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Comparison of the Treatment Efficacy of Rosuvastatin versus Atorvastatin Loading Prior to Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction. J Clin Med 2022; 11:jcm11175142. [PMID: 36079090 PMCID: PMC9457390 DOI: 10.3390/jcm11175142] [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: 08/01/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to compare the effect of a single high-dose rosuvastatin versus atorvastatin preloading in ST-elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PCI.) Methods: A total of 99 patients presented with STEMI and were randomly divided into three groups—a control group (n = 33) with no statin treatment, an atorvastatin group (n = 33) with a single 80 mg atorvastatin dose and the rosuvastatin group (n = 33) with a single 40 mg rosuvastatin dose in the emergency room (ER) prior to PCI. Post-interventional thrombolysis in myocardial infarction (TIMI) flow grade and corrected TIMI frame count (CTFC) were recorded, and ST-segment resolution was measured. Results: CTFC was significantly lower for the atorvastatin group (p-value < 0.01) than in the control group. A final TIMI flow grade 3 was achieved in 32 (97.0%) patients in the rosuvastatin group and 28 (84.8%) patients in the atorvastatin group compared with only 25 (75.8%) patients in the control group (p = 0.014). Peak CK-MB in the rosuvastatin group (263.2 [207.2−315.6]) and the atorvastatin group (208 [151.0−314.1]) was lower compared to that in the control group (398.4 [303.9−459.3]); p < 0.001. Conclusions: A single extensive dose of lipophilic atorvastatin prior to primary PCI in STEMI patients showed better improvement in microvascular myocardial perfusion compared to hydrophilic rosuvastatin.
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Fyenbo DB, Sommer A, Nørgaard BL, Kronborg MB, Kristensen J, Gerdes C, Jensen HK, Jensen JM, Nielsen JC. Long-term outcomes in a randomized controlled trial of multimodality imaging-guided left ventricular lead placement in cardiac resynchronization therapy. Europace 2022; 24:828-834. [PMID: 35041000 DOI: 10.1093/europace/euab314] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/08/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS This study aims to investigate the long-term occurrence of the composite endpoint of heart failure (HF) hospitalization or all-cause death (primary endpoint) in patients randomized to cardiac resynchronization therapy (CRT) using individualized multimodality imaging-guided left ventricular (LV) lead placement compared with a routine fluoroscopic approach. Furthermore, this study aims to evaluate whether inter-lead electrical delay (IED) is associated with improved response rate of this endpoint. METHODS AND RESULTS We reviewed follow-up data until November 2020 for all 182 patients included in the ImagingCRT trial for the occurrence of HF hospitalization and all-cause death. During median (inter-quartile range) time to primary endpoint/censuring of 6.7 (3.3-7.9) years, the rate of the primary endpoint was 60% (n = 53) in the imaging group compared with 52% (n = 48) in the control group [hazard ratio (HR) 1.22, 95% confidence interval (CI) 0.83-1.81, P = 0.31]. Neither the risk of HF hospitalization (HR 1.11, 95% CI 0.62-1.99, P = 0.72) nor of all-cause death differed between treatment groups (HR 1.23, 95% CI 0.82-1.85, P = 0.32). The risk of the primary endpoint was significantly reduced among those with IED ≥100 ms when compared with those with IED <100 ms (HR 0.62, 95% CI 0.39-0.98, P = 0.04). CONCLUSIONS In this study, an individualized multimodality imaging-guided strategy targeting LV lead placement towards the latest mechanically activated non-scarred myocardial segment during CRT implantation did not reduce HF hospitalization or all-cause death when compared with routine LV lead placement during long-term follow-up. Targeting the latest electrical activation should be studied as an alternative individualized strategy for optimizing LV lead placement in CRT recipients.
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Affiliation(s)
- Daniel Benjamin Fyenbo
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anders Sommer
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bjarne Linde Nørgaard
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jesper Møller Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Engblom H, Aletras AH, Heiberg E, Arheden H, Carlsson M. Quantification of myocardial salvage by myocardial perfusion SPECT and cardiac magnetic resonance — reference standards for ECG development. J Electrocardiol 2014; 47:525-34. [DOI: 10.1016/j.jelectrocard.2014.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Indexed: 01/08/2023]
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Ugander M, Soneson H, Engblom H, van der Pals J, Erlinge D, Heiberg E, Arheden H. Quantification of myocardium at risk in myocardial perfusion SPECT by co-registration and fusion with delayed contrast-enhanced magnetic resonance imaging - an experimental ex vivo study. Clin Physiol Funct Imaging 2011; 32:33-8. [DOI: 10.1111/j.1475-097x.2011.01051.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Munk K, Andersen NH, Nielsen SS, Bibby BM, Bøtker HE, Nielsen TT, Poulsen SH. Global longitudinal strain by speckle tracking for infarct size estimation. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:156-65. [PMID: 21131657 DOI: 10.1093/ejechocard/jeq168] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS To assess the utility of speckle tracking global longitudinal systolic strain (GLS) compared with traditional echocardiographic indices including left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and end-systolic volume index (ESVI), in estimating the infarct size (IS) following a ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS The study includes 227 patients with STEMI and day 1 and day 30 echocardiograms, and myocardial perfusion imaging (MPI) only at day 30 to assess IS. IS was modelled by linear regression with echocardiographic parameters using MPI as reference. Resulting echocardiographic IS estimates were compared by ratios of standard deviations of model residuals (RSD). To estimate the resultant day 30 IS 1 day after a STEMI, GLS was more precise than LVEF (RSD: 0.91, P = 0.014) and ESVI (RSD: 0.88, P = 0.002), and comparable with WMSI (RSD 0.99, P = 0.86). To estimate IS from a day 30 echocardiogram, GLS was comparable with LVEF (RSD: 0.98, P = 0.68) and ESVI (RSD: 1.04, P = 0.40), but WMSI was more precise (RSD: 0.89, P = 0.006). Multiple linear regression revealed that on day 1 after STEMI, GLS significantly complemented the standard parameters separately (P-values all models <0.001) or combined [multivariable model: GLS (P = 0.001), WMSI (P = 0.03), LVEF (P = 0.40)]. On day 30, GLS significantly complemented LVEF and ESVI, but when WMSI was in the model, GLS's association with IS was not significant. CONCLUSION On day 1 after revascularization for STEMI, GLS contains additional information about final IS compared with standard echocardiographic systolic function indices. Studies are needed to clarify whether this has prognostic implications.
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Affiliation(s)
- Kim Munk
- Department of Cardiology, Aarhus University Hospital Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark.
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Hedström E, Aström-Olsson K, Ohlin H, Frogner F, Carlsson M, Billgren T, Jovinge S, Cain P, Wagner GS, Arheden H. Peak CKMB and cTnT accurately estimates myocardial infarct size after reperfusion. SCAND CARDIOVASC J 2009; 41:44-50. [PMID: 17365977 DOI: 10.1080/14017430601071849] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To find the time-to-peak for creatine kinase MB(mass) (CKMB) and cardiac troponin T (cTnT) after acute reperfusion, to compare peak and cumulative values to estimate infarct size (IS), and to evaluate clinical routine sampling for assessment of IS. DESIGN Acute primary percutaneous coronary intervention (PCI) was performed in 38 patients with first-time myocardial infarction. In 21 patients, CKMB and cTnT were acquired before PCI and at 1.5, 3, 6, 12, 18, 24, and 48 hours thereafter. In 17 patients, clinical routine samples were acquired at arrival, and at 10 and 20 h. IS was assessed by delayed contrast-enhanced MRI (DE-MRI). RESULTS Time-to-peak was 7.6+/-3.6 h for CKMB and 8.1+/-3.4 h for cTnT. Peak values correlated strongly to cumulative values (r(s)=0.97-0.98) as well as to DE-MRI (r(s)=0.8-0.82). Clinical routine sampling showed lower rs values (0.47-0.60). CONCLUSIONS Peak values are likely captured if CKMB and cTnT are acquired at 3, 6, and 12 h after acute PCI. These peak values can be used to estimate myocardial infarct size after acute PCI.
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Affiliation(s)
- Erik Hedström
- Department of Clinical Physiology, Lund University, Lund, Sweden
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Rosendahl L, Blomstrand P, Ohlsson JL, Björklund PG, Ahlander BM, Starck SA, Engvall JE. Late gadolinium uptake demonstrated with magnetic resonance in patients where automated PERFIT analysis of myocardial SPECT suggests irreversible perfusion defect. BMC Med Imaging 2008; 8:17. [PMID: 19077270 PMCID: PMC2636796 DOI: 10.1186/1471-2342-8-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 12/12/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myocardial perfusion single photon emission computed tomography (MPS) is frequently used as the reference method for the determination of myocardial infarct size. PERFIT(R) is a software utilizing a three-dimensional gender specific, averaged heart model for the automatic evaluation of myocardial perfusion. The purpose of this study was to compare the perfusion defect size on MPS, assessed with PERFIT, with the hyperenhanced volume assessed by late gadolinium enhancement magnetic resonance imaging (LGE) and to relate their effect on the wall motion score index (WMSI) assessed with cine magnetic resonance imaging (cine-MRI) and echocardiography (echo). METHODS LGE was performed in 40 patients where clinical MPS showed an irreversible uptake reduction suggesting a myocardial scar. Infarct volume, extent and major coronary supply were compared between MPS and LGE as well as the relationship between infarct size from both methods and WMSI. RESULTS MPS showed a slightly larger infarct volume than LGE (MPS 29.6 +/- 23.2 ml, LGE 22.1 +/- 16.9 ml, p = 0.01), while no significant difference was found in infarct extent (MPS 11.7 +/- 9.4%, LGE 13.0 +/- 9.6%). The correlation coefficients between methods in respect to infarct size and infarct extent were 0.71 and 0.63 respectively. WMSI determined with cine-MRI correlated moderately with infarct volume and infarct extent (cine-MRI vs MPS volume r = 0.71, extent r = 0.71, cine-MRI vs LGE volume r = 0.62, extent r = 0.60). Similar results were achieved when wall motion was determined with echo. Both MPS and LGE showed the same major coronary supply to the infarct area in a majority of patients, Kappa = 0.84. CONCLUSION MPS and LGE agree moderately in the determination of infarct size in both absolute and relative terms, although infarct volume is slightly larger with MPS. The correlation between WMSI and infarct size is moderate.
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Affiliation(s)
- Lene Rosendahl
- Dept, of Clinical Physiology, County Hospital Ryhov, SE-55185 Jönköping, Sweden.
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Ugander M, Ekmehag B, Arheden H. The relationship between left ventricular ejection fraction and infarct size assessed by MRI. SCAND CARDIOVASC J 2008; 42:137-45. [PMID: 18365897 DOI: 10.1080/14017430701840317] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES We sought to study the relationship between left ventricular ejection fraction (LVEF) and infarct size in patients with ischemic heart disease (IHD) using magnetic resonance imaging (MRI), and to determine a dysfunction index based on the maximum possible LVEF in relation to infarct size. DESIGN In 149 patients with chronic IHD, LVEF and infarct size were quantified by MRI. Dysfunction index was defined as the maximum possible LVEF minus measured LVEF. RESULTS The maximum possible LVEF was found to be LVEF=72.2-[1.18*infarct size]. Dysfunction index for the study population was mean 20 (range -6 to 57), 74% of the study population had a dysfunction index >10 and 44% had a dysfunction index >20. CONCLUSIONS The present study suggests that infarct size by MRI can be used to estimate a maximum possible LVEF and a dysfunction index. The distribution of dysfunction index in the population suggests a considerable prevalence of dysfunctional but viable myocardium. Future studies are needed to assess if the dysfunction index can be useful to assess the potential for improvement in LVEF following revascularization.
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Affiliation(s)
- Martin Ugander
- Cardiac MR Group, Department of Clinical Physiology, Lund University Hospital, Lund, Sweden
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French BA, Kramer CM. Mechanisms of Post-Infarct Left Ventricular Remodeling. ACTA ACUST UNITED AC 2007; 4:185-196. [PMID: 18690295 DOI: 10.1016/j.ddmec.2007.12.006] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Heart failure secondary to myocardial infarction (MI) remains a major source of morbidity and mortality. Long-term outcome after MI can be largely be defined in terms of its impact on the size and shape of the left ventricle (i.e., LV remodeling). Three major mechanisms contribute to LV remodeling: 1) early infarct expansion, 2) subsequent infarct extension into adjacent noninfarcted myocardium, and 3) late hypertrophy in the remote LV. Future developments in preventing post-MI heart failure will depend not only on identifying drugs targeting each of these individual mechanisms, but also on diagnostic techniques capable of assessing efficacy against each mechanism.
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Affiliation(s)
- Brent A French
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908
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Fieno DS, Thomson LEJ, Slomka P, Abidov A, Friedman JD, Germano G, Berman DS. Quantitation of infarct size in patients with chronic coronary artery disease using rest-redistribution Tl-201 myocardial perfusion SPECT: correlation with contrast-enhanced cardiac magnetic resonance. J Nucl Cardiol 2007; 14:59-67. [PMID: 17276307 DOI: 10.1016/j.nuclcard.2006.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 08/24/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rest and rest-redistribution thallium 201 myocardial perfusion single photon emission computed tomography (SPECT) (MPS) has been incompletely validated in patients for determination of the total amount of scarred myocardium. We sought to determine whether rest or redistribution Tl-201 MPS provides an accurate determination of infarct size as defined by delayed contrast-enhanced cardiac magnetic resonance (CMR). METHODS AND RESULTS We studied patients (n = 44) with chronic coronary artery disease referred for rest-redistribution Tl-201 MPS, who were also studied by contrast-enhanced CMR within 3 +/- 4 days. Patients were considered retrospectively based on a series of patients referred for clinically indicated MPS. Defect size, as a percent of left ventricular mass (% LV), was determined by quantitative perfusion SPECT (QPS) and compared with the volume of delayed hyperenhancement on contrast-enhanced CMR, normalized to LV mass. Infarct size varied from 0% to 43% LV. Rest QPS defect size correlated with the amount of nonviable myocardium assessed by contrast-enhanced CMR (r = 0.76; mean difference, 4.3% +/- 8.0% LV). When delayed thallium data were considered, redistribution QPS was superior to rest QPS for determination of infarct size (redistribution r = 0.90; mean difference, 2.4% +/- 5.2% LV; P = .03 vs rest). CONCLUSION Rest-redistribution Tl-201 MPS provides a more accurate measurement of total infarct size than rest-only Tl-201 MPS and correlates with contrast-enhanced CMR.
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Affiliation(s)
- David S Fieno
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Finn JP, Saleh R, Thesen S, Ruehm SG, Lee MH, Grinstead J, Child JS, Laub G. MR Imaging with Remote Control: Feasibility Study in Cardiovascular Disease. Radiology 2006; 241:528-37. [PMID: 17005775 DOI: 10.1148/radiol.2412051898] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The institutional review board approved this HIPAA-compliant study and waived informed consent. The purpose was to retrospectively evaluate remote control magnetic resonance (MR) imaging in complex cardiovascular procedures, whereby operational expertise was made available locally from a remote location. Thirty patients underwent cardiac (12 patients) and/or vascular (30 patients) 1.5-T MR imaging with a remote operator by using a personal computer. All patient studies were compared with 30 control studies obtained with conventional local imaging. Cardiac cine, myocardial delayed enhancement, and MR angiograms were assessed for overall image quality and motion artifact. MR angiograms were evaluated for vascular definition. Image quality was excellent in 90% (38 of 42) of remote images versus 60% (25 of 42) of control group images (P < .01). Scores for motion artifact were not significantly different (P = .11). Interactive MR imaging was successfully implemented with remote control in complex cardiovascular cases; diagnostic quality of images was superior to that of images obtained locally.
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Affiliation(s)
- J Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Peter V. Ueberroth Bldg, Suite 3371, 10945 Le Conte Ave, Los Angeles, CA 90095-7206, USA.
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Heiberg E, Engblom H, Engvall J, Hedström E, Ugander M, Arheden H. Semi-automatic quantification of myocardial infarction from delayed contrast enhanced magnetic resonance imaging. SCAND CARDIOVASC J 2006; 39:267-75. [PMID: 16269396 DOI: 10.1080/14017430500340543] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Accurate and reproducible assessment of myocardial infarction is important for treatment planning in patients with ischemic heart disease. This study describes a novel method to quantify myocardial infarction by semi-automatic delineation of hyperenhanced myocardium in delayed contrast enhanced (DE) magnetic resonance (MR) images. DESIGN The proposed method automatically detects the hyperenhanced tissue by first determining the signal intensity of non-enhanced myocardium. A fast level set algorithm was used to limit the heterogeneity of the hyperenhanced regions, and to exclude small regions that constitute noise rather than infarction. The method was evaluated in 40 patients; 20 with acute infarction and 20 with chronic healed infarction using scanners from two different manufacturers. Infarct size measured by the proposed semi-automatic method was compared with manual measurements from three experienced observers. The software used is freely available for research purposes at http://segment.heiberg.se. RESULTS The difference in infarct size between semi-automatic quantification and the mean of the three observers was 6.1+/-6.6 ml (mean+/-SD), and the interobserver variability (SD) was 4.2 ml. CONCLUSIONS The method presented is a highly automated method for analyzing myocardial viability from DE-MR images. The bias of the method is acceptable and the variability is in the same order of magnitude as the interobserver variability for manual delineations.
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Affiliation(s)
- Einar Heiberg
- Department of Clinical Physiology, Lund University Hospital, Sweden.
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Affiliation(s)
- Raymond J Gibbons
- Division of Cardiovascular Diseases and Internal Medicine, Department of Medicine, Rochester, Minnesota 55905, USA
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Current awareness in NMR in biomedicine. NMR IN BIOMEDICINE 2005; 18:205-12. [PMID: 15920785 DOI: 10.1002/nbm.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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