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Ota S, Izumiya Y, Kitada R, Nishi T, Taruya A, Wada T, Takahata M, Ozaki Y, Kashiwagi M, Shiono Y, Kuroi A, Takemoto K, Tanimoto T, Kitabata H, Fukuda D, Tanaka A. Diagnostic significance of paradoxical left ventricular hypertrophy in detecting cardiac amyloidosis. IJC HEART & VASCULATURE 2023; 49:101279. [PMID: 37859641 PMCID: PMC10582063 DOI: 10.1016/j.ijcha.2023.101279] [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: 09/15/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
Background Cardiac amyloidosis (CA) progresses rapidly with a poor prognosis. Therefore, methods for early diagnosis that are easily accessible in any hospital, are required. We hypothesized that based on the pathology of CA, morphological left ventricular hypertrophy (LVH) without electrical augmentation, namely paradoxical LVH, could be used to diagnose CA. This study aimed to investigate whether paradoxical LVH has diagnostic significance in identifying CA in patients with LVH. Methods Patients who presented with left ventricular (LV) wall thickness ≥ 12 mm on cardiac magnetic resonance (CMR) were enrolled from a multicentre CMR registry. Paradoxical LVH was defined as a LV wall thickness ≥ 12 mm on CMR, SV1 + RV5 < 3.5 mV, and a lack of secondary ST-T abnormalities. The diagnostic significance of paradoxical LVH in identifying CA was assessed. Results Of the 110 patients enrolled, 30 (27 %) were diagnosed with CA and 80 (73 %) with a non-CA aetiology. The CA group demonstrated paradoxical LVH more frequently than the non-CA group (80 % vs. 16 %, P < 0.001). It was an independent predictor for detecting CA in patients with LVH (odds ratio: 33.44, 95 % confidence interval: 8.325-134.3, P < 0.001). The sensitivity, specificity, positive predict value, negative predict value and accuracy of paradoxical LVH for CA detection were 80 %, 84 %, 65 %, 92 % and 83 %, respectively. Conclusions Paradoxical LVH can be used for identifying CA in patients with LVH. Our findings could contribute to the early diagnosis of CA, even in non-specialized hospitals.
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Affiliation(s)
- Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ryoko Kitada
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Nishi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yuichi Ozaki
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kazushi Takemoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Bigler MR, Zimmermann P, Papadis A, Seiler C. Accuracy of intracoronary ECG parameters for myocardial ischemia detection. J Electrocardiol 2020; 64:50-57. [PMID: 33316551 DOI: 10.1016/j.jelectrocard.2020.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The electrocardiogram (ECG) is a valuable diagnostic tool for the diagnosis of myocardial ischemia during acute coronary syndrome. Aside from the commonly used ST-segment shift indicative of ischemia, several other ECG parameters are pathophysiologically reasonable. Thus, the goal of this study was to assess the accuracy of different ischemia parameters as obtained by the highly susceptible intracoronary ECG (icECG). METHOD This was a retrospective observational study in 100 patients with chronic coronary syndrome. From each patient, a non-ischemic as well as ischemic icECG at the end of a one-minute proximal coronary balloon occlusion was available, and analysed twice by three different physicians, as well as once together for consensual results. The evaluated parameters were icECG ST-segment shift (mV), ST-integral (mV*sec), T-wave-integral (mV*sec), T-peak (mV), T-peak-to-end time (TPE; msec) and QTc-time (msec). RESULTS All six icECG parameters showed significant differences between the non-ischemic and the ischemic recording. Using the icECG recording during coronary patency or occlusion as criterion for absent or present myocardial ischemia, ROC-analysis of icECG ST-segment shift showed an area under the curve (AUC) of 0.963 ± 0.029 (p < 0.0001). AUC for ST-integral was 0.899 ± 0.044 (p < 0.0001), for T-wave integral 0.791 ± 0.059 (p < 0.0001), for T-peak 0.811 ± 0.057 (p < 0.0001), for TPE 0.667 ± 0.068 (p < 0.0001), and for QTc-time 0.770 ± 0.061 (p < 0.0001). The best cut-off point for the detection of ischemia by icECG ST-segment shift was 0.365 mV (sensitivity 90%, specificity 95%). CONCLUSION When tested in a setting with artificially induced absolute myocardial ischemia, icECG ST-segment shift at a threshold of 0.365 mV most accurately distinguishes between absent and present ischemia.
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Affiliation(s)
- Marius Reto Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Patrick Zimmermann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Athanasios Papadis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christian Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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Birnbaum Y, Fiol M, Nikus K, Garcia Niebla J, Bacharova L, Dubner S, Zareba W, Macfarlane PW, Ribeiro AL, Cygankiewicz I, Bayes de Luna A. A counterpoint paper: Comments on the electrocardiographic part of the 2018 Fourth Universal Definition of Myocardial Infarction endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology. Ann Noninvasive Electrocardiol 2020; 25:e12786. [PMID: 32638432 PMCID: PMC7507065 DOI: 10.1111/anec.12786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022] Open
Abstract
The Fourth Universal Definition of Myocardial Infarction (FUDMI) focuses on the distinction between nonischemic myocardial injury and myocardial infarction (MI), along with the role of cardiovascular magnetic resonance, in order to define the etiology of myocardial injury. As a consequence, there is less emphasis on updating the parts of the definition concerning the electrocardiographic (ECG) changes related to MI. Evidence of myocardial ischemia is a prerequisite for the diagnosis of MI, and the ECG is the main available tool for (a) detecting acute ischemia, (b) triage, and (c) risk stratification upon presentation. This review focuses on multiple aspects of ECG interpretation that we firmly believe should be considered for incorporation in any future update to the Universal Definition of MI.
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Affiliation(s)
- Yochai Birnbaum
- The Department of MedicineThe Section of CardiologyBaylor College of MedicineHoustonTXUSA
| | - Miguel Fiol
- Health Research Institute of the Balearic IslandsHospital Son EspasesPalmaSpain
| | - Kjell Nikus
- Faculty of Medicine and Health TechnologyFinnish Cardiovascular Research CenterUniversity of TampereTampereFinland
- Heart HospitalTampere University HospitalTampereFinland
| | - Javier Garcia Niebla
- Servicios Sanitarios del Area de Salud de El HeirroValle del Golfo Health CenterFronteraSpain
| | - Ljuba Bacharova
- International Laser CenterBratislavaSlovak Republic
- Institute of PathophysiologyMedical SchoolComenius UniversityBratislavaSlovak Republic
| | - Sergio Dubner
- Clinica y Maternidad Suizo Argentina and De Los Arcos SanatorioBuenos AiresArgentina
| | - Wojciech Zareba
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNYUSA
| | - Peter W. Macfarlane
- Electrocardiology SectionInstitute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Antonio Luiz Ribeiro
- Internal Medicine DepartmentSchool of Medicine, and Telehealth CenterHospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | | | - Antoni Bayes de Luna
- Cardiovascular ICCC‐ ProgramResearch Institute Hospital de la Santa Creu i Sant PauCardiovascular Research FoundationBarcelonaSpain
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Ter Haar CC, Kors JA, Peters RJG, Tanck MWT, Snijder MB, Maan AC, Swenne CA, van den Born BJH, de Jong JSSG, Macfarlane PW, Postema PG. Prevalence of ECGs Exceeding Thresholds for ST-Segment-Elevation Myocardial Infarction in Apparently Healthy Individuals: The Role of Ethnicity. J Am Heart Assoc 2020; 9:e015477. [PMID: 32573319 PMCID: PMC7670498 DOI: 10.1161/jaha.119.015477] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Early prehospital recognition of critical conditions such as ST‐segment–elevation myocardial infarction (STEMI) has prognostic relevance. Current international electrocardiographic STEMI thresholds are predominantly based on individuals of Western European descent. However, because of ethnic electrocardiographic variability both in health and disease, there is a need to reevaluate diagnostic ST‐segment elevation thresholds for different populations. We hypothesized that fulfillment of ST‐segment elevation thresholds of STEMI criteria (STE‐ECGs) in apparently healthy individuals is ethnicity dependent. Methods and Results HELIUS (Healthy Life in an Urban Setting) is a multiethnic cohort study including 10 783 apparently healthy subjects of 6 different ethnicities (African Surinamese, Dutch, Ghanaian, Moroccan, South Asian Surinamese, and Turkish). Prevalence of STE‐ECGs across ethnicities, sexes, and age groups was assessed with respect to the 2 international STEMI thresholds: sex and age specific versus sex specific. Mean prevalence of STE‐ECGs was 2.8% to 3.4% (age/sex‐specific and sex‐specific thresholds, respectively), although with large ethnicity‐dependent variability. Prevalences in Western European Dutch were 2.3% to 3.0%, but excessively higher in young (<40 years) Ghanaian males (21.7%–27.5%) and lowest in older (≥40 years) Turkish females (0.0%). Ethnicity (sub‐Saharan African origin) and other variables (eg, younger age, male sex, high QRS voltages, or anterolateral early repolarization pattern) were positively associated with STE‐ECG occurrence, resulting in subgroups with >45% STE‐ECGs. Conclusions The accuracy of diagnostic tests partly relies on background prevalence in healthy individuals. In apparently healthy subjects, there is a highly variable ethnicity‐dependent prevalence of ECGs with ST‐segment elevations exceeding STEMI thresholds. This has potential consequences for STEMI evaluations in individuals who are not of Western European descent, putatively resulting in adverse outcomes with both over‐ and underdiagnosis of STEMI.
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Affiliation(s)
- C Cato Ter Haar
- Department of Cardiology Heart Center Amsterdam UMC University of Amsterdam The Netherlands.,Department of Cardiology Heart-Lung Center Leiden University Medical Center Leiden The Netherlands
| | - Jan A Kors
- Department of Medical Informatics Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Ron J G Peters
- Department of Cardiology Heart Center Amsterdam UMC University of Amsterdam The Netherlands
| | - Michael W T Tanck
- Department of Clinical Epidemiology Biostatistics & Bioinformatics, Amsterdam Public Health Research Institute Amsterdam UMC University of Amsterdam The Netherlands
| | - Marieke B Snijder
- Department of Clinical Epidemiology Biostatistics & Bioinformatics, Amsterdam Public Health Research Institute Amsterdam UMC University of Amsterdam The Netherlands.,Department of Public Health Amsterdam Public Health research institute Amsterdam UMC University of Amsterdam The Netherlands
| | - Arie C Maan
- Department of Cardiology Heart-Lung Center Leiden University Medical Center Leiden The Netherlands
| | - Cees A Swenne
- Department of Cardiology Heart-Lung Center Leiden University Medical Center Leiden The Netherlands
| | - Bert-Jan H van den Born
- Department of Vascular Medicine Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | | | | | - Pieter G Postema
- Department of Cardiology Heart Center Amsterdam UMC University of Amsterdam The Netherlands
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Birnbaum Y, Fiol M, Nikus K, Niebla JG, Bacharova L, Dubner S, Zareba W, Macfarlane PW, Ribeiro AL, Cygankiewicz I, de Luna AB. A counterpoint paper: Comments on the electrocardiographic part of the 2018 Fourth Universal Definition of Myocardial Infarction. J Electrocardiol 2020; 60:142-147. [PMID: 32361523 DOI: 10.1016/j.jelectrocard.2020.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 12/12/2022]
Abstract
The Fourth Universal Definition of Myocardial Infarction (FUDMI) [published simultaneously in 2018 in numerous journals including Circulation, Journal of the American College of Cardiology and European Heart Journal] focuses mainly on the distinction between non-ischemic myocardial injury and myocardial infarction (MI), along with the role of cardiovascular magnetic resonance, in order to define the etiology of myocardial injury. As a consequence, there is less emphasis on updating the parts of the definition concerning the electrocardiographic (ECG) changes related to MI. Evidence of myocardial ischemia is a prerequisite for the diagnosis of MI and the ECG is the main available tool for i) detecting acute ischemia, ii) triage and iii) risk stratification upon presentation. This review focuses on multiple aspects of ECG interpretation that we firmly believe should be considered for incorporation in any future update to the Universal Definition of MI. Our counterpoint view is that: a) the use of the ECG following coronary artery bypass surgery should be better explored and defined; b) the emphasis in the FUDMI on convex versus concave ST-elevation, which is questionable, should be balanced by the fact that many patients with true ST-elevation MI (STEMI) present with a concave form of ST elevation; c) reciprocal ST-depression in STEMI caused by right coronary artery or left circumflex artery occlusion, should be set against the fact that not all anterior STEMIs present with reciprocal ST-depression which can also be seen in cardiomyopathy and left ventricular hypertrophy; d) the "posterior" leads V7-V9 should be placed on a horizontal line from V4, rather than follow the 5th intercostal space; e) ST-depression in V1-V3 is not a manifestation of ischemia of the basal inferior segment, placed horizontally; f) Interpreting ST-T changes in patients with conduction abnormalities and pacemakers should be further defined.
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Affiliation(s)
- Yochai Birnbaum
- The Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.
| | - Miguel Fiol
- Health Research Institute of the Balearic Islands, Hospital Son Espases, Palma, Spain
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, University of Tampere, Finnish Cardiovascular Research Center, Tampere, Finland; Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Javier Garcia Niebla
- Servicios Sanitarios del Area de Salud de El Heirro, Valle del Golfo Health Center, C/Marcos Luis Barrera, 1.38911 Frontera, El Hierro, Spain
| | - Ljuba Bacharova
- International Laser Center, Institute of Pathophysiology, Medical School, Comenius University, Bratislava, Slovak Republic
| | - Sergio Dubner
- Clinica y Maternidad Suizo Argentina and De Los Arcos Sanatorio, Buenos Aires, Argentina
| | - Wojciech Zareba
- Division of Cardiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter W Macfarlane
- Institute of Health and Wellbeing, University of Glasgow, Electrocardiology Section, Royal Infirmary, Glasgow, Scotland, UK
| | - Antonio Luiz Ribeiro
- Internal Medicine Department, School of Medicine, Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Antoni Bayes de Luna
- Cardiovascular Research Foundation, Cardiovascular ICCC- Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
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Walsh B, Macfarlane PW, Prutkin JM, Smith SW. Distinctive ECG patterns in healthy black adults. J Electrocardiol 2019; 56:15-23. [DOI: 10.1016/j.jelectrocard.2019.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/04/2019] [Accepted: 06/12/2019] [Indexed: 01/26/2023]
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Ola O, Tak T. Pseudo-Wellens Syndrome in a Patient with Hypertension and Left Ventricular Hypertrophy. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1231-1234. [PMID: 31427564 PMCID: PMC6711489 DOI: 10.12659/ajcr.916623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Male, 61 Final Diagnosis: Left ventricular hypertrophy Symptoms: Chest pain Medication: — Clinical Procedure: Coronary angiography • echocardiogram Specialty: Cardiology
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Affiliation(s)
- Olatunde Ola
- Department of Hospital Medicine, Mayo Clinic Health System, La Crosse, WI, USA
| | - Tahir Tak
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Abstract
BACKGROUND Rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is crucial for appropriate management. Catheterization for a false STEMI activation has risks including exposure to contrast agent and radiation, increased healthcare costs and delay in treatment of the primary medical condition. PATIENTS AND METHODS This was a single center retrospective study including all 'cath alerts' between January 2012 and December 2015. 'Cath alert' is a term used to activate the interventional cardiology team when STEMI is suspected by the emergency department physicians based on review of the initial ECG. We reviewed all STEMI alerts to understand ECG differences between true and false STEMI. RESULTS Our study population (N = 361) included 221 (61%) men and 140 (39%) women, with average age 60 ± 4.2 years. Among the 361 STEMI alerts, 82 (22.7%) did not have acute coronary syndrome. Common ECG causes of misdiagnosis included left ventricular hypertrophy (LVH, found in 40/82, 49%), early repolarization changes (20/82, 24%), right bundle branch block (RBBB) (13/82, 16%), and Brugada pattern (3/82, 4%). Multivariate regression analysis showed that LVH and RBBB were independent predictors of nonacute coronary syndrome false STEMI (odds ratio: 0.54; 95% confidence interval: 0.32-0.93; P = 0.03 for LVH, and odds ratio: 0.26, 95% confidence interval: 0.1-0.62, P = 0.004 for RBBB). CONCLUSION The incidence of false STEMI alerts was almost 23% at our center. This number might be reduced with additional training of emergency department physicians in ECG interpretation, and recognition of common causes of misdiagnosis such as LVH, early repolarization changes, RBBB, and Brugada pattern.
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Yennu Nandan A, Singh A, Mukundu Nagesh N, Gandhi MM. Suspected ST segment elevation myocardial infarction referred for primary angioplasty: a masquerader. BMJ Case Rep 2019; 12:12/1/bcr-2018-227687. [PMID: 30642864 DOI: 10.1136/bcr-2018-227687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 50-year-old man collapsed at the roadside with retrosternal pain, shortness of breath and generalised weakness. An ECG in the emergency department was reported as demonstrating ST segment elevation of up to 1.5 mm in leads V1 to V3, leading to a diagnosis of an acute ST-elevation myocardial infarction. He was immediately transferred to the cardiac catheterisation laboratory. Introduction of a coronary catheter produced signs that raised suspicion of aortic dissection. An aortogram revealed a grossly dilated aortic root of 7.3 cm with a type A ascending aortic dissection. The patient was urgently transferred to the cardiothoracic surgical centre and underwent emergency aortic root and ascending aorta replacement. Following a 20-day hospital admission, and postoperative atrial fibrillation, the patient made a steady and full recovery.
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Affiliation(s)
| | - Abhinav Singh
- King's College NHS Foundation Trust, Princess Royal University Hospital, Orpington, UK
| | - Navin Mukundu Nagesh
- Cardiology Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Manish M Gandhi
- Cardiology Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
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Taniguchi T, Shiomi H, Kosuge M, Morimoto T, Nakatsuma K, Nishiga M, Sasa T, Saito N, Kimura T. Prognostic Significance of ST-Segment Elevation in Leads V 1–2 in Patients With Severe Aortic Stenosis. Circ J 2016; 80:526-34. [DOI: 10.1253/circj.cj-15-0641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | | | - Kenji Nakatsuma
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masataka Nishiga
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Tomoki Sasa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Naritatsu Saito
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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Bacharova L, Schocken DD, Wagner GS. The 1st symposium on ECG changes in left or right ventricular hypertension or hypertrophy in conditions of pressure overload. J Electrocardiol 2014; 47:589-92. [DOI: 10.1016/j.jelectrocard.2014.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Indexed: 10/25/2022]
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