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Wahadneh OA, Alitter Q, Raju A, Alziadin N, Alshurafa AH, Aldabbas HO, Shaik I. Prevalence and impact of pulmonary hypertension on acute decompensated heart failure with preserved ejection fraction hospitalizations: A five-year retrospective analysis. Curr Probl Cardiol 2024; 49:102537. [PMID: 38522770 DOI: 10.1016/j.cpcardiol.2024.102537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
Heart Failure with Preserved Ejection Fraction (HFpEF) is a major and common cardiovascular condition with widely variable clinical outcomes. Pulmonary hypertension (PH) often co-exists with HFpEF and tends to affect patient outcomes; this study aims to identify the impact of PH on the clinical outcome of patients admitted to the hospital with acute HFpEF exacerbations. We analyzed data from the National Inpatient Sample between 2016 and 2020, focusing on 464,438 acute HFpEF exacerbation hospitalizations. Outcomes were compared between those with PH (27.1 %) and those without PH (72.9 %). HFpEF hospitalizations with PH exhibited elevated in-hospital mortality (adjusted odds ratio [aOR]: 1.20, 95 % confidence interval [95 CI]: 1.08-1.31, P < 0.05), prolonged length of stay (adjusted β: 0.90 days, P < 0.05), and increased overall costs (adjusted β: $2,858, P < 0.05). Furthermore, HFpEF hospitalizations with PH demonstrated higher rates of atrial fibrillation, ventricular tachycardia, right ventricular failure, and conduction abnormalities. This population also displayed an increased incidence of acute hypoxic respiratory failure, necessitating increased non-invasive and mechanical ventilation. The co-existence of PH in HFpEF presents an increased risk of mortality and morbidity, with higher healthcare costs and the need for ventilatory support, in addition to higher risks of cardiovascular and pulmonary complications. Therefore, an early diagnosis of PH in patients with HFpEF is crucial, and further research is required to determine appropriate management.
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Affiliation(s)
- Omar Al Wahadneh
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL, USA.
| | - Qusai Alitter
- Department of Pulmonary & Critical Care, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Apoorva Raju
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL, USA
| | - Nmair Alziadin
- Department of Internal Medicine, HCA Healthcare/Tufts University School of Medicine: Portsmouth Regional Hospital, Portsmouth, NH, USA
| | | | | | - Ibrahim Shaik
- Cardiovascular Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
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Tsujimoto Y, Kumasawa J, Shimizu S, Nakano Y, Kataoka Y, Tsujimoto H, Kono M, Okabayashi S, Imura H, Mizuta T. Doppler trans-thoracic echocardiography for detection of pulmonary hypertension in adults. Cochrane Database Syst Rev 2022; 5:CD012809. [PMID: 35532166 PMCID: PMC9132178 DOI: 10.1002/14651858.cd012809.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) is an important cause of morbidity and mortality, which leads to a substantial loss of exercise capacity. PH ultimately leads to right ventricular overload and subsequent heart failure and early death. Although early detection and treatment of PH are recommended, due to the limited responsiveness to therapy at late disease stages, many patients are diagnosed at a later stage of the disease because symptoms and signs of PH are nonspecific at earlier stages. While direct pressure measurement with right-heart catheterisation is the clinical reference standard for PH, it is not routinely used due to its invasiveness and complications. Trans-thoracic Doppler echocardiography is less invasive, less expensive, and widely available compared to right-heart catheterisation; it is therefore recommended that echocardiography be used as an initial diagnosis method in guidelines. However, several studies have questioned the accuracy of noninvasively measured pulmonary artery pressure. There is substantial uncertainty about the diagnostic accuracy of echocardiography for the diagnosis of PH. OBJECTIVES To determine the diagnostic accuracy of trans-thoracic Doppler echocardiography for detecting PH. SEARCH METHODS We searched MEDLINE, Embase, Web of Science Core Collection, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform from database inception to August 2021, reference lists of articles, and contacted study authors. We applied no restrictions on language or type of publication. SELECTION CRITERIA We included studies that evaluated the diagnostic accuracy of trans-thoracic Doppler echocardiography for detecting PH, where right-heart catheterisation was the reference standard. We excluded diagnostic case-control studies (two-gate design), studies where right-heart catheterisation was not the reference standard, and those in which the reference standard threshold differed from 25 mmHg. We also excluded studies that did not provide sufficient diagnostic test accuracy data (true-positive [TP], false-positive [FP], true-negative [TN], and false-negative [FN] values, based on the reference standard). We included studies that provided data from which we could extract TP, FP, TN, and FN values, based on the reference standard. Two authors independently screened and assessed the eligibility based on the titles and abstracts of records identified by the search. After the title and abstract screening, the full-text reports of all potentially eligible studies were obtained, and two authors independently assessed the eligibility of the full-text reports. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias and extracted data from each of the included studies. We contacted the authors of the included studies to obtain missing data. We assessed the methodological quality of studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. We estimated a summary receiver operating characteristic (SROC) curve by fitting a hierarchical summary ROC (HSROC) non-linear mixed model. We explored sources of heterogeneity regarding types of PH, methods to estimate the right atrial pressure, and threshold of index test to diagnose PH. All analyses were performed using the Review Manager 5, SAS and STATA statistical software. MAIN RESULTS We included 17 studies (comprising 3656 adult patients) assessing the diagnostic accuracy of Doppler trans-thoracic echocardiography for the diagnosis of PH. The included studies were heterogeneous in terms of patient distribution of age, sex, WHO classification, setting, country, positivity threshold, and year of publication. The prevalence of PH reported in the included studies varied widely (from 6% to 88%). The threshold of index test for PH diagnosis varied widely (from 30 mmHg to 47 mmHg) and was not always prespecified. No study was assigned low risk of bias or low concern in each QUADAS-2 domain assessed. Poor reporting, especially in the index test and reference standard domains, hampered conclusive judgement about the risk of bias. There was little consistency in the thresholds used in the included studies; therefore, common thresholds contained very sparse data, which prevented us from calculating summary points of accuracy estimates. With a fixed specificity of 86% (the median specificity), the estimated sensitivity derived from the median value of specificity using HSROC model was 87% (95% confidence interval [CI]: 78% to 96%). Using a prevalence of PH of 68%, which was the median among the included studies conducted mainly in tertiary hospitals, diagnosing a cohort of 1000 adult patients under suspicion of PH would result in 88 patients being undiagnosed with PH (false negatives) and 275 patients would avoid unnecessary referral for a right-heart catheterisation (true negatives). In addition, 592 of 1000 patients would receive an appropriate and timely referral for a right-heart catheterisation (true positives), while 45 patients would be wrongly considered to have PH (false positives). Conversely, when we assumed low prevalence of PH (10%), as in the case of preoperative examinations for liver transplantation, the number of false negatives and false positives would be 13 and 126, respectively. AUTHORS' CONCLUSIONS Our evidence assessment of echocardiography for the diagnosis of PH in adult patients revealed several limitations. We were unable to determine the average sensitivity and specificity at any particular index test threshold and to explain the observed variability in results. The high heterogeneity of the collected data and the poor methodological quality would constrain the implementation of this result into clinical practice. Further studies relative to the accuracy of Doppler trans-thoracic echocardiography for the diagnosis of PH in adults, that apply a rigorous methodology for conducting diagnostic test accuracy studies, are needed.
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Affiliation(s)
- Yasushi Tsujimoto
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
- Department of Nephrology and Dialysis, Kyoritsu Hospital, Kawanishi, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Junji Kumasawa
- Department of Critical Care Medicine, Department of Clinical Research and Epidemiology, Sakai City Medical Center, Sakai City, Japan
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sayaka Shimizu
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshio Nakano
- Department of Respiratory Medicine, Sakai City Medical Center, Sakai City, Japan
| | - Yuki Kataoka
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Hiraku Tsujimoto
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Michihiko Kono
- Department of Critical Care Medicine, Sakai City Medical Center, Osaka, Japan
| | - Shinji Okabayashi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruki Imura
- Department of Health Informatics, School of Public Health in Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahiro Mizuta
- Department of Dermatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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Björkman A, Lund LH, Faxén UL, Lindquist P, Venkateshvaran A. Accuracy and diagnostic performance of doppler echocardiography to estimate mean pulmonary artery pressure in heart failure. Echocardiography 2021; 38:1624-1631. [PMID: 34510533 DOI: 10.1111/echo.15188] [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: 06/08/2021] [Revised: 07/26/2021] [Accepted: 08/15/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Multiple echocardiographic algorithms have been proposed to estimate mean pulmonary artery pressure (PAPM ) and assess pulmonary hypertension (PH) likelihood. We assessed the accuracy of four echocardiographic approaches to estimate PAPM in heart failure (HF) patients undergoing near-simultaneous right heart catheterization (RHC), and compared diagnostic performance to identify PH with recommendation-advised tricuspid regurgitation peak velocity (TRVmax ). METHODS We employed four validated echocardiographic algorithms incorporating tricuspid regurgitation peak or mean gradient, pulmonary regurgitation peak gradient, and right ventricular outflow tract acceleration time to estimate PAPM . Echocardiographic estimates of right atrial pressure were incorporated in all algorithms but one. Association and agreement with invasive PAPM were assessed. Diagnostic performance of all algorithms to identify PH was evaluated and compared with the recommended TRVmax cut-off. RESULTS In 112 HF patients, all echocardiographic algorithms demonstrated reasonable association (r = .41-.65; p < 0.001) and good agreement with invasive PAPM , with relatively lower mean bias and higher precision observed in algorithms that incorporated tricuspid regurgitation peak or mean gradient. All methods demonstrated strong ability to identify PH (AUC = .70-.80; p < 0.001) but did not outperform TRVmax (AUC = .84; p < 0.001). Echocardiographic estimates of right atrial pressure were falsely elevated in 30% of patients. CONCLUSIONS Echocardiographic estimates demonstrate reasonable association with invasive PAPM and strong ability to identify PH in HF. However, none of the algorithms outperformed recommendation-advised TRVmax . The incremental value of echocardiographic estimates of right atrial pressure may need to be re-evaluated.
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Affiliation(s)
- Alva Björkman
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Lars H Lund
- Department of Medicine, Cardiology Unit, Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Ljung Faxén
- Department of Medicine, Cardiology Unit, Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden.,Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Per Lindquist
- Department of Clinical Physiology, Surgical & Perioperative sciences, Umeå University, Umeå, Sweden
| | - Ashwin Venkateshvaran
- Department of Medicine, Cardiology Unit, Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden
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Gao C, Wang Y, Gu X, Shen X, Zhou D, Zhou S, Huang JA, Cao B, Guo Q. Association Between Cardiac Injury and Mortality in Hospitalized Patients Infected With Avian Influenza A (H7N9) Virus. Crit Care Med 2020; 48:451-458. [PMID: 32205590 PMCID: PMC7098447 DOI: 10.1097/ccm.0000000000004207] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To evaluate the prevalence of cardiac injury and its association with mortality in hospitalized patients infected with avian influenza A (H7N9) virus. DESIGN Retrospective cohort study. SETTING A total of 133 hospitals in 17 provinces, autonomous regions, and municipalities of mainland China that admitted influenza A (H7N9) virus-infected patients between January 22, 2015, and June 16, 2017. PATIENTS A total of 321 patients with influenza A (H7N9) virus infection were included in the final analysis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographics and clinical characteristics were collected from medical records. Cardiac injury was defined according to cardiac biomarkers, electrocardiography, or echocardiography. Among the 321 patients, 203 (63.2%) showed evidence of cardiac injury. Compared with the uninjured group, the cardiac injury group had lower PaO2/FIO2 (median, 102.0 vs 148.4 mm Hg; p < 0.001), higher Acute Physiology and Chronic Health Evaluation II score (median, 17.0 vs 11.0; p < 0.001), longer stay in the ICU (10.0 vs 9.0 d; p = 0.029), and higher proportion of in-hospital death (64.0% vs 20.3%; p < 0.001). The proportion of virus clearance until discharge or death was lower in the cardiac injury group than in the uninjured group (58.6% vs 86.4%; p < 0.001). Multivariable-adjusted Cox proportional hazards regression analysis showed that cardiac injury was associated with higher mortality (hazards ratio, 2.06; 95% CI, 1.31-3.24) during hospitalization. CONCLUSIONS Cardiac injury is a frequent condition among hospitalized patients infected with influenza A (H7N9) virus, and it is associated with higher risk of mortality.
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Affiliation(s)
- Chang Gao
- Department of Critical Care Medicine, Dushuhu Public Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yeming Wang
- Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoying Gu
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Xinghua Shen
- Department of Critical Care Medicine, The Fifth People's Hospital of Suzhou, Suzhou, Jiangsu, China
| | - Daming Zhou
- Department of infectious diseases, Taizhou People's Hospital, Taizhou, Jiangsu, China
| | - Shujun Zhou
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Jian-An Huang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Capital Medical University, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
- Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
| | - Qiang Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Sohail A, Korejo HB, Shaikh AS, Ahsan A, Chand R, Patel N, Karim M. Correlation between Echocardiography and Cardiac Catheterization for the Assessment of Pulmonary Hypertension in Pediatric Patients. Cureus 2019; 11:e5511. [PMID: 31687287 PMCID: PMC6818733 DOI: 10.7759/cureus.5511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction Cardiac catheterization is widely considered the “gold standard” for the diagnosis of pulmonary hypertension. However, its routine use is limited due to its invasive nature. Therefore, the aim of this study was to evaluate the correlation between pulmonary artery pressures obtained by various parameters of transthoracic echocardiography and cardiac catheterization. Methods This study includes 50 consecutive patients with intracardiac shunt lesions diagnosed with severe pulmonary hypertension on echocardiography and admitted for cardiac catheterization at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan. Cardiac catheterization and transthoracic echocardiography were performed in all patients simultaneously and systolic (sPAP) and mean pulmonary artery pressure (mPAP) were assessed with both modalities. Correlations and agreement, in terms of Bland-Altman plot, were computed between both modalities for sPAP and mPAP. Results Out of 50 patients, 46% (23) were male and mean age was 7.49 ± 4.45 years. On cardiac catheterization, sPAP was 93.92 ± 17.91 mmHg and mPAP was 67.0 ± 14.28 mmHg. Correlation between cardiac catheterization and echocardiography for the assessment of sPAP was 0.917 (p<0.001), and mPAP was 0.832 (p<0.001) for mean gradient of tricuspid regurgitation (PGTRmean), 0.749 (p<0.001) for peak gradient of pulmonary regurgitation (PGPRpeak), 0.691 (p<0.001) for Acceleration time across right ventricular outflow tract (RVOT), and 0.752 (p<0.001) for end gradient of pulmonary regurgitation (PGPRend). Bland-Altman plot showed moderate agreement between two modalities. Conclusion A positive but modest correlation was observed between hemodynamic parameters of transthoracic echocardiography and cardiac catheterization for assessment of pulmonary artery pressures. Transthoracic echocardiography can reliably be used as an initial non-invasive modality for the assessment of pulmonary artery hypertension and can obviate the need of right heart catheterization in some patient especially with mild pulmonary hypertension.
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Affiliation(s)
- Arshad Sohail
- Pediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Hussain B Korejo
- Pediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | | | - Aliya Ahsan
- Pediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Ram Chand
- Pediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Najma Patel
- Paediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Musa Karim
- Miscellaneous, National Institute of Cardiovascular Diseases, Karachi, PAK
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Dzudie A, Dzekem BS, Tchoumi CT, Aminde LN, Mocumbi AO, Abanda M, Thienemann F, Kengne AP, Sliwa K. Pulmonary hypertension as seen in a rural area in sub-Saharan Africa: high prevalence, late clinical presentation and a high short-term mortality rate during follow up. Cardiovasc J Afr 2018; 29:208-212. [PMID: 30059129 PMCID: PMC6291806 DOI: 10.5830/cvja-2018-007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/14/2018] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The epidemiology of pulmonary hypertension (PH) in low- to middle-income countries is poorly characterised. We assessed the prevalence, baseline characteristics and mortality rate in patients with echocardiographically diagnosed PH at a rural cardiac centre in Cameroon. METHODS We conducted a prospective cohort study in a subsample of 150 participants, aged 18 years and older, diagnosed with PH [defined as right ventricular systolic pressure (RVSP) ≥ 35 mmHg in the absence of pulmonary stenosis and right heart failure]. PH was classified as mild (RVSP: 35-50 mmHg), moderate (RVSP: 51-60 mmHg) and severe (RVSP: > 60 mmHg). RESULTS Of 2 194 patients screened via echocardiograms, 343 (crude prevalence 15.6%) had PH. The sub-sample of 150 patients followed up (54.7% women, mean age of 62.7 ± 18.7 years) had a mean RVSP of 68.6 mmHg. They included 7.3% mild, 29.3% moderate and 63.4% severe PH cases. Co-morbidities included log smoke (80.7%), hypertension (52.0%), family history of cardiovascular disease (50.0%), diabetes (31.3%), alcohol abuse (21.3%) and HIV infection (8.7%). Main clinical features were dyspnoea (78.7%), fatigue (76.7%), palpitations (57.3%), cough (56.7%), jugular venous distension (68%) and peripheral oedema (66.7%). Overall, 70% presented in World Health Organisation functional class III/IV. PH due to left heart disease (PHLHD) was the commonest (64.7%), and rheumatic valvular disease accounted for 36.1%. The six-month mortality rate was 28%. CONCLUSION PH, dominated by PHLHD, was common among adults attending this rural centre and was associated with a high mortality rate. Related co-morbidities and late clinical presentation reflect the poor socio-economic context. Improved awareness of PH among physicians could promote early diagnosis and management.
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Affiliation(s)
- Anastase Dzudie
- Departments of Internal Medicine and Physiology, Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon; Douala General Hospital and Clinical Research Education, Networking and Consultancy, Douala, Cameroon; Soweto Cardiovascular Research Group, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa; NIH Millennium Fogarty Chronic Disease Leadership Programme
| | - Bonaventure Suiru Dzekem
- Departments of Internal Medicine and Physiology, Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon; Douala General Hospital and Clinical Research Education, Networking and Consultancy, Douala, Cameroon
| | | | - Leopold Ndemnge Aminde
- Douala General Hospital and Clinical Research Education, Networking and Consultancy, Douala, Cameroon; School of Public Health, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - Ana O Mocumbi
- Instituto Nacional de Saúde, and Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Martin Abanda
- Departments of Internal Medicine and Physiology, Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon; Douala General Hospital and Clinical Research Education, Networking and Consultancy, Douala, Cameroon
| | - Friedrich Thienemann
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Andre Pascal Kengne
- Non-communicable Diseases Unit, South African Medical Research Council, Cape Town, South Africa
| | - Karen Sliwa
- NIH Millennium Fogarty Chronic Disease Leadership Programme; Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Study of platelet activation, hypercoagulable state, and the association with pulmonary hypertension in children with β-thalassemia. Hematol Oncol Stem Cell Ther 2018. [DOI: 10.1016/j.hemonc.2017.05.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Hellenkamp K, Unsöld B, Mushemi-Blake S, Shah AM, Friede T, Hasenfuß G, Seidler T. Echocardiographic Estimation of Mean Pulmonary Artery Pressure: A Comparison of Different Approaches to Assign the Likelihood of Pulmonary Hypertension. J Am Soc Echocardiogr 2018; 31:89-98. [DOI: 10.1016/j.echo.2017.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Indexed: 02/04/2023]
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Jung JY, Lee CH, Kim HA, Choi ST, Lee JH, Yoon BY, Kang DR, Suh CH. Pulmonary Hypertension in Connective Tissue Disease is Associated with the New York Heart Association Functional Class and Forced Vital Capacity, But Not with Interstitial Lung Disease. JOURNAL OF RHEUMATIC DISEASES 2018; 25:179. [DOI: 10.4078/jrd.2018.25.3.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/14/2018] [Accepted: 03/28/2018] [Indexed: 08/30/2023]
Affiliation(s)
- Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Chan Hee Lee
- Department of Rheumatology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Sang Tae Choi
- Department of Rheumatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joo-Hyun Lee
- Division of Rheumatology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Bo-Young Yoon
- Division of Rheumatology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Dae-Ryong Kang
- Department of Medical Humanities and Social Medicine, Office of Biostatistics, Ajou University School of Medicine, Suwon, Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
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Zivanovic S, Pushparajah K, Calvert S, Marlow N, Razavi R, Peacock JL, Greenough A. Pulmonary Artery Pressures in School-Age Children Born Prematurely. J Pediatr 2017; 191:42-49.e3. [PMID: 29173320 DOI: 10.1016/j.jpeds.2017.08.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/18/2017] [Accepted: 08/15/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To test the hypothesis that pulmonary artery pressures were higher in school aged children born extremely premature than those born at term. We also wanted to assess whether pulmonary artery pressures differed between children born prematurely with or without bronchopulmonary dysplasia (BPD) or between those randomized in the neonatal period to different ventilation modes. STUDY DESIGN Transthoracic echocardiography was performed on 193 children born extremely premature (106 had BPD) and 110 children born at term when they were 11-14 years of age. Ninety-nine children born extremely premature had been supported by high-frequency oscillation and 94 by conventional ventilation. Tricuspid regurgitation was assessed in the apical 4-chamber and modified parasternal long-axis views. Continuous-wave Doppler of the peak regurgitant jet velocity was used to estimate the right-ventricular-to-right-atrial systolic pressure gradient. RESULTS Tricuspid regurgitation was measurable in 71% (137/193) of the children born preterm and 75% (83/110) of the children born at term (P .23). The children born prematurely compared with the children born at term had a greater peak tricuspid regurgitation velocity (2.21 vs 1.95 m/s, P < .001) and the children born prematurely who had BPD vs those without BPD had a greater peak tricuspid regurgitation velocity (P = .023). There were no significant differences in pulmonary artery pressures according to neonatal ventilation mode. CONCLUSIONS Pulmonary artery pressures were estimated to be greater in 11- to 14-year-old children born extremely prematurely compared with those born at term and in those born prematurely who developed BPD compared with those who did not but did not differ significantly by neonatal ventilation mode.
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Affiliation(s)
- Sanja Zivanovic
- Division of Asthma, Allergy and Lung Biology, Medical Research Council Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom
| | - Kuberan Pushparajah
- Department of Paediatric Cardiology, Evelina Children's Hospital London, London, United Kingdom
| | - Sandy Calvert
- Department of Child Health, St George's Hospital, London, United Kingdom
| | - Neil Marlow
- Neonatal Medicine, University College, London, United Kingdom
| | - Reza Razavi
- Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom; NIHR Biomedical Research Centre at Guy's & St Thomas NHS Foundation Trust and King's College London, London, United Kingdom
| | - Janet L Peacock
- NIHR Biomedical Research Centre at Guy's & St Thomas NHS Foundation Trust and King's College London, London, United Kingdom; Division of Health and Social Care Research, King's College London, London, United Kingdom
| | - Anne Greenough
- Division of Asthma, Allergy and Lung Biology, Medical Research Council Centre for Allergic Mechanisms in Asthma, King's College London, London, United Kingdom; NIHR Biomedical Research Centre at Guy's & St Thomas NHS Foundation Trust and King's College London, London, United Kingdom.
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Hou Y, Sun DD, Yuan LJ, Zhu XY, Shang FJ, Hou CJ, Duan YY. Clinical Application of Superior Vena Cava Spectra in Evaluation of Pulmonary Hypertension: A Comparative Echocardiography and Catheterization Study. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:110-117. [PMID: 26478279 DOI: 10.1016/j.ultrasmedbio.2015.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 06/25/2015] [Accepted: 07/27/2015] [Indexed: 06/05/2023]
Abstract
This study was designed to assess whether superior vena cava (SVC) Doppler flow velocities are associated with invasive measures of pulmonary arterial pressure. Eighty patients with unrepaired congenital heart disease who underwent cardiac catheterization were included (31 men, 49 women; mean age: 37.3 ± 14.7 y). Compared with the non-pulmonary hypertension group, the moderate and severe pulmonary hypertension groups had decreased SVC ventricular reserve flow velocity and a significantly increased ratio of atrial reverse flow to systolic flow (AR/S). AR/S correlated significantly with invasive pulmonary arterial systolic pressure (r = 0.426, p < 0.0001). A cutoff of 0.45 had a sensitivity and specificity of 74% and 80%, respectively, for prediction of pulmonary hypertension. Good correlation also existed between SVC AR/S and pulmonary arterial systolic pressure in cases without tricuspid regurgitation (r = 0.706, p = 0.034). These results indicate that SVC AR/S may be an alternative method for assessing pulmonary hypertension.
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Affiliation(s)
- Ying Hou
- Department of Ultrasound Diagnosis, Tangdu Hospital of the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Dan-Dan Sun
- Department of Ultrasound Diagnosis, Tangdu Hospital of the Fourth Military Medical University, Xi'an, Shaanxi, China; Department of Stomatology and Medical Imaging, Jilin Medical College, Jilin, Jilin, China
| | - Li-Jun Yuan
- Department of Ultrasound Diagnosis, Tangdu Hospital of the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xian-Yang Zhu
- Department of Congenital Heart Disease Internal, General Hospital of Shenyang Military Area Command, Shenhe District, Shenyang, China
| | - Fu-Jun Shang
- Department of Cardiology, Tangdu Hospital of the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chuan-Ju Hou
- Department of Congenital Heart Disease Internal, General Hospital of Shenyang Military Area Command, Shenhe District, Shenyang, China
| | - Yun-You Duan
- Department of Ultrasound Diagnosis, Tangdu Hospital of the Fourth Military Medical University, Xi'an, Shaanxi, China.
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Hemodynamic changes of the middle hepatic vein in patients with pulmonary hypertension using echocardiography. PLoS One 2015; 10:e0121408. [PMID: 25821961 PMCID: PMC4379104 DOI: 10.1371/journal.pone.0121408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 02/01/2015] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to analyze the changes of the middle hepatic vein (MHV) spectra in patients with pulmonary hypertension (PH) caused by congenital heart disease (CHD) and determine the proper parameters of MHV to predict PH. Eighty patients with CHD were included, whose pulmonary artery pressure was measured via right heart catheterization, and the MHV spectra were detected via echocardiography. The peak value of velocity (V) and velocity time integral (VTI) of the waves, including S wave, D wave and A wave, were measured at the end of inspiration. The values of the MHV parameters that were predictive of PH were evaluated and their cut-off points were determined. Compared with the control group, V of S wave (S), VTI of S wave (SVTI), V of D wave (D), VTI of D wave (DVTI) decreased and V of A wave (A), VTI of A wave (AVTI), A/S, AVTI/SVTI, A/(S+D), AVTI/ (SVTI+DVTI) increased in the PH group. These differences were statistically significant (P<0.05). A correlation analysis determined that the ratios of A/S, A/(S+D), AVTI/(SVTI+DVTI) were positively correlated with pulmonary artery mean pressure (r=0.529,0.575,0.438,P<0.001). An ROC curve analysis determined that the diagnostic effect of A/(S+D) was superior to the other two parameters. On the ROC curve, when the ratio of A/(S+D) was 0.30, the sensitivity was 85.37% and specificity was 75.00% for predicting PH. The spectral parameters of MHV, including the ratios of A/S, A/(S+D) and AVTI/(SVTI+DVTI), increased with increasing pulmonary pressure in CHD patients. When the ratio of A/(S+D) was 0.30 in MHV spectra, it had sufficient sensitivity and specificity for diagnosing PH, and this method could be used as a new non-invasive complementary echocardiographic parameter for predicting PH.
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13
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Prognostic Value of RV Function Before and After Lung Transplantation. JACC Cardiovasc Imaging 2014; 7:1084-94. [DOI: 10.1016/j.jcmg.2014.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/09/2014] [Accepted: 07/16/2014] [Indexed: 11/20/2022]
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Marangu D, Jowi C, Aswani J, Wambani S, Nduati R. Prevalence and associated factors of pulmonary hypertension in Kenyan children with adenoid or adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2014; 78:1381-6. [PMID: 24969347 DOI: 10.1016/j.ijporl.2014.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/29/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Adenotonsillar hypertrophy is a common condition in childhood, whose serious complications of pulmonary hypertension and cor pulmonale are devastating but local prevalence is unknown. This study determined the prevalence and associated factors of pulmonary hypertension in children with adenoid or adenotonsillar hypertrophy at Kenyatta National Hospital, Kenya. METHODS This was a cross sectional hospital based survey conducted among children below 12 years of age with clinical and radiological adenoid hypertrophy attending the ear, nose and throat (ENT) outpatient clinic and general pediatric wards. Doppler echocardiography was used to determine pulmonary hypertension defined as a mean pulmonary arterial pressure (mPAP) of ≥ 25 mm Hg using the Chemla equation. Children with mPAP of ≥ 25 mm Hg were compared to those with lower pressures and clinical and radiological factors associated with pulmonary hypertension determined using multivariate logistic regression analysis. RESULTS Of the 123 eligible children in the study, 27 had pulmonary hypertension giving a prevalence of 21.9% (95% CI 14.64%-29.27%). Independent factors associated with pulmonary hypertension included nasal obstruction (OR=3.0 [95% CI 1.08-8.44] p=0.035) and hyperactivity on history (OR=0.2 [95% CI 0.07-0.59] p=0.003) and adenoid-nasopharyngeal ratio (ANR) >0.825 on lateral neck radiography (OR=5.0 [95% CI 1.01-24.37] p=0.048). CONCLUSION One in five children with adenoid or adenotonsillar hypertrophy had pulmonary hypertension with a 3-fold and 5-fold increased odds in those with nasal obstruction on history and ANR >0.825 on lateral neck radiography respectively and an 80% reduced odds in reportedly hyperactive children.
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Affiliation(s)
- Diana Marangu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
| | - Christine Jowi
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Joyce Aswani
- Department of ENT Surgery, University of Nairobi, Nairobi, Kenya
| | - Sidika Wambani
- Radiology Department of Kenyatta National Hospital (KNH), Nairobi, Kenya
| | - Ruth Nduati
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Finkelhor RS, Lewis SA, Pillai D. Limitations and strengths of doppler/echo pulmonary artery systolic pressure-right heart catheterization correlations: a systematic literature review. Echocardiography 2014; 32:10-8. [PMID: 24661140 DOI: 10.1111/echo.12594] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS Because many recent studies have questioned the accuracy of Doppler echocardiography (D) in determining pulmonary artery systolic pressure (PASP), we performed a detailed literature analysis attempting add clarity. METHODS AND RESULTS Studies through 2011 comparing D and right heart catheterization (RHC) PASP, with at least 25 studied patients and reporting correlation coefficients (r) were identified. Patient demographics, study characteristics, the percent of patients studied for left or right heart pathologies, and study biases were determined. After adjusting for differing study sizes, each study's r value was used as a single datapoint and dichotomized above or below the entire cohort's mean values. From 32 studies 2604 D-RHC parings were reported. Their overall weighted r was 0.68 ± 0.19. Poorer correlations were found for right heart pathologies compared to left heart pathologies (r = 0.58 vs. 0.84, P < 0.001) and for normal PASP patients in a study compared to abnormal PASP patients (r = 0.55 vs. 0.82, P < 0.001). Studies with predominately right heart pathology had a significantly greater D-RHC time difference, fewer successful D determinations, a greater percentage of normal PASPs on RHC, and more between-method differences >10 mmHg. Metaregression analyses indicated that both right heart pathology predominance and a greater percent of normal PASPs on RHC remained associated with poorer correlations. CONCLUSIONS D PASP-RHC correlations were high and between-method differences less in patients with left heart pathology but were poorer for right heart diseases and studies with proportionately more normal PASPs on RHC for which further study is needed.
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Affiliation(s)
- Robert S Finkelhor
- Heart and Vascular Center, Case Western Reserve University at the MetroHealth Medical Center Campus, Cleveland, Ohio
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CT signs of right ventricular dysfunction correlated with echocardiography-derived pulmonary arterial systolic pressure: incremental value of the pulmonary arterial diameter index. Int J Cardiovasc Imaging 2013; 29 Suppl 2:109-18. [DOI: 10.1007/s10554-013-0322-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
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Yin M, Hou Y, Zhang T, Cui C, Zhou X, Sun F, Li H, Li X, Zheng J, Chen X, Li C, Ning X, Li K, Lou G. Evaluation of chemotherapy response with serum squamous cell carcinoma antigen level in cervical cancer patients: a prospective cohort study. PLoS One 2013; 8:e54969. [PMID: 23349993 PMCID: PMC3551772 DOI: 10.1371/journal.pone.0054969] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 12/18/2012] [Indexed: 11/18/2022] Open
Abstract
MRI does not always reflect tumor response after chemotherapy. Therefore, it is necessary to explore additional parameters to more accurately evaluate tumor response for the subsequent clinical determination about radiotherapy or radical surgery. A training cohort and an external validation cohort were used to examine the predictive performance of SCC-ag to evaluate tumor response from teaching hospital of Harbin Medical University. The study included 397 women with SCC (age: 28–73 years). Patients consecutively enrolled between August 2008 and January 2010 (n = 205) were used as training cohort. Patients consecutively enrolled between February 2010 and May 2011 (n = 192) were used as validation cohort. A multivariate regression analysis of the data from the training cohort indicated that serum SCC-ag level is an independent factor for neo-adjuvant chemotherapy (NACT) response. Analysis of the data from the validation cohort suggested that chemotherapy response could be more accurately predicted by SCC-ag than by magnetic resonance imaging (MRI) (sensitivity (Se): 0.944 vs. 0.794; specificity (Sp): 0.727 vs. 0.636; positive predictive value (PPV): 0.869 vs. 0.806; negative predictive value (NPV): 0.873 vs. 0.618; the area under ROC curve (AUC): 0.898 vs. 0.734). Combining SCC-ag with MRI was more powerful than MRI alone (Se: 0.952 vs. 0.794; Sp: 0.833 vs. 0.636; PPV: 0.916 vs. 0.806; NPV: 0.902 vs. 0.618; AUC: 0.950 vs. 0.734). Our study indicates that serum SCC-ag level is a sensitive and reliable measure to evaluate cervical cancer response to chemotherapy. Using SCC-ag in combination with MRI findings further improves the predictive power.
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Affiliation(s)
- Mingzhu Yin
- Department of Gynecology and Oncology, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yan Hou
- Department of Epidemiology and Biostatistics, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Tao Zhang
- Department of Epidemiology and Biostatistics, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Changyi Cui
- Laboratory of Genetics, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, United States of America
| | - Xiaohua Zhou
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Fengyu Sun
- Department of Epidemiology and Biostatistics, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Huiyan Li
- Department of Radiotherapy Oncology, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, China
| | - Xia Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jian Zheng
- Department of Radiotherapy Oncology, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, China
| | - Xiuwei Chen
- Department of Gynecology and Oncology, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Cong Li
- Department of Pathology, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, China
| | - Xiaoming Ning
- Department of Pathology, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, China
| | - Kang Li
- Department of Epidemiology and Biostatistics, Harbin Medical University, Harbin, Heilongjiang Province, China
- * E-mail: (GL); (KL)
| | - Ge Lou
- Department of Gynecology and Oncology, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
- * E-mail: (GL); (KL)
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