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Song Y, Xu F, Feng W. Surgical treatment of left ventricular aneurysm in patients with prior myocardial infarction in the absence of obstructive coronary artery disease (MINOCA): a cohort study. J Cardiothorac Surg 2023; 18:304. [PMID: 37907998 PMCID: PMC10617135 DOI: 10.1186/s13019-023-02385-0] [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: 01/01/2023] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND There is a paucity of studies examining the treatment of patients with prior myocardial infarction in the absence of obstructive coronary arteries (MINOCA) and with a concomitant left ventricular aneurysm. Our study aims to illustrate the clinical characteristics and report the mid-term surgical outcomes in this distinct entity. METHODS Ten patients with MINOCA and left ventricular aneurysm were investigated. The MINOCA was diagnosed according to Scientific Statement from the American Heart Association. The indication for left ventricular reconstruction was as follows: clear evidence of both an aneurysmal and akinetic left ventricle with a history of myocardial infarction accompanied by heart failure symptoms, angina, or ventricular arrhythmias. Major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infarction, stroke was considered the primary endpoints. RESULTS The median follow-up for the whole study population was 64.5 months. Seven MINOCA patients developed a left ventricular aneurysm within 4 years and three MINOCA patients were found to have a concomitant left aneurysm at the first admission. Before surgery, no patients were prescribed angiotensin-converting enzyme inhibitors. Statins, dual antiplatelet therapy, and β-blockers were prescribed in 2, 5, and 5 patients, respectively. After surgery, no MACCE occurred in the follow-up. There was a significant increase in ejection fraction (EF) in the follow-up (p = 0.0009). CONCLUSIONS Close monitoring and standard medical treatment are required before a left ventricular aneurysm occurs in MINOCA patients. Left ventricular reconstruction remains a viable option for MINOCA patients with left ventricular aneurysms and mid-term outcomes were satisfying in this distinct entity.
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Affiliation(s)
- Yangwu Song
- Department of Cardiovascular Surgery, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Xu
- Department of Cardiovascular Surgery, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Feng
- Department of Cardiovascular Surgery, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Kim KH, She L, Lee KL, Dabrowski R, Grayburn PA, Rajda M, Prior DL, Desvigne-Nickens P, Zoghbi WA, Senni M, Stefanelli G, Beghi C, Huynh T, Velazquez EJ, Oh JK, Lin G. Incremental prognostic value of echocardiography of left ventricular remodeling and diastolic function in STICH trial. Cardiovasc Ultrasound 2020; 18:17. [PMID: 32466790 PMCID: PMC7257201 DOI: 10.1186/s12947-020-00195-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/27/2020] [Indexed: 11/10/2022] Open
Abstract
Aims We sought to determine which echocardiographic markers of left ventricular (LV) remodeling and diastolic dysfunction can contribute as incremental and independent prognostic information in addition to current clinical risk markers of ischemic LV systolic dysfunction in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Methods and results The cohort consisted of 1511 of 2136 patients in STICH for whom baseline transmitral Doppler (E/A ratio) could be measured by an echocardiographic core laboratory blinded to treatment and outcomes, and prognostic value of echocardiographic variables was determined by a Cox regression model. E/A ratio was the most significant predictor of mortality amongst diastolic variables with lowest mortality for E/A closest 0.8, although mortality was consistently low for E/A 0.6 to 1.0. Mortality increased for E/A < 0.6 and > 1.0 up to approximately 2.3, beyond which there was no further increase in risk. Larger LV end-systolic volume index (LVESVI) and E/A < 0.6 and > 1.0 had incremental negative effects on mortality when added to a clinical multivariable model, where creatinine, LVESVI, age, and E/A ratio accounted for 74% of the prognostic information for predicting risk. LVESVI and E/A ratio were stronger predictors of prognosis than New York Heart Association functional class, anemia, diabetes, history of atrial fibrillation, and stroke. Conclusions Echocardiographic markers of advanced LV remodeling and diastolic dysfunction added incremental prognostic value to current clinical risk markers. LVESVI and E/A ratio outperformed other markers and should be considered as standard in assessing risks in ischemic heart failure. E/A closest to 0.8 was the most optimal filling pattern.
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Affiliation(s)
- Kyung-Hee Kim
- Division of Cardiovascular Diseases, Sejong General Hospital, Bucheon, South Korea.,Division of Cardiovascular Diseases, Echocardiography Core Laboratory, Mayo Clinic, Gonda 6 South, 200 First St SW, Rochester, MN, USA
| | - Lilin She
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Kerry L Lee
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | | | - Miroslaw Rajda
- Capital Health Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | | | | | - William A Zoghbi
- Cardiovascular Imaging Institute, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | | | - Cesare Beghi
- Ospedale di Circolo, University of Insubria, Varese, Italy
| | - Thao Huynh
- Montreal General Hospital, McGill Health University Center, Montreal, Canada
| | | | - Jae K Oh
- Division of Cardiovascular Diseases, Echocardiography Core Laboratory, Mayo Clinic, Gonda 6 South, 200 First St SW, Rochester, MN, USA
| | - Grace Lin
- Division of Cardiovascular Diseases, Echocardiography Core Laboratory, Mayo Clinic, Gonda 6 South, 200 First St SW, Rochester, MN, USA.
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Shipulin VM, Pryakhin AS, Andreev SL, Shipulin VV, Kozlov BN. [Surgical Treatment of Ischemic Cardiomyopathy: Current State of the Problem]. ACTA ACUST UNITED AC 2019. [PMID: 31540578 DOI: 10.18087//cardio.2019.9.n329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this article we present discussion of the current state of the problem of surgical treatment of ischemic cardiomyopathy (ICM). The pathophysiological aspects of left ventricular remodeling in patients with ICM are also covered. A detailed characterization of methods for assessing the myocardial viability is given and their role in patients with ICM is shown. The problem of right ventricular dysfunction in ICM is discussed. Main attention is focused on the methods of surgical treatment of ICM. Limitations of the Surgical Treatment for Ischemic Heart Failure (STICH) study are analyzed. The article is intended for cardiologists, general practitioners and cardiac surgeons.
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Affiliation(s)
- V M Shipulin
- Сardiology Research Institute, Tomsk National Research Medical Centre, Siberian State Medical University
| | - A S Pryakhin
- Сardiology Research Institute, Tomsk National Research Medical Centre
| | - S L Andreev
- Сardiology Research Institute, Tomsk National Research Medical Centre
| | - V V Shipulin
- Сardiology Research Institute, Tomsk National Research Medical Centre
| | - B N Kozlov
- Сardiology Research Institute, Tomsk National Research Medical Centre, Siberian State Medical University
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Prior DL, Stevens SR, Holly TA, Krejca M, Paraforos A, Pohost GM, Byrd K, Kukulski T, Jones RH, Desvigne-Nickens P, Varadarajan P, Amanullah A, Lin G, Al-Khalidi HR, Aldea G, Santambrogio C, Bochenek A, Berman DS. Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery. Heart 2017; 103:1359-1367. [PMID: 28446548 DOI: 10.1136/heartjnl-2016-310693] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/08/2017] [Accepted: 02/12/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To define the prognostic contribution of global and regional left ventricular (LV) function measurements in patients with ischaemic cardiomyopathy randomised to coronary artery bypass graft surgery (CABG) with (n=501) or without (n=499) surgical ventricular reconstruction (SVR). METHODS Novel multivariable methods to analyse global and regional LV systolic function were used to better formulate prediction models for long-term mortality following CABG with or without SVR in the entire cohort of 1000 randomised SVR hypothesis patients. Key clinical variables were included in the analysis. Regional function was classified according to the discreteness of anteroapical hypokinesia and akinesia into those most likely to benefit from SVR, those least likely and those felt to have intermediate likelihood of benefit from SVR. RESULTS The most prognostic clinical variables identified in multivariable models include creatinine, LV end-systolic volume index (ESVI), age and NYHA (New York Heart Association) class. Addition of LV ejection fraction, LV end-diastolic volume index and regional function assessment did not contribute additional power to the model. Subgroup analysis based on regional function did not identify a cohort in which SVR improved mortality. CONCLUSIONS ESVI is the single parameter of LV function most predictive of mortality in patients with LV systolic dysfunction following CABG with or without SVR in multivariable models that include all key clinical and LV systolic function parameters. Assessment of regional cardiac function does not enhance prediction of mortality nor identify a subgroup for which SVR improves mortality. These results do not support elective addition of LV reconstruction surgery in patients undergoing CABG. TRIAL REGISTRATION NUMBER NCT00023595.
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Affiliation(s)
- David L Prior
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Susanna R Stevens
- Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA
| | - Thomas A Holly
- Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michal Krejca
- 1st Cardiac Surgery Department, Medical University of Silesia, Katowice, Poland
| | | | - Gerald M Pohost
- Department of Medicine-Cardiology, University of Southern California, Los Angeles, California, USA
| | - Krysti Byrd
- Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA
| | - Tomasz Kukulski
- Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Robert H Jones
- Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA
| | - Patrice Desvigne-Nickens
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Padmini Varadarajan
- Department of Medicine-Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Aman Amanullah
- Department of Medicine-Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Grace Lin
- Department of Medicine-Cardiology, Mayo Clinic, Rochester, New York, USA
| | - Hussein R Al-Khalidi
- Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA
| | - Gabriel Aldea
- Department of Surgery-Cardiothoracic, University of Washington Medical Center, Seattle, Washington, USA
| | | | - Andrzej Bochenek
- 1st Cardiac Surgery Department, Medical University of Silesia, Katowice, Poland
| | - Daniel S Berman
- Department of Medicine-Nuclear Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Kukulski T, She L, Racine N, Gradinac S, Panza JA, Velazquez EJ, Chan K, Petrie MC, Lee KL, Pellikka PA, Romanov A, Biernat J, Rouleau JL, Batlle C, Rogowski J, Ferrazzi P, Zembala M, Oh JK. Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. J Thorac Cardiovasc Surg 2014; 149:1312-21. [PMID: 25451487 DOI: 10.1016/j.jtcvs.2014.09.117] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/03/2014] [Accepted: 09/28/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. METHODS Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35% or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point. RESULTS Right ventricular dysfunction was mild in 102 patients (12%) and moderate or severe in 78 patients (9%). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P < .0001) compared with normal or mildly reduced right ventricular function. A significant interaction between right ventricular dysfunction and treatment allocation was observed. Patients with moderate or severe right ventricular dysfunction who received coronary artery bypass grafting + surgical ventricular reconstruction had significantly worse outcomes compared with patients who received coronary artery bypass grafting alone on both the primary (hazard ratio, 1.86; confidence interval, 1.06-3.26; P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality (P = .022). CONCLUSIONS Adding surgical ventricular reconstruction to coronary artery bypass grafting may worsen long-term survival in patients with ischemic cardiomyopathy with moderate to severe right ventricular dysfunction, which reflects advanced left ventricular remodeling.
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Affiliation(s)
- Tomasz Kukulski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland.
| | - Lilin She
- Duke Clinical Research Institute, Durham, NC
| | - Normand Racine
- Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Canada
| | | | | | - Eric J Velazquez
- Duke Clinical Research Institute, Durham, NC; Department of Medicine-Cardiology, Duke University School of Medicine, Durham, NC
| | - Kwan Chan
- University of Ottawa Heart Institute, Ottawa, Canada
| | | | - Kerry L Lee
- Duke Clinical Research Institute, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | | | | | | | - Jean L Rouleau
- Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Canada
| | | | | | | | - Marian Zembala
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland
| | - Jae K Oh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
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Allman KC. Noninvasive assessment myocardial viability: current status and future directions. J Nucl Cardiol 2013; 20:618-37; quiz 638-9. [PMID: 23771636 DOI: 10.1007/s12350-013-9737-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 05/22/2013] [Indexed: 12/22/2022]
Abstract
Observations of reversibility of cardiac contractile dysfunction in patients with coronary artery disease and ischemia were first made more than 40 years ago. Since that time a wealth of basic science and clinical data has been gathered exploring the mechanisms of this phenomenon of myocardial viability and relevance to clinical care of patients. Advances in cardiac imaging techniques have contributed greatly to knowledge in the area, first with thallium-201 imaging, then later with Tc-99m-based tracers for SPECT imaging and metabolic tracers used in conjunction with positron emission tomography (PET), most commonly F-18 FDG in conjunction with blood flow imaging with N-13 ammonia or Rb-82 Cl. In parallel, stress echocardiography has made great progress also. Over time observational studies in patients using these techniques accumulated and were later summarized in several meta-analyses. More recently, cardiac magnetic resonance imaging (CMR) has contributed further information in combination with either late gadolinium enhancement imaging or dobutamine stress. This review discusses the tracer and CMR imaging techniques, the pooled observational data, the results of clinical trials, and ongoing investigation in the field. It also examines some of the current challenges and issues for researchers and explores the emerging potential of combined PET/CMR imaging for myocardial viability.
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Affiliation(s)
- Kevin C Allman
- Department of PET and Nuclear Medicine, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
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Suma H, Anyanwu AC. Current Status of Surgical Ventricular Restoration for Ischemic Cardiomyopathy. Semin Thorac Cardiovasc Surg 2012; 24:294-301. [DOI: 10.1053/j.semtcvs.2013.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 11/11/2022]
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Abstract
Heart failure (HF) is an emerging epidemic affecting 15 million people in the USA and Europe. HF-related mortality was unchanged between 1995 and 2009, despite a decrease in the incidence of cardiovascular disease. Conventional explanations include an aging population and improved treatment of acute myocardial infarction and HF. An adverse relationship between structure and function is the central theme in patients with systolic dysfunction. The normal elliptical ventricular shape becomes spherical in ischemic, valvular, and nonischemic dilated cardiomyopathy. Therapeutic decisions should be made on the basis of ventricular volume rather than ejection fraction. When left ventricular end-systolic volume index exceeds 60 ml/m², medical therapy, CABG surgery, and mitral repair have limited benefit. This form-function relationship can be corrected by surgical ventricular restoration (SVR), which returns the ventricle to a normal volume and shape. Consistent early and late benefits in the treatment of ischemic dilated cardiomyopathy with SVR have been reported in >5,000 patients from various international centers. The prospective, randomized STICH trial did not confirm these findings and the reasons for this discrepancy are examined in detail. Future surgical options for SVR in nonischemic and valvular dilated cardiomyopathy, and its integration with left ventricular assist devices and cell therapy, are described.
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Buckberg G. Outcomes of left ventricular reconstruction when established parameters are followed, and subsequent questions. Eur J Cardiothorac Surg 2012; 42:393-7. [DOI: 10.1093/ejcts/ezs374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Velazquez EJ. Does imaging-guided selection of patients with ischemic heart failure for high risk revascularization improve identification of those with the highest clinical benefit?: Myocardial imaging should not exclude patients with ischemic heart failure from coronary revascularization. Circ Cardiovasc Imaging 2012; 5:271-9; discussion 279. [PMID: 22438425 DOI: 10.1161/circimaging.111.964650] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eric J Velazquez
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA.
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Almenar L, Díaz Molina B, Comín Colet J, Pérez de la Sota E. [Heart failure and heart transplant]. Rev Esp Cardiol 2011; 64 Suppl 1:42-9. [PMID: 21276489 DOI: 10.1016/s0300-8932(11)70006-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The mission of the Heart Failure and Transplantation Section of the Spanish Society of Cardiology is to study, to promote interest in, and to disseminate information about all aspects of myocardial dysfunction and heart transplantation. Heart failure is a highly prevalent condition that consumes a substantial proportion of healthcare resources. Consequently, there is considerable interest in the disorder. Numerous lines of clinical and preclinical research are actively being pursued and new ways of increasing knowledge about the disease are constantly being explored. The aim of this article was to describe the most recent developments concerning heart failure and its treatment. Firstly, the latest publications on chronic heart failure are analyzed. Then, there is a review of the most recent studies on resynchronization therapy and of clinical trials on acute heart failure. Thirdly, new developments in right heart dysfunction and pulmonary hypertension, and the findings of the Spanish Pulmonary Hypertension Registry are discussed. Finally, the latest information on ventricular assist devices and heart transplantation is presented. In addition, the most important data obtained from official transplantation registries (i.e. the Spanish Heart Transplantation Registry and the Spanish Post-Heart Transplantation Tumor Registry) are reviewed.
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Shroyer ALW, Collins JF, Grover FL. Evaluating Clinical Applicability. J Am Coll Cardiol 2010; 56:508-9. [DOI: 10.1016/j.jacc.2010.03.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 03/23/2010] [Accepted: 03/30/2010] [Indexed: 10/19/2022]
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