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Batool A, Chaudhry S, Koratala A. Transcending boundaries: Unleashing the potential of multi-organ point-of-care ultrasound in acute kidney injury. World J Nephrol 2023; 12:93-103. [PMID: 37766842 PMCID: PMC10520752 DOI: 10.5527/wjn.v12.i4.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/24/2023] [Accepted: 09/11/2023] [Indexed: 09/20/2023] Open
Abstract
Acute kidney injury (AKI) is a clinical syndrome characterized by a rapid increase in serum creatinine levels or a decrease in urine output or both. In spite of thorough history-taking, physical examination, and laboratory analysis, there are limitations in the diagnostic process and clinical monitoring of AKI. Point-of-care ultrasonography (POCUS), a limited ultrasound study performed by clinicians at the bedside, has emerged as a valuable tool in different clinical settings. In this discussion, we explore the potential of POCUS performed by nephrologists to address specific questions encountered in the diagnosis and management of AKI patients. POCUS not only aids in excluding hydronephrosis but also provides real-time insights into hemodynamics, enabling formulation of individualized treatment plans. Further studies are required to assess the impact of multi-organ POCUS on pragmatic patient outcomes related to AKI, as well as its potential in risk stratification and identification of different levels of AKI severity and pathophysiological signatures.
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Affiliation(s)
- Aisha Batool
- Department of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Shahzad Chaudhry
- Department of Family Medicine, Advocate Aurora Healthcare, Milwaukee, WI 53202, United States
| | - Abhilash Koratala
- Department of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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López-Candales A, Vallurupalli S. Utility of the tricuspid annular tissue doppler systolic velocity and pulmonary artery systolic pressure relationship in right ventricular systolic function assessment: A pilot study. Echocardiography 2022; 39:1276-1283. [PMID: 36100955 DOI: 10.1111/echo.15441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/15/2022] [Accepted: 08/09/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio has been validated as a valuable noninvasive measure of right ventricular (RV) elastance and systolic function. However, the more reliable TA systolic (s') velocity measure of RV systolic function compared to TAPSE has not been previously studied. METHODS We conducted a pilot study using several variables of RV function in 50 patients with the main aim to determine which numerical expression between TA TDI s'/PASP and TAPSE/PASP ratio was most useful. RESULTS In a stepwise multiple regression analysis, TA TDI s'/PASP ratio (p < .0002); LVOT VTI/RVOT VTI ratio (p < .0002); RVOT VTI (p < .0047); TAPSE/PASP ratio (p < .0259) and TA TDI e' (p < .0292) were best in discriminating normal versus abnormal RV systolic function. Using receiver operator curve analysis, cut-off values for both TA TDI s'/PASP (>3.9 mm/c/mmHg) had 82.1% sensitivity and 77.3% specificity while the TAPSE/PASP (>.61 mm/mmHg) had 89.3% sensitivity and 68.2% specificity in identifying normal RV function in our studied population. CONCLUSION Our results indicate that TA TDI s'/PASP is a better mathematical expression when examining the relationship between RV contractility and RV resistance relationship. Furthermore, we also found that inclusion of RVOT VTI, RV diastolic properties, and left ventricular systolic function are important determinants of RV systolic function assessments and should be routinely included. Additional prospective studies are now needed to confirm these results using hemodynamic data.
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Affiliation(s)
- Angel López-Candales
- Cardiovascular Medicine Division, University Health Truman Medical Center, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Srikanth Vallurupalli
- Cardiology Division, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Takahama H, McCully RB, Frantz RP, Kane GC. Unraveling the RV Ejection Doppler Envelope. JACC Cardiovasc Imaging 2017; 10:1268-1277. [DOI: 10.1016/j.jcmg.2016.12.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 12/16/2016] [Accepted: 12/21/2016] [Indexed: 11/30/2022]
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Marra AM, Benjamin N, Ferrara F, Vriz O, D'Alto M, D'Andrea A, Stanziola AA, Gargani L, Cittadini A, Grünig E, Bossone E. Reference ranges and determinants of right ventricle outflow tract acceleration time in healthy adults by two-dimensional echocardiography. Int J Cardiovasc Imaging 2016; 33:219-226. [PMID: 27714602 DOI: 10.1007/s10554-016-0991-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/30/2016] [Indexed: 12/25/2022]
Abstract
The right ventricular outflow tract acceleration time (RVOT-AT) has shown to progressively shorten with increasing degrees of pulmonary pressure. However, the physiologic ranges of RVOT AT are based on small sample sizes and have not been investigated regarding their determining factors. The aim of this study was to investigate reference values and determining factors of RVOT-AT in a large population of healthy subjects and by values described in the literature. In the first part of the study, 1029 healthy subjects (mean age 45.6 ± 16.0 years, 565 (54.7 %) females) were prospectively assessed by clinical examination including demography, vital signs and echocardiography. In the second part, we performed a pooled analysis of eight published studies describing RVOT-AT in healthy subjects (n = 450). Statistical analysis included the calculation of 5 % quantiles for defining reference values. RVOT-AT significantly but weakly correlated with age (r: -0.207; p < 0.001), body mass Index (r: -0.16), systolic (r: -0.158) and diastolic (r: -0.137) blood pressure, heart rate (r: -0.197) and left ventricular (LV) E/A ratio (r: 0.229) (all p < 0.001). No differences were found with regards to sex. In a synopsis of both prospective and literature-based data sets, RVOT-AT weighted means was 138.51 ms and the 5 % quantile was 104.7 ms (95 % confidence interval 98.2-110.1). This study delineates the range of RVOT-AT in healthy adults and it's determining factors. Our study is in line with the cut-off value stated by the European guidelines with an RVOT-AT ≤105 ms denoting abnormal values.
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Affiliation(s)
| | - Nicola Benjamin
- Pulmonary Hypertension Center, Thoraxclinic at University of Heidelberg, Heidelberg, Germany
| | - Francesco Ferrara
- Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana", Salerno, Italy
| | - Olga Vriz
- Department of Emergency and Cardiology, "S. Antonio" Community Hospital, San Daniele del Friuli, UD, Italy
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University Federico II, Naples, Italy
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ekkehard Grünig
- Pulmonary Hypertension Center, Thoraxclinic at University of Heidelberg, Heidelberg, Germany
| | - Eduardo Bossone
- Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana", Salerno, Italy.
- Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University of Salerno - Italy, Via Pr. Amedeo, 36, 83023, Lauro, AV, Italy.
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Negi PC, Marwaha R, Asotra S, Kandoria A, Ganju N, Sharma R, Kumar RV, Bhardwaj R. Prevalence of high altitude pulmonary hypertension among the natives of Spiti Valley--a high altitude region in Himachal Pradesh, India. High Alt Med Biol 2015; 15:504-10. [PMID: 25531464 DOI: 10.1089/ham.2013.1112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The study aimed to determine the prevalence of high altitude pulmonary hypertension (HAPH) and its predisposing factors among natives of Spiti Valley. A cross-sectional survey study was done on the permanent natives of Spiti Valley residing at an altitude of 3000 m to 4200 m. Demographic characteristics, health behavior, anthropometrics, and blood pressure were recorded. Investigations included recording of 12 lead electrocardiogram (ECG), SaO2 with pulse oximeter, spirometry and echocardiography study, and measurement of Hb levels using the cynmethhemoglobin method. HAPH was diagnosed using criteria; tricuspid regurgitation (TR) gradient of ≥46 mmHg. ECG evidence of RV overload on 12 lead ECG was documented based on presence of 2 out of 3 criteria; R>S in V1, right axis deviation or RV strain, T wave inversion in V1 and V2. Data of 1087 subjects were analyzed who were free of cardiorespiratory diseases to determine the prevalence of HAPH and its predisposing factors. HAPH was recorded in 3.23% (95% C.I. of 0.9-8.1%) and ECG evidence of right ventricular (RV) overload was 1.5% in the study population. Prevalence of HAPH was not different in men and women 2.63% vs. 3.54% p<0.2. Age (Z statistics of 3.4 p<0.0006), hypoxemia (Z statistics of 2.9 p<0.002), and erythrocythemia (Z statistics of 4.7 p<0.003) were independently associated with HAPH. Altitude of residence was not found to be significantly associated with HAPH, although there was a trend of increasing prevalence with increasing altitude. It can be concluded that HAPH is prevalent in 3.23% of natives of Spiti Valley. Increasing age, erythrocythemia and hypoxemia are independent predisposing factors.
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Affiliation(s)
- Prakash Chand Negi
- Department of Cardiology, Indira Gandhi Medical College , Shimla, Himachal Pradesh, India
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López-Candales A. Determinants of an Abnormal Septal Curvature in Chronic Pulmonary Hypertension. Echocardiography 2014; 32:49-55. [DOI: 10.1111/echo.12609] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Angel López-Candales
- Division of Cardiovascular Diseases; University of Cincinnati College of Medicine; Cincinnati Ohio
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López-Candales A. Automated Functional Imaging for Assessment of Left Ventricular Mechanics in the Presence of Left Ventricular Hypertrophy. Echocardiography 2013; 31:605-14. [DOI: 10.1111/echo.12441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Angel López-Candales
- Division of Cardiovascular Diseases; University of Cincinnati College of Medicine; Cincinnati Ohio
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López-Candales A, Lopez FR, Trivedi S, Elwing J. Right Ventricular Ejection Efficiency: A New Echocardiographic Measure of Mechanical Performance in Chronic Pulmonary Hypertension. Echocardiography 2013; 31:516-23. [DOI: 10.1111/echo.12419] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Angel López-Candales
- Division of Cardiovascular Diseases; University of Cincinnati; College of Medicine; Cincinnati Ohio
| | - Francisco R. Lopez
- Department of Medicine; University of Cincinnati; College of Medicine; Cincinnati Ohio
| | - Setu Trivedi
- Department of Medicine; University of Cincinnati; College of Medicine; Cincinnati Ohio
| | - Jean Elwing
- Division of Pulmonary; Critical Care & Sleep Medicine; University of Cincinnati; College of Medicine; Cincinnati Ohio
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Risk of death and need for transplantation in chronic pulmonary hypertension. Am J Med Sci 2013; 347:106-11. [PMID: 23689051 DOI: 10.1097/maj.0b013e3182956d80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Echo-Doppler parameters that exemplify right ventricular (RV) outflow dynamics and measures of annular tissue Doppler imaging to assess left ventricular (LV) and RV diastolic function, known to be affected in chronic pulmonary hypertension (cPH), have never been studied to determine if they could be predictive of mortality or need for transplantation 1-year after follow-up. METHODS Numerous echo-Doppler parameters of RV and LV performance were recorded from 120 patients. This patient population was divided into 3 groups. Group I had no PH, group II had cPH but no documented death or need for either lung or heart transplantation, at 1-year follow-up after their initial echocardiogram whereas group III had cPH and patients had either died or required heart and/or lung transplantation during the same time period. RESULTS Analysis of variance was first used to identify which echo-Doppler variables were significant among the studied groups. A logistic regression analysis was then performed to identify predictive variables of the occurrence death and need for transplantation. Finally, a multiple regression analysis was used between groups II and III to identify which echo-Doppler variables were most useful in identifying severe cPH patients at risk of the prespecified events. CONCLUSIONS Even though older patients with worse RV fractional area change might be considered at risk of worse prognosis in patients with severe cPH, only a low mitral annular early diastolic velocity was useful in identifying which of those individuals were at highest risk of death or in need of transplantation.
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López-Candales A, Edelman K. Right ventricular outflow tract systolic excursion: a distinguishing echocardiographic finding in acute pulmonary embolism. Echocardiography 2013; 30:649-57. [PMID: 23347247 DOI: 10.1111/echo.12120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Even though chronic pulmonary hypertension (cPH) and acute pulmonary embolism (aPE) increase pulmonary vascular resistance and result in right ventricular (RV) dilatation and systolic dysfunction; both conditions operate through drastically different mechanisms. Unfortunately, simple echocardiographic examination might be insufficient to distinguish both entities. This study attempted to determine which objective measures would be useful in differentiating aPE from cPH. METHODS Standard measures of main RV as well as RV outflow tract (RVOT) size and systolic performance calculations were retrospectively measured from 15 patients with confirmed aPE by chest computed tomography and compared with similar data collected from the same number of age-matched patients with moderate (mcPH), severe (scPH), and patients without PH. RESULTS Although a positive McConnell sign was seen in 60% of aPE patients and in 17% of the cPH patients, all aPE had a profound reduction in RVOT systolic excursion when compared with cPH patients. Furthermore, maximal tricuspid annular plane systolic excursion, velocity time integral of the RVOT ejection signal, end-systolic or end-diastolic RV to left ventricle (LV) dimension ratio were not useful to distinguish aPE from any of the 2 forms of cPH. CONCLUSION This study demonstrated that measurement of RVOT systolic excursion not only is feasible but also extremely useful in identifying aPE and it is particularly helpful in differentiating it from patients with either mcPH or scPH. This variable might be useful to estimate the global impairment in RV contractility and acute hemodynamic derangement seen in aPE.
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Affiliation(s)
- Angel López-Candales
- Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0542, USA.
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Hansel J, Burgstahler C, Medler S, Axmann D, Niess AM, Tetzlaff K. Effect of simulated diving trips on pulmonary artery pressure in healthy men. Clin Res Cardiol 2012; 101:947-53. [DOI: 10.1007/s00392-012-0482-9] [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: 01/12/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
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Temporal differences in ejection between right and left ventricles in chronic pulmonary hypertension: a pulsed Doppler study. Int J Cardiovasc Imaging 2012; 28:1943-50. [PMID: 22476907 DOI: 10.1007/s10554-011-9971-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 10/22/2011] [Indexed: 10/28/2022]
Abstract
Chronic pulmonary hypertension (cPH) is known to alter right ventricular (RV) deformation and cause mechanical dyssynchrony. Since not all echocardiographic laboratories are equipped with sophisticated imaging tools, we decided to determine if Doppler would be useful to detect temporal differences between the ejection of the right and left ventricle (LV) as a result of cPH using pulsed outflow tract (RVOT and LVOT) spectral signals. Data was collected from 30 patients without PH (Group I: 53 ± 7 years and 31 ± 5 mmHg) and from 40 patients with cPH (Group II: 53 ± 13 years; P = NS and 82 ± 24 mmHg; P < 0.00001). Group II patients had a longer temporal delay from onset between RVOT and LVOT (23 ± 12 ms vs. 0 ± 0 ms; P < 0.0001) with a significantly shorter temporal difference between RVOT and LVOT spectral signals to reach maximum peak of ejection (27 ± 24 ms vs. 61 ± 23 ms; P < 0.0001) than Group I. In addition, Group II had a statistically lower RVOT VTI value (0.14 ± 0.05 cm vs. 0.17 ± 0.03 cm; P < 0.01). Our data seems to suggest that increasing severity of PH mainly affects ejection of the RV resulting in noticeable temporal alterations in both time of onset as well as time to reach maximum peak ejection between RV and LV. More studies are now required to determine the utility of obtaining these measurements prospectively in the follow-up and treatment of cPH patients.
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Lopez-Candales A, Edelman K. Shape of the right ventricular outflow Doppler envelope and severity of pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2011; 13:309-16. [DOI: 10.1093/ejechocard/jer235] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tanindi A, Demirci U, Tacoy G, Buyukberber S, Alsancak Y, Coskun U, Yalcin R, Benekli M. Assessment of right ventricular functions during cancer chemotherapy. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:834-40. [DOI: 10.1093/ejechocard/jer142] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Current world literature. Curr Opin Cardiol 2011; 26:356-61. [PMID: 21654380 DOI: 10.1097/hco.0b013e328348da50] [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: 01/09/2023]
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López-Candales A, Edelman K. Ratio of right to left ventricular ejection: a pilot study using Doppler to detect interventricular dyssynchrony. Clin Cardiol 2011; 34:366-71. [PMID: 21538384 DOI: 10.1002/clc.20889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 12/30/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Chronic pulmonary hypertension (cPH) is known to delay maximal right ventricular (RV) deformation, causing mechanical dyssynchrony, which previously has been identified only through the use of myocardial tissue Doppler imaging. However, alterations between RV and left ventricular (LV) ejection should be easily identified during routine echocardiographic examinations. HYPOTHESIS We hypothesized that assessment of differences in ejection fraction between left and right ventricles would be detected using pulsed Doppler. METHODS Standard echo and Doppler data were collected from 30 patients without PH (mean age, 53 ± 7 y; mean pulmonary artery systolic pressure [PASP], 31 ± 5 mm Hg) and from 40 patients with cPH (mean age, 53 ± 13 y, P not significant; mean PASP, 82 ± 24 mm Hg, P<0.00001). Temporal differences in the ejection of both ventricles were measured as the ratio of total duration of RV to LV outflow tract (RVOT and LVOT) pulsed Doppler signals. RESULTS A ratio (<0.99) of RVOT to LVOT total duration of ejection was found not only to be the best Doppler parameter to identify an abnormal pulmonary artery systolic pressure, with a 90% sensitivity and 100% specificity (area under the curve 0.958, P = 0.0001), but also identified differences in the temporal ejection between the 2 ventricles, or dyssynchrony, as a result of cPH. CONCLUSIONS The ratio of pulsed Doppler RV to LV total duration of ejection is easily obtainable and appears useful in identifying the presence of interventricular dyssynchrony in cPH patients. A prospective study is now required to determine if this Doppler ratio can identify minute changes in the ejection of both ventricles as a result of changes in disease status or response to PH therapy.
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Affiliation(s)
- Angel López-Candales
- Cardiovascular Institute at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2582, USA.
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Lopez-Candales A, Edelman K, Gulyasy B, Candales MD. Differences in the Duration of Total Ejection between Right and Left Ventricles in Chronic Pulmonary Hypertension. Echocardiography 2011; 28:509-15. [DOI: 10.1111/j.1540-8175.2010.01377.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Imaging in Pulmonary Hypertension. JACC Cardiovasc Imaging 2010; 3:1287-95. [DOI: 10.1016/j.jcmg.2010.09.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 08/26/2010] [Accepted: 09/17/2010] [Indexed: 11/21/2022]
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