Methods CPET and μQFR were analyzed in 138 patients with stable coronary artery disease (CAD). The O2-pulse morphology was quantified through calculating the O2-pulse slope ratio. The presence of O2-pulse plateau was defined according to the best cutoff value of O2-pulse slope ratio for predicting μQFR ≤ 0.8. Results The optimal cutoff value of O2-pulse slope ratio for predicting μQFR ≤ 0.8 was 0.4, with area under the curve (AUC) of 0.632 (95 % CI: 0.505-0.759, p = 0.032). The total discordance rate between O2-pulse slope ratio and μQFR was 27.5 %, with 13 patients (9.4 %) being classified as mismatch (O2-pulse slope ratio > 0.4 and μQFR ≤ 0.8) and 25 patients being classified as reverse-mismatch (O2-pulse slope ratio ≤ 0.4 and μQFR > 0.8). Angiography-derived microvascular resistance was independently associated with mismatch (OR 0.07; 95 % CI: 0.01-0.38, p = 0.002) and reverse-mismatch (OR 9.76; 95 % CI: 1.47-64.82, p = 0.018). Conclusion Our findings demonstrate the potential of the CPET-derived O2-pulse slope ratio for assessing myocardial ischemia in stable CAD patients.
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Affiliation(s)
- Liang Geng
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Shangwei Huang
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
- Department of Cardiology, Shanghai East Hospital JI'AN Hospital, Ji'an, Jiangxi 343000, China
| | - Tingting Zhang
- Department of Biomedical Engineering, College of Medicine, Kyung Hee University, Seoul 02447, South Korea
| | - Jimin Li
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Lijie Wang
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Junyan Zhou
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Liming Gao
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Yunkai Wang
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Jiming Li
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Wei Guo
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Ying Li
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
| | - Qi Zhang
- Department of Cardiology, East Hospital, Tongji University, Shanghai 200120, China
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Carvalho TD, Freitas OGAD, Chalela WA, Hossri CAC, Milani M, Buglia S, Precoma DB, Falcão AMGM, Mastrocola LE, Castro I, Albuquerque PFD, Coutinho RQ, Brito FSD, Alves JDC, Serra SM, Santos MAD, Colombo CSSDS, Stein R, Herdy AH, Silveira ADD, Castro CLBD, Silva MMFD, Meneghello RS, Ritt LEF, Malafaia FL, Marinucci LFB, Pena JLB, Almeida AEMD, Vieira MLC, Stier Júnior AL. Brazilian Guideline for Exercise Test in the Adult Population - 2024. Arq Bras Cardiol 2024; 121:e20240110. [PMID: 38896581 DOI: 10.36660/abc.20240110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Affiliation(s)
- Tales de Carvalho
- Clínica de Prevenção e Reabilitação Cardiosport, Florianópolis, SC - Brasil
- Universidade do Estado de Santa Catarina, Florianópolis, SC - Brasil
| | | | - William Azem Chalela
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Mauricio Milani
- Universidade de Brasília (UnB), Brasília, DF, Brasil
- Hasselt University, Hasselt - Bélgica
- Jessa Ziekenhuis, Hasselt - Bélgica
| | - Susimeire Buglia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | - Andréa Maria Gomes Marinho Falcão
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Iran Castro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | | | | | | | - Salvador Manoel Serra
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, RJ - Brasil
| | - Mauro Augusto Dos Santos
- Instituto Nacional de Cardiologia do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Linkcare Saúde, Rio de Janeiro, RJ - Brasil
| | | | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | - Artur Haddad Herdy
- Clínica de Prevenção e Reabilitação Cardiosport, Florianópolis, SC - Brasil
| | - Anderson Donelli da Silveira
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | - Claudia Lucia Barros de Castro
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- CLINIMEX - Clínica de Medicina de Exercício, Rio de Janeiro, RJ - Brasil
| | | | | | - Luiz Eduardo Fonteles Ritt
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
- Instituto D'Or de Pesquisa e Ensino, Salvador, BA - Brasil
- Hospital Cárdio Pulmonar, Salvador, BA - Brasil
| | - Felipe Lopes Malafaia
- Hospital Samaritano Paulista, São Paulo, SP - Brasil
- UnitedHealth Group Brasil, São Paulo, SP - Brasil
| | - Leonardo Filipe Benedeti Marinucci
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felício Rocho, Belo Horizonte, MG - Brasil
| | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Arnaldo Laffitte Stier Júnior
- Universidade Federal do Paraná (UFPR), Curitiba, PR - Brasil
- Secretaria Municipal de Saúde Curitiba, Curitiba, PR - Brasil
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Liu SX, Yu SQ, Yang KJ, Liu JY, Yang F, Li Y, Yao CL, Zhao GS, Sun FZ. Establishment and effectiveness evaluation of pre-test probability model of coronary heart disease combined with cardiopulmonary exercise test indexes. Sci Rep 2023; 13:16411. [PMID: 37775542 PMCID: PMC10541865 DOI: 10.1038/s41598-023-41884-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023] Open
Abstract
To establish a pre-test probability model of coronary heart disease (CHD) combined with cardiopulmonary exercise test (CPET) indexes and to compare the clinical effectiveness with Duke clinical score (DCS) and updated Diamond-Forrester model (UDFM), thus further explore the predictive value. 342 cases were used to establish the prediction model equation and another 80 cases were used to verify the effectiveness. The patients were divided into CHD group (n = 157) and non-CHD group (n = 185) according to coronary artery stenosis degree >50% or not. Combining DCS and UDFM as reference models with CPET indexes, a multivariate logistic regression model was established. The area under the ROC curve of the three models were calculated to compare the predictive effectiveness. There were significant differences in gender, chest pain type, myocardial infarction history, hypertension history, smoking, pathological Q wave and ST-T change between two groups (P < 0.01), as well as age, LVEF, heart rate at anaerobic domain, peak oxygen uptake in kilograms of body weight, percentage of peak oxygen uptake to the predicted value, the oxygen uptake efficiency slope and carbon dioxide ventilation equivalent slope (P < 0.05). Multivariate analysis showed gender, age, chest pain type, myocardial infarction history, hypertension history, smoking, pathological Q wave, ST-T change, and peak oxygen pulse were independent risk factors of CHD. The pre-test probability model of CHD combined with CPET indexes has good distinguish and calibrate ability, its prediction accuracy is slightly better than DCS and UDFM, which still needs to be verified externally in more samples.
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Affiliation(s)
- Si Xu Liu
- Heart Center, Affiliated Zhongshan Hospital of Dalian University, No.6 Jie Fang Street, Zhongshan District, Dalian, 116001, Liaoning Province, China
| | - Sheng Qin Yu
- Heart Center, Affiliated Zhongshan Hospital of Dalian University, No.6 Jie Fang Street, Zhongshan District, Dalian, 116001, Liaoning Province, China
| | - Kai Jing Yang
- Heart Center, Affiliated Zhongshan Hospital of Dalian University, No.6 Jie Fang Street, Zhongshan District, Dalian, 116001, Liaoning Province, China
| | - Ji Yi Liu
- Heart Center, Affiliated Zhongshan Hospital of Dalian University, No.6 Jie Fang Street, Zhongshan District, Dalian, 116001, Liaoning Province, China
| | - Fan Yang
- Heart Center, Affiliated Zhongshan Hospital of Dalian University, No.6 Jie Fang Street, Zhongshan District, Dalian, 116001, Liaoning Province, China
| | - Ye Li
- Heart Center, Affiliated Zhongshan Hospital of Dalian University, No.6 Jie Fang Street, Zhongshan District, Dalian, 116001, Liaoning Province, China
| | - Chang Li Yao
- Heart Center, Affiliated Zhongshan Hospital of Dalian University, No.6 Jie Fang Street, Zhongshan District, Dalian, 116001, Liaoning Province, China
| | - Guang Sheng Zhao
- Minimally invasive interventional diagnosis and treatment center, Affiliated Zhongshan Hospital of Dalian University, No.6 Jie Fang Street, Zhongshan District, Dalian, 116001, Liaoning Province, China.
| | - Feng Zhi Sun
- Heart Center, Affiliated Zhongshan Hospital of Dalian University, No.6 Jie Fang Street, Zhongshan District, Dalian, 116001, Liaoning Province, China.
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Ganesananthan S, Rajkumar CA, Foley M, Thompson D, Nowbar AN, Seligman H, Petraco R, Sen S, Nijjer S, Thom SA, Wensel R, Davies J, Francis D, Shun-Shin M, Howard J, Al-Lamee R. Cardiopulmonary exercise testing and efficacy of percutaneous coronary intervention: a substudy of the ORBITA trial. Eur Heart J 2022; 43:3132-3145. [PMID: 35639660 PMCID: PMC9433310 DOI: 10.1093/eurheartj/ehac260] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/10/2022] [Accepted: 05/06/2022] [Indexed: 01/10/2023] Open
Abstract
AIMS Oxygen-pulse morphology and gas exchange analysis measured during cardiopulmonary exercise testing (CPET) has been associated with myocardial ischaemia. The aim of this analysis was to examine the relationship between CPET parameters, myocardial ischaemia and anginal symptoms in patients with chronic coronary syndrome and to determine the ability of these parameters to predict the placebo-controlled response to percutaneous coronary intervention (PCI). METHODS AND RESULTS Patients with severe single-vessel coronary artery disease (CAD) were randomized 1:1 to PCI or placebo in the ORBITA trial. Subjects underwent pre-randomization treadmill CPET, dobutamine stress echocardiography (DSE) and symptom assessment. These assessments were repeated at the end of a 6-week blinded follow-up period.A total of 195 patients with CPET data were randomized (102 PCI, 93 placebo). Patients in whom an oxygen-pulse plateau was observed during CPET had higher (more ischaemic) DSE score [+0.82 segments; 95% confidence interval (CI): 0.40 to 1.25, P = 0.0068] and lower fractional flow reserve (-0.07; 95% CI: -0.12 to -0.02, P = 0.011) compared with those without. At lower (more abnormal) oxygen-pulse slopes, there was a larger improvement of the placebo-controlled effect of PCI on DSE score [oxygen-pulse plateau presence (Pinteraction = 0.026) and oxygen-pulse gradient (Pinteraction = 0.023)] and Seattle angina physical-limitation score [oxygen-pulse plateau presence (Pinteraction = 0.037)]. Impaired peak VO2, VE/VCO2 slope, peak oxygen-pulse, and oxygen uptake efficacy slope was significantly associated with higher symptom burden but did not relate to severity of ischaemia or predict response to PCI. CONCLUSION Although selected CPET parameters relate to severity of angina symptoms and quality of life, only an oxygen-pulse plateau detects the severity of myocardial ischaemia and predicts the placebo-controlled efficacy of PCI in patients with single-vessel CAD.
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Affiliation(s)
- Sashiananthan Ganesananthan
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Christopher A Rajkumar
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Michael Foley
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Alexandra N Nowbar
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
| | - Henry Seligman
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Ricardo Petraco
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Sayan Sen
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Sukhjinder Nijjer
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Simon A Thom
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
| | - Roland Wensel
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- DRK-Kliniken-Berlin and Charité Berlin, Germany
| | | | - Darrel Francis
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Matthew Shun-Shin
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - James Howard
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road W12 0HS, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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Christopoulos G, Bois J, Allison TG, Rodriguez-Porcel M, Chareonthaitawee P. The impact of combined cardiopulmonary exercise testing and SPECT myocardial perfusion imaging on downstream evaluation and management. J Nucl Cardiol 2019; 26:92-106. [PMID: 28508270 DOI: 10.1007/s12350-017-0910-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/11/2017] [Accepted: 04/17/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The diagnostic yield of combined cardiopulmonary exercise testing (CPET) and myocardial perfusion imaging (MPI) in patients referred for stress testing has received limited study. METHODS We evaluated consecutive patients who underwent combined CPET-MPI at a single tertiary referral center between 2011 and 2015. An abnormal CPET was defined as any of the following: reduced oxygen consumption, cardiac output impairment, or pulmonary impairment. Normal MPI was defined as the absence of resting or stress perfusion defect. The primary study outcome was change in clinical decision-making after CPET-MPI including management of pulmonary disease, management of deconditioning, heart failure management, and referral for cardiac catheterization. Outcomes of patients with normal and abnormal MPI were presented based on the specific CPET abnormality. RESULTS 415 patients were included in the study. Of the 269 patients that had normal MPI, 206 (77%) had abnormal CPET. Patients with abnormal CPET and normal MPI, compared with patients that had normal CPET and normal MPI, were more frequently diagnosed with pulmonary disease (11.7% vs 3.2%, P = .04) and deconditioning (33.5% vs 17.4%, P = .01). Of the 146 patients that had abnormal MPI, 128 (88%) had abnormal CPET. Patients with abnormal CPET and abnormal MPI, compared with patients that had normal CPET and abnormal MPI, did not statistically differ with regard to the study outcome. CONCLUSION An abnormal CPET, if the MPI was normal, prompted further evaluation and led to management of pulmonary disease and deconditioning.
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Affiliation(s)
| | - John Bois
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Thomas G Allison
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Martin Rodriguez-Porcel
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Mazaheri R, Shakerian F, Vasheghani-Farahani A, Halabchi F, Mirshahi M, Mansournia MA. The usefulness of cardiopulmonary exercise testing in assessment of patients with suspected coronary artery disease. Postgrad Med J 2016; 92:328-32. [DOI: 10.1136/postgradmedj-2015-133576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 12/28/2015] [Indexed: 11/04/2022]
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Dominguez-Rodriguez A, Thibodeau JT, Abreu-Gonzalez P, Ayers CR, Jimenez-Sosa A, Aranda JM, Drazner MH. Association Between Bendopnea and Key Parameters of Cardiopulmonary Exercise Testing in Patients With Advanced Heart Failure. J Card Fail 2015; 22:163-5. [PMID: 26708354 DOI: 10.1016/j.cardfail.2015.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/24/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Alberto Dominguez-Rodriguez
- Department of Cardiology, Hospital Universitario de Canarias, Tenerife, Spain; Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Tenerife, Spain
| | - Jennifer T Thibodeau
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Pedro Abreu-Gonzalez
- Departmento de Ciencias Médicas Básicas (Unidad de Fisiología), Universidad de La Laguna, Tenerife, Spain
| | - Colby R Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Juan M Aranda
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Mark H Drazner
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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Coeckelberghs E, Buys R, Goetschalckx K, Cornelissen VA, Vanhees L. Prognostic value of the oxygen uptake efficiency slope and other exercise variables in patients with coronary artery disease. Eur J Prev Cardiol 2015; 23:237-44. [DOI: 10.1177/2047487315569410] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/06/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Ellen Coeckelberghs
- Department of Rehabilitation Sciences, KU Leuven and Department of Cardiovascular Diseases, University Hospitals of Leuven, Belgium
| | - Roselien Buys
- Department of Rehabilitation Sciences, KU Leuven and Department of Cardiovascular Diseases, University Hospitals of Leuven, Belgium
| | - Kaatje Goetschalckx
- Department of Rehabilitation Sciences, KU Leuven and Department of Cardiovascular Diseases, University Hospitals of Leuven, Belgium
| | - Véronique A Cornelissen
- Department of Rehabilitation Sciences, KU Leuven and Department of Cardiovascular Diseases, University Hospitals of Leuven, Belgium
| | - Luc Vanhees
- Department of Rehabilitation Sciences, KU Leuven and Department of Cardiovascular Diseases, University Hospitals of Leuven, Belgium
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Dominguez-Rodriguez A, Abreu-Gonzalez P, Mendez-Vargas C, Martin-Cabeza M, Gonzalez J, del Carmen Garcia-Baute M, de la Rosa A, Laynez-Cerdeña I. Ventilatory efficiency predicts adverse cardiovascular events in asymptomatic patients with severe aortic stenosis and preserved ejection fraction. Int J Cardiol 2014; 177:1116-8. [DOI: 10.1016/j.ijcard.2014.08.073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 08/11/2014] [Indexed: 11/25/2022]
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10
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Microvascular coronary disease in women: Role of the cardiopulmonary exercise testing. Int J Cardiol 2013; 168:3012-3. [DOI: 10.1016/j.ijcard.2013.04.055] [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] [Received: 02/15/2013] [Accepted: 04/05/2013] [Indexed: 11/23/2022]
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