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Nicolosi GL. Why are left ventricular linear internal diameters still so important for clinical decision-making to undergo surgery in asymptomatic patients with chronic severe aortic or primary mitral regurgitation? J Cardiovasc Med (Hagerstown) 2022; 23:304-307. [PMID: 35486681 DOI: 10.2459/jcm.0000000000001298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Gian Luigi Nicolosi
- Division of Cardiology, A.R.C., Policlinico San Giorgio, Via Gemelli 10, Pordenone, Italy
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Berndt N, Eckstein J, Wallach I, Nordmeyer S, Kelm M, Kirchner M, Goubergrits L, Schafstedde M, Hennemuth A, Kraus M, Grune T, Mertins P, Kuehne T, Holzhütter HG. CARDIOKIN1: Computational Assessment of Myocardial Metabolic Capability in Healthy Controls and Patients With Valve Diseases. Circulation 2021; 144:1926-1939. [PMID: 34762513 PMCID: PMC8663543 DOI: 10.1161/circulationaha.121.055646] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Many heart diseases can result in reduced pumping capacity of the heart muscle. A mismatch between ATP demand and ATP production of cardiomyocytes is one of the possible causes. Assessment of the relation between myocardial ATP production (MVATP) and cardiac workload is important for better understanding disease development and choice of nutritional or pharmacologic treatment strategies. Because there is no method for measuring MVATP in vivo, the use of physiology-based metabolic models in conjunction with protein abundance data is an attractive approach. METHOD: We developed a comprehensive kinetic model of cardiac energy metabolism (CARDIOKIN1) that recapitulates numerous experimental findings on cardiac metabolism obtained with isolated cardiomyocytes, perfused animal hearts, and in vivo studies with humans. We used the model to assess the energy status of the left ventricle of healthy participants and patients with aortic stenosis and mitral valve insufficiency. Maximal enzyme activities were individually scaled by means of protein abundances in left ventricle tissue samples. The energy status of the left ventricle was quantified by the ATP consumption at rest (MVATP[rest]), at maximal workload (MVATP[max]), and by the myocardial ATP production reserve, representing the span between MVATP(rest) and MVATP(max). Results: Compared with controls, in both groups of patients, MVATP(rest) was increased and MVATP(max) was decreased, resulting in a decreased myocardial ATP production reserve, although all patients had preserved ejection fraction. The variance of the energetic status was high, ranging from decreased to normal values. In both patient groups, the energetic status was tightly associated with mechanic energy demand. A decrease of MVATP(max) was associated with a decrease of the cardiac output, indicating that cardiac functionality and energetic performance of the ventricle are closely coupled. Conclusions: Our analysis suggests that the ATP-producing capacity of the left ventricle of patients with valvular dysfunction is generally diminished and correlates positively with mechanical energy demand and cardiac output. However, large differences exist in the energetic state of the myocardium even in patients with similar clinical or image-based markers of hypertrophy and pump function. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03172338 and NCT04068740.
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Affiliation(s)
- Nikolaus Berndt
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes Eckstein
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Institute of Biochemistry, Charitá - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Iwona Wallach
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Institute of Biochemistry, Charitá - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sarah Nordmeyer
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
| | - Marcus Kelm
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (DZHK), Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Marieluise Kirchner
- Berlin Institute of Health (BIH), Berlin, Germany; Proteomics Platform, Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
| | - Leonid Goubergrits
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Einstein Center Digital Future, Berlin, Germany
| | - Marie Schafstedde
- Institute of Computer-assisted Cardiovascular Medicine, Charité; Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Anja Hennemuth
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Milena Kraus
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Germany
| | - Tilman Grune
- Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (DZHK), Berlin, Germany; Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Philipp Mertins
- Berlin Institute of Health (BIH), Berlin, Germany; Proteomics Platform, Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
| | - Titus Kuehne
- Institute of Computer-assisted Cardiovascular Medicine, Charité; Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (DZHK), Berlin, Germany
| | - Hermann-Georg Holzhütter
- Institute of Biochemistry, Charitá - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Surrogates for myocardial power and power efficiency in patients with aortic valve disease. Sci Rep 2019; 9:16407. [PMID: 31712631 PMCID: PMC6848480 DOI: 10.1038/s41598-019-52909-9] [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] [Received: 08/20/2018] [Accepted: 10/12/2019] [Indexed: 01/05/2023] Open
Abstract
We aimed to assess surrogate markers for left ventricular (LV) myocardial power and efficiency in patients with isolated aortic stenosis (AS) and combined stenosis/regurgitation (AS/AR). In AS (n = 59), AS/AR (n = 21) and controls (n = 14), surrogates for LV myocardial power and circulatory/external myocardial efficiency were obtained from cardiac MRI. Median surrogate LV myocardial power was increased in AS, 7.7 W/m2 (interquartile range 6.0–10.2; p = 0.010) and AS/AR, 10.8 W/m2 (8.9–13.4; p < 0.001) when compared to controls, 5.4 W/m2 (4.2–6.5), and was lower in AS than AS/AR (p < 0.001). Surrogate circulatory efficiency was decreased in AS, 8.6% (6.8–11.1; p < 0.001) and AS/AR, 5.4% (4.1–6.2; p < 0.001) when compared to controls, 11.8% (9.8–16.9). Surrogate external myocardial efficiency was higher in AS, 15.2% (11.9–18.6) than in AS/AR, 12.2% (10.1–14.2; p = 0.031) and was significantly lower compared to controls, 12.2% (10.7–18.1) in patients with reduced ejection fraction (EF), 9.8% (8.1–11.7; p = 0.025). In 16% of all cases, left ventricular mass/volume indices and EF were within normal ranges, wheras surrogate LV myocardial power was elevated and patients were symptomatic. Although influenced by pressure/volume load, the myocardium is additionally affected by remodelling processes. Surrogates for circulatory efficiency and LV myocardial power gradually reflect alterations in patients with AS and AS/AR, even when surrogate external myocardial efficiency, EF, mass and volume indices still remain compensated.
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Nicolosi GL, Antonini-Canterin F, Pavan D, Piazza R. Simplified three-dimensional spatial approach for improving confidence in reliably measuring left ventricular linear internal dimensions. J Cardiovasc Med (Hagerstown) 2019; 20:367-371. [PMID: 31045854 DOI: 10.2459/jcm.0000000000000775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | | | - Daniela Pavan
- Cardiologia, ARC, Ospedale Civile, San Vito al Tagliamento
| | - Rita Piazza
- Cardiologia, ARC, Ospedale Civile, Pordenone, Italy
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Ali Rizvi HMF, Khalid ZR, Baksh A, Raza Baig MA. Frequency of early remodeling of left ventricle and its comparison between patients with stroke volume ≥97 Ml versus patients with stroke volume <97 Ml after aortic valve replacement for severe aortic regurgitation. Pak J Med Sci 2017; 32:1360-1363. [PMID: 28083026 PMCID: PMC5216282 DOI: 10.12669/pjms.326.11173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: To evaluate the frequency of early remodeling in patients of severe aortic regurgitation after aortic valve replacement and to see the incidence of early remodeling in patients with stroke volume >97 ml versus < 97 ml before aortic valve replacement. Method: This was a prospective comparative study conducted from August 2013 to December 2014 in a tertiary care hospital. Fifty seven (57) patients of isolated chronic aortic regurgitation were included in this study. SPSS v23 was used for data analysis. Independent sample t-test was used for analysis of continuous variables and chi-square test for qualitative variables. Results: Out of fifty seven patients, early remodeling occurred in 34 (59.64%) patients after surgery. The mean pre-operative stroke volume of patient in whom remodeling occurred was 110.3+9.66 ml while mean pre-operative stroke volume of patients who did not undergo remodeling was 86.65+7.63 ml. There were 28 (82.4%) patients with stroke volume >97 ml in whom Remodeling occurred where as in patients with stroke volume <97 ml remodeling occurred only in 6 (17.6%) patients (p value 0.004). There was no in-hospital mortality. Conclusion: There is an association between stroke volume and early LV remodeling after Aortic valve replacement. Stroke volume >97 ml is a good predictor of early LV remodeling.
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Affiliation(s)
| | - Zaigham Rasool Khalid
- Zaigham Rasool Khalid, FCPS CS. Senior Registrar Pediatric Cardiac Surgery, Pakistan
| | - Allah Baksh
- Allah Baksh, FCPS CS. Senior Registrar Cardiac Surgery, Pakistan
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Zhang Z, Yang J, Yu Y, Huang H, Ye W, Yan W, Shen H, Ii M, Shen Z. Preoperative ejection fraction determines early recovery of left ventricular end-diastolic dimension after aortic valve replacement for chronic severe aortic regurgitation. J Surg Res 2015; 196:49-55. [DOI: 10.1016/j.jss.2015.02.069] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 01/09/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
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Enache R, Popescu BA, Piazza R, Muraru D, Călin A, Beladan CC, Roşca M, Nicolosi GL, Ginghină C. Left ventricular shape and mass impact torsional dynamics in asymptomatic patients with chronic aortic regurgitation and normal left ventricular ejection fraction. Int J Cardiovasc Imaging 2015; 31:1315-26. [PMID: 25994762 DOI: 10.1007/s10554-015-0684-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/15/2015] [Indexed: 12/13/2022]
Abstract
Chronic aortic regurgitation (AR) is associated with a unique pattern of left ventricular (LV) volume and pressure overload, leading to LV remodelling. LV torsional motion, a key component of LV performance, can be altered in this setting. We aimed to assess the impact of LV remodelling on LV torsional dynamics parameters using speckle-tracking echocardiography (STE) in asymptomatic AR patients. We prospectively enrolled 60 patients with chronic AR and LVEF > 50% and 55 healthy controls. LV rotation, twisting and untwisting were assessed using STE. Patients with AR had higher LV diameters, volumes and mass, a more spherical LV shape than controls, but similar LVEF. In AR patients we found reduced peak LV apical rotation and decreased (2.1 ± 0.8 vs 2.9 ± 0.9°/cm, p < 0.001) and delayed (time to peak LV twist: 0.94 ± 0.12 vs 0.99 ± 0.09, p = 0.004) peak LV torsion. Also, peak LV untwisting velocity was decreased (-123.5 ± 41.5 vs -152.3 ± 55.0°/s, p = 0.002) due to lower peak LV apical diastolic rotation rate. LV shape influenced LV torsional dynamics, a more spherical LV displaying reduced peak LV apical rotation and diastolic rotation rate and decreased LV twist. A more hypertrophied LV had a lower peak LV torsion, peak LV apical diastolic rotation rate and peak LV untwisting velocity. LV apical rotation and torsion are decreased and LV twist is delayed in patients with chronic AR and normal LVEF, detecting early subclinical LV dysfunction before LVEF declines. Also, LV untwisting is reduced in these patients. LV remodelling impairs LV torsional dynamics parameters in this setting.
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Affiliation(s)
- Roxana Enache
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania. .,"Prof. Dr. C. C. Iliescu" Emergency Institute of Cardiovascular Diseases, Sos. Fundeni, No 258, Bucharest, 022328, Romania.
| | - Bogdan A Popescu
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.,"Prof. Dr. C. C. Iliescu" Emergency Institute of Cardiovascular Diseases, Sos. Fundeni, No 258, Bucharest, 022328, Romania
| | - Rita Piazza
- Cardiology Department, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Science, School of Medicine, University of Padua, Padua, Italy
| | - Andreea Călin
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.,"Prof. Dr. C. C. Iliescu" Emergency Institute of Cardiovascular Diseases, Sos. Fundeni, No 258, Bucharest, 022328, Romania
| | - Carmen C Beladan
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.,"Prof. Dr. C. C. Iliescu" Emergency Institute of Cardiovascular Diseases, Sos. Fundeni, No 258, Bucharest, 022328, Romania
| | - Monica Roşca
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.,"Prof. Dr. C. C. Iliescu" Emergency Institute of Cardiovascular Diseases, Sos. Fundeni, No 258, Bucharest, 022328, Romania
| | | | - Carmen Ginghină
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.,"Prof. Dr. C. C. Iliescu" Emergency Institute of Cardiovascular Diseases, Sos. Fundeni, No 258, Bucharest, 022328, Romania
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Beaudoin J, Handschumacher MD, Zeng X, Hung J, Morris EL, Levine RA, Schwammenthal E. Mitral valve enlargement in chronic aortic regurgitation as a compensatory mechanism to prevent functional mitral regurgitation in the dilated left ventricle. J Am Coll Cardiol 2013; 61:1809-16. [PMID: 23500248 DOI: 10.1016/j.jacc.2013.01.064] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/01/2013] [Accepted: 01/21/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that mitral valve (MV) enlargement occurring in chronic aortic regurgitation (AR) prevents functional mitral regurgitation (FMR). BACKGROUND Chronic AR causes left ventricular (LV) dilation, creating the potential for FMR. However, FMR is typically absent during compensated AR despite substantial LV enlargement. Increased mitral leaflet area has been identified in AR, but it is unknown whether increased MV size can represent a compensatory mechanism capable of preventing FMR. METHODS Database review of 816 patients with at least moderate AR evaluated the prevalence of FMR. A total of 90 patients were enrolled prospectively for 3-dimensional echocardiography (30 AR, 30 FMR, and 30 controls) to assess MV geometry including total leaflet area. RESULTS FMR was present in 5.6% of AR patients by database review. Prospectively, only 1 AR patient had more than mild FMR despite increased LV end-diastolic volume (82 ± 22, 86 ± 23, and 51 ± 12 cm(3)/m(2), respectively, for AR, FMR vs. control patients; p < 0.01) and similar sphericity index, annular area, and tethering distances compared with FMR. Total MV area was largest in AR (31.3% greater than normal), increasing significantly more than in FMR. The ratio of valve size to closure area was maintained in AR, whereas decreases in this ratio and LV ejection fraction independently predicted FMR. CONCLUSIONS FMR prevalence is low in chronic AR. MV leaflet area is significantly increased compared with control and FMR patients, preserving a normal relationship to the area needed for closure in the dilated LV. Understanding the mechanisms underlying this adaptation could lead to new therapeutic interventions to prevent FMR.
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Affiliation(s)
- Jonathan Beaudoin
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Buddhe S, Du W, Walters HL, Delius R, Pettersen MD. Predictors of Left Ventricular Remodeling after Aortic Valve Replacement in Pediatric Patients with Isolated Aortic Regurgitation. CONGENIT HEART DIS 2012; 8:167-73. [DOI: 10.1111/j.1747-0803.2012.00703.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Sujatha Buddhe
- Section of Pediatric Cardiology and Cardiovascular Surgery; Carmen and Ann Adams Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit; Mich; USA
| | - Wei Du
- Section of Pediatric Cardiology and Cardiovascular Surgery; Carmen and Ann Adams Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit; Mich; USA
| | - Henry L. Walters
- Section of Pediatric Cardiology and Cardiovascular Surgery; Carmen and Ann Adams Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit; Mich; USA
| | - Ralph Delius
- Section of Pediatric Cardiology and Cardiovascular Surgery; Carmen and Ann Adams Department of Pediatrics; The Children's Hospital of Michigan; Wayne State University School of Medicine; Detroit; Mich; USA
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Albertí JFF, de Diego JJG, Delgado RV, Riera JC, Torres RA. [State of the art: new developments in cardiac imaging]. Rev Esp Cardiol 2012; 65 Suppl 1:24-34. [PMID: 22269837 DOI: 10.1016/j.recesp.2011.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 11/03/2011] [Indexed: 11/16/2022]
Abstract
Cardiac imaging continues to reveal new anatomical and functional insights into heart disease. In echocardiography, both transesophageal and transthoracic three-dimensional imaging have been fully developed and optimized, and the value of the techniques that have increased our understanding of cardiac mechanics and ventricular function is well established. At the same time, the healthcare industry has released new devices onto the market which, although they are easier to use, have limitations that restrict their use for routine assessment. Tomography's diagnostic and prognostic value in coronary artery disease continues to increase while radiation exposure becomes progressively lower. With cardiac magnetic resonance imaging, myocardial injury and recovery in ischemic heart disease and following acute coronary syndrome can be monitored in exquisite detail. The emergence of new combined tomographic and gamma camera techniques, exclusively developed for nuclear cardiology, have improved the quality of investigations and reduced radiation exposure. The hybrid or fusion images produced by combining different techniques, such as nuclear cardiology techniques and tomography, promise an exciting future.
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Strain Value in the Assessment of Left Ventricular Function and Prediction of Heart Failure Markers in Aortic Regurgitation. Echocardiography 2011; 28:983-92. [DOI: 10.1111/j.1540-8175.2011.01483.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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