1
|
Shahlaee S, Alimi H, Poorzand H, Morovatdar N, Vakilian F, Shahlaee S. <p>Relationship Between Isovolumic Acceleration (IVA) and TEI Index with Pro-BNP in Heart Failure</p>. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2020. [DOI: 10.2147/rrcc.s253688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
2
|
Ifeoluwa AA, Adewole AA, Abiodun AM, Akinyemi A. Right ventricular systolic function in Nigerians with heart failure secondary to hypertensive heart disease. Afr Health Sci 2019; 19:2130-2139. [PMID: 31656497 PMCID: PMC6794531 DOI: 10.4314/ahs.v19i2.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Right ventricular (RV) dysfunction has been shown to be a major contributor to the adverse outcomes in subjects with heart failure. Few studies evaluating the right ventricle in heart failure subjectshave been carried out in Sub-Saharan Africa. This studywas therefore designed to evaluate the right ventricular systolic function in subjects with heart failure secondary to hypertensive heart disease presenting to the University College Hospital, Ibadan Nigeria. Methodology Seventy-six subjects with heart failure secondary to hypertension and 92 normal controls underwent clinical, electrocardiographic and echocardiographic evaluation. Indices of right ventricular systolic function that were measured include tricuspid annular plane systolic excursion (TAPSE), tissue Doppler derived tricuspid peak systolic lateral annulus velocity(S′) and right ventricular fractional areachange(RVFAC). Results Sixty-two (81.6%) heart failure subjects had right ventricular systolic dysfunction, 31(40.8%) had abnormal TAPSE, 42(55.5%) had abnormal S′ while 49(64.5%) had abnormal RVFAC. Elevated pulmonary artery systolic pressure was found in 25(32.9%) of the subjects. There was no relationship between the indices of right ventricular systolic function and the estimated systolic pulmonary artery pressures. The independent predictor of right ventricular systolic dysfunction was the right atrial size. Conclusion Right ventricular systolic function is impaired in patients with heart failure secondary to hypertensive heart disease. There is no relationship between the indices of right ventricular systolic function and systolic pulmonary artery pressure. Further studies are needed to assess right ventricular systolic function in Nigerians.
Collapse
Affiliation(s)
| | - Adesoji Adebiyi Adewole
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Adeoye M Abiodun
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Aje Akinyemi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| |
Collapse
|
3
|
Kamimura Y, Okumura N, Adachi S, Shimokata S, Tajima F, Nakano Y, Hirashiki A, Murohara T, Kondo T. Usefulness of scoring right ventricular function for assessment of prognostic factors in patients with chronic thromboembolic pulmonary hypertension. Heart Vessels 2018; 33:1220-1228. [PMID: 29704099 PMCID: PMC6133067 DOI: 10.1007/s00380-018-1168-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/20/2018] [Indexed: 12/12/2022]
Abstract
Right ventricular (RV) function is associated with prognosis in chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to establish an RV dysfunction score using RV echocardiographic parameters to clarify the clinical characteristics in patients with CTEPH and to compare RV dysfunction score with parameters such as World Health Organization (WHO) functional class, hemodynamics, exercise capacity, and plasma BNP level. We enrolled 35 inpatients with CTEPH (mean age, 62 ± 15 years, 15 males). We constructed ‘an RV dysfunction score’ calculated as the summation of each point awarded for the presence of four parameters: tricuspid annular plane systolic excursion (TAPSE) < 16 mm, 1 point; tissue Doppler-derived tricuspid lateral annular systolic velocity (S′) < 10 cm/s, 1 point; right ventricular fractional area change (RVFAC) < 35%, 1 point; and right ventricular myocardial performance index (RV-MPI) > 0.4, 1 point. TAPSE, S′, RVFAC, and RV-MPI was 18.7 ± 4.8 mm, 11.9 ± 3.1 cm/s, 33.5 ± 13.9%, and 0.39 ± 0.2, respectively. The RV dysfunction score was associated with symptom [WHO functional class (p = 0.026)], hemodynamics [mean PAP (p = 0.01), cardiac index (p = 0.009), pulmonary vascular resistance (p = 0.001), and SvO2 (p = 0.039)], exercise capacity [6-min walk distance (p = 0.046), peakVO2 (p = 0.016), and VE/VCO2 slope (p = 0.031)], and plasma BNP level (p = 0.005). This RV dysfunction score using the four RV echocardiographic parameters could be a simple and useful scoring system to evaluate prognostic factors in patients with CTEPH.
Collapse
Affiliation(s)
- Yoshihiro Kamimura
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8550, Japan
| | - Naoki Okumura
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8560, Japan
| | - Shiro Adachi
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8560, Japan
| | - Shigetake Shimokata
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8550, Japan
| | - Fumitaka Tajima
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8550, Japan
| | - Yoshihisa Nakano
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8550, Japan
| | - Akihiro Hirashiki
- Department of Cardiology, National Center for Geriatrics and Gerontology, Morioka-cho 7-430, Obu, 474-8511, Japan
| | - Toyoaki Murohara
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8550, Japan
| | - Takahisa Kondo
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8560, Japan.
| |
Collapse
|
4
|
Amsallem M, Lu H, Tang X, Do Couto Francisco NL, Kobayashi Y, Moneghetti K, Shiran H, Rogers I, Schnittger I, Liang D, Haddad F. Optimizing right ventricular focused four-chamber views using three-dimensional imaging, a comparative magnetic resonance based study. Int J Cardiovasc Imaging 2018; 34:1409-1417. [PMID: 29654480 DOI: 10.1007/s10554-018-1356-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/11/2018] [Indexed: 12/31/2022]
Abstract
Obtaining focused right ventricular (RV) apical view remains challenging using conventional two-dimensional (2D) echocardiography. This study main objective was to determine whether measurements from RV focused views derived from three-dimensional (3D) echocardiography (3D-RV-focused) are closely related to measurements from magnetic resonance (CMR). A first cohort of 47 patients underwent 3D echocardiography and CMR imaging within 2 h of each other. A second cohort of 25 patients had repeat 3D echocardiography to determine the test-retest characteristics; and evaluate the bias associated with unfocused RV views. Tomographic views were extracted from the 3D dataset: RV focused views were obtained using the maximal RV diameter in the transverse plane, and unfocused views from a smaller transverse diameter enabling visualization of the tricuspid valve opening. Measures derived using the 3D-RV-focused view were strongly associated with CMR measurements. Among functional metrics, the strongest association was between RV fractional area change (RVFAC) and ejection fraction (RVEF) (r = 0.92) while tricuspid annular plane systolic excursion moderately correlated with RVEF (r = 0.47), all p < 0.001. Among RV size measures, the strongest association was found between RV end-systolic area (RVESA) and volume (r = 0.87, p < 0.001). RV unfocused views led on average to 10% underestimation of RVESA. The 3D-RV-focused method had acceptable test-retest characteristics with a coefficient of variation of 10% for RVESA and 11% for RVFAC. Deriving standardized RV focused views using 3D echocardiography strongly relates to CMR-derived measures and may improve reproducibility in RV 2D measurements.
Collapse
Affiliation(s)
- Myriam Amsallem
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA. .,Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA. .,Laboratory of Surgical Research and INSERM U999, University of Paris-Sud, Marie Lannelongue Hospital, Le Plessis Robinson, France.
| | - HongQuan Lu
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.,Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Xiu Tang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Nadia L Do Couto Francisco
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.,Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Kegan Moneghetti
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.,Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Hadas Shiran
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Ian Rogers
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.,Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.,Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - David Liang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.,Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - François Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.,Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
5
|
Lee JZ, Low SW, Pasha AK, Howe CL, Lee KS, Suryanarayana PG. Comparison of tricuspid annular plane systolic excursion with fractional area change for the evaluation of right ventricular systolic function: a meta-analysis. Open Heart 2018; 5:e000667. [PMID: 29387425 PMCID: PMC5786917 DOI: 10.1136/openhrt-2017-000667] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/09/2017] [Accepted: 11/18/2017] [Indexed: 11/04/2022] Open
Abstract
Background Accurate determination of right ventricular ejection fraction (RVEF) is challenging because of the unique geometry of the right ventricle. Tricuspidannular plane systolic excursion (TAPSE) and fractional area change (FAC) are commonly used echocardiographic quantitative estimates of RV function. Cardiac MRI (CMRI) has emerged as the gold standard for assessment of RVEF. We sought to summarise the available data on correlation of TAPSE and FAC with CMRI-derived RVEF and to compare their accuracy. Methods We searched PubMed, EMBASE, Web of Science, CINAHL, ClinicalTrials.gov and the Cochrane Library databases for studies that assessed the correlation of TAPSE or FAC with CMRI-derived RVEF. Data from each study selected were pooled and analysed to compare the correlation coefficient of TAPSE and FAC with CMRI-derived RVEF. Subgroup analysis was performed on patients with pulmonary hypertension. Results Analysis of data from 17 studies with a total of 1280 patients revealed that FAC had a higher correlation with CMRI-derived RVEF compared with TAPSE (0.56vs0.40, P=0.018). In patients with pulmonary hypertension, there was no statistical difference in the mean correlation coefficient of FAC and TAPSE to CMR (0.57vs0.46, P=0.16). Conclusions FAC provides a more accurate estimate of RV systolic function (RVSF) compared with TAPSE. Adoption of FAC as a routine tool for the assessment of RVSF should be considered, especially since it is also an independent predictor of morbidity and mortality. Further studies will be needed to compare other methods of echocardiographic measurement of RV function.
Collapse
Affiliation(s)
- Justin Z Lee
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - See-Wei Low
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
| | - Ahmed K Pasha
- Division of Hospital Medicine, Mayo Clinic Health System, Mankato, Minnesota, USA
| | - Carol L Howe
- Arizona Health Sciences Library, University of Arizona, Tucson, Arizona, USA
| | - Kwan S Lee
- Department of Cardiovascular Diseases, University of Arizona, Tucson, Arizona, USA
| | | |
Collapse
|
6
|
Morita T, Nakamura K, Osuga T, Yokoyama N, Morishita K, Sasaki N, Ohta H, Takiguchi M. Changes in right ventricular function assessed by echocardiography in dog models of mild RV pressure overload. Echocardiography 2017; 34:1040-1049. [DOI: 10.1111/echo.13560] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Tomoya Morita
- Department of Veterinary Clinical Sciences; Laboratory of Veterinary Internal Medicine; Graduate School of Veterinary Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Kensuke Nakamura
- Department of Veterinary Clinical Sciences; Veterinary Teaching Hospital; Graduate School of Veterinary Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Tatsuyuki Osuga
- Department of Veterinary Clinical Sciences; Laboratory of Veterinary Internal Medicine; Graduate School of Veterinary Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Nozomu Yokoyama
- Department of Veterinary Clinical Sciences; Laboratory of Veterinary Internal Medicine; Graduate School of Veterinary Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Keitaro Morishita
- Department of Veterinary Clinical Sciences; Veterinary Teaching Hospital; Graduate School of Veterinary Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Noboru Sasaki
- Department of Veterinary Clinical Sciences; Laboratory of Veterinary Internal Medicine; Graduate School of Veterinary Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Hiroshi Ohta
- Department of Veterinary Clinical Sciences; Laboratory of Veterinary Internal Medicine; Graduate School of Veterinary Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Mitsuyoshi Takiguchi
- Department of Veterinary Clinical Sciences; Laboratory of Veterinary Internal Medicine; Graduate School of Veterinary Medicine; Hokkaido University; Sapporo Hokkaido Japan
| |
Collapse
|
7
|
Sokalskis V, Peluso D, Jagodzinski A, Sinning C. Added clinical value of applying myocardial deformation imaging to assess right ventricular function. Echocardiography 2017; 34:919-927. [PMID: 28317170 DOI: 10.1111/echo.13521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Right heart dysfunction has been found to be a strong prognostic factor predicting adverse outcome in various cardiopulmonary diseases. Conventional echocardiographic measurements can be limited by geometrical assumptions and impaired reproducibility. Speckle tracking-derived strain provides a robust quantification of right ventricular function. It explicitly evaluates myocardial deformation, as opposed to tissue Doppler-derived strain, which is computed from tissue velocity gradients. Right ventricular longitudinal strain provides a sensitive tool for detecting right ventricular dysfunction, even at subclinical levels. Moreover, the longitudinal strain can be applied for prognostic stratification of patients with pulmonary hypertension, pulmonary embolism, and congestive heart failure. Speckle tracking-derived right atrial strain, right ventricular longitudinal strain-derived mechanical dyssynchrony, and three-dimensional echocardiography-derived strain are emerging imaging parameters and methods. Their application in research is paving the way for their clinical use.
Collapse
Affiliation(s)
- Vladislavs Sokalskis
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Diletta Peluso
- Department of Cardiac, Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice Mestre, Italy
| | - Annika Jagodzinski
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Christoph Sinning
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| |
Collapse
|
8
|
Ptaszyńska-Kopczyńska K, Krentowska A, Sawicka E, Skoneczny A, Jasiewicz M, Knapp M, Musiał WJ, Sobkowicz B, Kamiński KA. The strengths and weaknesses of non-invasive parameters obtained by echocardiography and cardiopulmonary exercise testing in comparison with the hemodynamic assessment by the right heart catheterization in patients with pulmonary hypertension. Adv Med Sci 2017; 62:39-44. [PMID: 28187374 DOI: 10.1016/j.advms.2016.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 05/08/2016] [Accepted: 06/02/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Pulmonary hypertension (PH) diagnosis requires invasive assessment by right heart catheterization (RHC), but screening and monitoring are performed using non-invasive methods: echocardiography and cardiopulmonary exercise testing (CPET). The aim of the study was to assess correlations between the parameters obtained in non-invasive testing and RHC in patients with PH of different etiologies. MATERIAL/METHODS The study included 53 medical records of PH patients (32 women) aged 29-81 years. We analyzed correlations between RHC (systolic pulmonary artery pressure (sPAP), diastolic pulmonary artery pressure (dPAP), pulmonary vascular resistance (PVR), cardiac output (CO)) and echocardiographic (tricuspid annular plane systolic excursion (TAPSE), sPAP) and CPET parameters (end-tidal oxygen and carbon dioxide pressures (PetO2, PetCO2), ventilation efficiency (VE/VCO2) slope). RESULTS Echocardiographic estimation correlated well with RHC measurement of sPAP (r=0.65, P<0.001). TAPSE correlated with PVR assessed with thermodilution method (r=-0.5, P=0.005), dPAP (r=-0.53, P=0.002) and CO (r=0.53, P=0.002). PVR assessed with thermodilution and Fick methods showed positive correlation with PetO2 (r=0.74, P<0.001 and r=0.72, P<0.001) and negative correlation with PetCO2 (r=-0.59, P=0.004 and r=-0.64, P=0.002) at the anaerobic threshold. VE/VCO2 slope correlated with dPAP (r=0.43, P=0.04) and PVR calculated with both methods (r=0.52, P=0.01 and r=0.52, P=0.02). CONCLUSIONS Simple cardiac function indicators obtained by commonly used non-invasive methods allow only approximate estimation of the main hemodynamic RHC-derived parameters: sPAP, CO and PVR. Obtained results suggest the relationship between RV dysfunction and ventilation abnormalities in PH patients.
Collapse
|
9
|
Li W, Yang T, Zhang Y, Gu Q, Liu ZH, Ni XH, Luo Q, Xiong CM, He JG. Prognostic value of right ventricular ejection/filling parameters in IPAH using cardiac magnetic resonance: A prospective pilot study. Respirology 2016; 22:172-178. [PMID: 27442028 DOI: 10.1111/resp.12861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 05/14/2016] [Accepted: 06/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Wen Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Tao Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Yan Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Qing Gu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Zhi-Hong Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Xin-Hai Ni
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Qin Luo
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Chang-Ming Xiong
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Jian-Guo He
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| |
Collapse
|
10
|
Salvianolic acid A attenuates vascular remodeling in a pulmonary arterial hypertension rat model. Acta Pharmacol Sin 2016; 37:772-82. [PMID: 27180980 DOI: 10.1038/aps.2016.22] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/08/2016] [Indexed: 12/28/2022] Open
Abstract
AIM The current therapeutic approaches have a limited effect on the dysregulated pulmonary vascular remodeling, which is characteristic of pulmonary arterial hypertension (PAH). In this study we examined whether salvianolic acid A (SAA) extracted from the traditional Chinese medicine 'Dan Shen' attenuated vascular remodeling in a PAH rat model, and elucidated the underlying mechanisms. METHODS PAH was induced in rats by injecting a single dose of monocrotaline (MCT 60 mg/kg, sc). The rats were orally treated with either SAA (0.3, 1, 3 mg·kg(-1)·d(-1)) or a positive control bosentan (30 mg·kg(-1)·d(-1)) for 4 weeks. Echocardiography and hemodynamic measurements were performed on d 28. Then the hearts and lungs were harvested, the organ indices and pulmonary artery wall thickness were calculated, and biochemical and histochemical analysis were conducted. The levels of apoptotic and signaling proteins in the lungs were measured using immunoblotting. RESULTS Treatment with SAA or bosentan effectively ameliorated MCT-induced pulmonary artery remodeling, pulmonary hemodynamic abnormalities and the subsequent increases of right ventricular systolic pressure (RVSP). Furthermore, the treatments significantly attenuated MCT-induced hypertrophic damage of myocardium, parenchymal injury and collagen deposition in the lungs. Moreover, the treatments attenuated MCT-induced apoptosis and fibrosis in the lungs. The treatments partially restored MCT-induced reductions of bone morphogenetic protein type II receptor (BMPRII) and phosphorylated Smad1/5 in the lungs. CONCLUSION SAA ameliorates the pulmonary arterial remodeling in MCT-induced PAH rats most likely via activating the BMPRII-Smad pathway and inhibiting apoptosis. Thus, SAA may have therapeutic potential for the patients at high risk of PAH.
Collapse
|
11
|
Right to Left Ventricular Diameter Ratio ≥0.42 is the Warning Flag for Suspecting Atrial Septal Defect in Preschool Children: Age- and Body Surface Area-Related Reference Values Determined by M-Mode Echocardiography. Pediatr Cardiol 2016; 37:704-13. [PMID: 26700967 DOI: 10.1007/s00246-015-1334-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
It is not always easy to observe and screen atrial septal defects (ASD) using echocardiography. In addition, there are no established echocardiographic reference indices for screening patients with ASDs. We retrospectively reviewed our database and recruited 151 isolated ASD patients and 2769 healthy subjects. In total, 307 echocardiographic studies were performed for ASD patients. Surgical repairs were done in 75 of the ASD patients. The ratio of right to left ventricular end-diastolic dimensions (RVD/LVD), which was determined by M-mode echocardiography, was used as an index of RV dilatation. After obtaining age- and body surface area (BSA)-related RVD/LVD nomograms in healthy subjects, we calculated the z-scores of RVD/LVD for all subjects and obtained the optimal cut-off values to differentiate patients with ASD from healthy subjects. The optimal cut-off values were high in neonates and gradually decreased with an increase in the age and BSA, but were almost constant in children aged >4 years or whose BSA was >0.65 m(2). The cut-off values of RVD/LVD for suspected ASD were ≥0.42 in children aged >4 years or those whose BSA was >0.65 m(2). Those for an ASD operation were ≥0.46 in those whose BSA > 0.65 m(2). The RVD/LVD determined by M-mode echocardiography is a useful index to evaluate RV dilatation in patients with ASDs. The RVD/LVD ≥ 0.42 is the warning flag for suspecting ASD in preschool children and that ≥0.46 may be a clinical important sign to determine ASD operation.
Collapse
|
12
|
Becker MO, Riemekasten G. Risk factors for severity and manifestations in systemic sclerosis and prediction of disease course. Expert Rev Clin Immunol 2015; 12:115-35. [PMID: 26558747 DOI: 10.1586/1744666x.2016.1115717] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Systemic sclerosis (SSc, or scleroderma) is a rheumatic disease with distinct features that encompass autoimmunity, vascular lesions (vasculopathy) and tissue fibrosis. The disease has a high morbidity and mortality compared with other rheumatic diseases. This review discusses risk factors and markers that predict the disease course and the occurrence of disease manifestations, with an emphasis on major organ involvement. In addition, risk factors will be described that are associated with mortality in SSc patients. The review addresses the impact of recent developments on screening, diagnosis and risk stratification as well as the need for further research where data are lacking.
Collapse
Affiliation(s)
- Mike O Becker
- a Department of Rheumatology and Clinical Immunology , University Hospital Charité Berlin , Berlin , Germany
| | | |
Collapse
|
13
|
Torbicki A. Right ventricle in pulmonary hypertension: echocardiography strikes back? Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003518. [PMID: 26038433 DOI: 10.1161/circimaging.115.003518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Adam Torbicki
- From the Department of Pulmonary Circulation and Thromboembolic Diseases, Medical Center for Postgraduate Education, Otwock, Poland.
| |
Collapse
|
14
|
Harrison A, Hatton N, Ryan JJ. The right ventricle under pressure: evaluating the adaptive and maladaptive changes in the right ventricle in pulmonary arterial hypertension using echocardiography (2013 Grover Conference series). Pulm Circ 2015; 5:29-47. [PMID: 25992269 DOI: 10.1086/679699] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/19/2014] [Indexed: 01/02/2023] Open
Abstract
The importance of the right ventricle (RV) in pulmonary arterial hypertension (PAH) has been gaining increased recognition. This has included a reconceptualization of the RV as part of an RV-pulmonary circulation interrelated unit and the observation that RV function is a major determinant of prognosis in PAH. Noninvasive imaging of RV size and function is critical to the longitudinal management of patients with PAH, and continued understanding of the pathophysiology of pulmonary vascular disease relies on the response of the RV to pulmonary vascular remodeling. Echocardiography, in particular the newer echocardiographic measurements and techniques, allows easy, readily accessible means to assess and follow RV size and function.
Collapse
Affiliation(s)
- Alexis Harrison
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Nathan Hatton
- Division of Pulmonary Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - John J Ryan
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
15
|
Moretti C, Grosso Marra W, D'Ascenzo F, Omedè P, Cannillo M, Libertucci D, Fusaro E, Meynet I, Giordana F, Salera D, Annone U, Chen SL, Marra S, Gaita F. Beta blocker for patients with pulmonary arterial hypertension: A single center experience. Int J Cardiol 2015; 184:528-532. [PMID: 25767009 DOI: 10.1016/j.ijcard.2015.02.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 02/21/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Claudio Moretti
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Walter Grosso Marra
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy.
| | - Pierluigi Omedè
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Margherita Cannillo
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Daniela Libertucci
- Division of Pneumology, Department of Internal Medicine, Città Della Salute e Della Scienza, Turin, Italy
| | - Enrico Fusaro
- Division of Rheumatology, Department of Internal Medicine, Città Della Salute e Della Scienza, Turin, Italy
| | - Ilaria Meynet
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Francesca Giordana
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Davide Salera
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - Umberto Annone
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| | - S L Chen
- Department of Cardiology, Njang, China
| | - Sebastiano Marra
- Division of Cardiology, Città Della Salute e Della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, University of Turin, Città Della Salute e Della Scienza, Turin, Italy
| |
Collapse
|
16
|
Li YD, Wang YD, Zhai ZG, Guo XJ, Wu YF, Yang YH, Lu XZ. Relationship between echocardiographic and cardiac magnetic resonance imaging-derived measures of right ventricular function in patients with chronic thromboembolic pulmonary hypertension. Thromb Res 2015; 135:602-6. [PMID: 25628143 DOI: 10.1016/j.thromres.2015.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/27/2014] [Accepted: 01/04/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Echocardiography is widely used to evaluate right ventricular (RV) function. However, the value of echocardiographic parameters to assess RV function in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is unknown. In this study, we analyzed the correlations between echocardiographic parameters and the RV ejection fraction (RVEF) as measured by cardiac magnetic resonance (CMR) imaging to systematically elucidate the role of echocardiographic parameters in the assessment of RV function in patients with CTEPH. METHODS Echocardiography was used to measure the tissue Doppler-derived tricuspid lateral annular systolic velocity (S'), fractional area change (FAC), myocardial performance index (MPI), and tricuspid annular plane systolic excursion (TAPSE). CMR was used to measure the RV end-diastolic volume (RVEDV) and end-systolic volume (RVESV), and the RVEF was calculated. RESULTS A significant positive correlation was found between S' and RVEF (r=0.689, P<0.0001) and between FAC and RVEF (r=0.423, P=0.022), a significant negative correlation was found between MPI and RVEF (r=-0.387, P=0.048), and no correlation was found between TAPSE and RVEF (r=0.451, P=0.22). CONCLUSION Echocardiography can be routinely used in the clinical setting to measure S', FAC, and MPI for the evaluation of right heart function in patients with CTEPH.
Collapse
Affiliation(s)
- Yi-dan Li
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Yi-dan Wang
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Zhen-guo Zhai
- Department of Respiratory Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Xiao-juan Guo
- Department of Radiology, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Ya-feng Wu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Yuan-hua Yang
- Department of Respiratory Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Xiu-zhang Lu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China.
| |
Collapse
|
17
|
Patel A, Weismann C, Weiss P, Russell K, Bazzy-Asaad A, Kadan-Lottick NS. Association between right ventricular dysfunction and restrictive lung disease in childhood cancer survivors as measured by quantitative echocardiography. Pediatr Blood Cancer 2014; 61:2059-64. [PMID: 25130668 DOI: 10.1002/pbc.25157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 05/19/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Restrictive lung disease is a complication in childhood cancer survivors who received lung-toxic chemotherapy and/or thoracic radiation. Left ventricular dysfunction is documented in these survivors, but less is known about right ventricular (RV) function. Quantitative echocardiography may help detect subclinical RV dysfunction. The aim of this study was to assess RV function quantitatively in childhood cancer survivors after lung-toxic therapy. PROCEDURES We identified records of 33 childhood cancer survivors who (1) were treated with lung-toxic therapy and/or radiation, (2) were cancer-free for ≥ one year after therapy, and (3) had pulmonary function tests and echocardiograms from their most recent follow-up visit. RESULTS Participants' mean age was 11.6 ± 4.5 years at cancer diagnosis and 23 ± 8.6 years at evaluation. The most common diagnosis was lymphoma/leukemia (n = 27). Twenty-nine subjects had anthracycline exposure. Eleven of the 33 subjects demonstrated restrictive pulmonary impairment (total lung capacity 3.69 ± 1.5 L [69.3 ± 22.4% predicted]). Among quantitative measures of RV function, isovolumetric acceleration (IVA), a measure of contractility, was significantly lower in the group with restrictive lung disease (2.42 ± 0.56 vs. 1.83 ± 0.78 m/sec(2); P < 0.05). There was a trend towards lower tissue Doppler derived S' and tricuspid annular plane systolic excursion in the group with restrictive lung disease. Subjects with restrictive lung disease were found to have ≥ 2 abnormal parameters (P < 0.01). CONCLUSION IVA may detect early RV dysfunction in childhood cancer survivors with restrictive lung disease. Our findings require confirmation in a larger study population and validation by cardiac MRI.
Collapse
Affiliation(s)
- Amee Patel
- Section of Pediatric Respiratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | | | | | | | | |
Collapse
|
18
|
Zakaria D, Sachdeva R, Gossett JM, Tang X, O'Connor MJ. Tricuspid Annular Plane Systolic Excursion Is Reduced in Infants with Pulmonary Hypertension. Echocardiography 2014; 32:834-8. [DOI: 10.1111/echo.12797] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Dala Zakaria
- Division of Pediatric Cardiology; University of Arkansas for Medical Sciences, Arkansas Children's Hospital; Little Rock Arkansas
| | - Ritu Sachdeva
- Division of Pediatric Cardiology; University of Arkansas for Medical Sciences, Arkansas Children's Hospital; Little Rock Arkansas
| | - Jeffrey M. Gossett
- Biostatistics Program; Department of Pediatrics; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Xinyu Tang
- Biostatistics Program; Department of Pediatrics; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Matthew J. O'Connor
- Division of Pediatric Cardiology; University of Arkansas for Medical Sciences, Arkansas Children's Hospital; Little Rock Arkansas
| |
Collapse
|
19
|
Maron BA. Hemodynamics should be the primary approach to diagnosing, following, and managing pulmonary arterial hypertension. Can J Cardiol 2014; 31:515-20. [PMID: 25742869 DOI: 10.1016/j.cjca.2014.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 08/28/2014] [Accepted: 09/04/2014] [Indexed: 12/18/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a highly morbid cardiopulmonary disease characterized by plexogenic pulmonary arteriole remodelling. Importantly, PAH severity correlates inversely with cardiac output and directly with pulmonary vascular resistance and right atrial pressure, illustrating the importance of accurately measured hemodynamics to define the clinical profile of patients. Currently available noninvasive technology offers only hemodynamic estimates. In contrast, right heart catheterization is the principle diagnostic procedure in PAH and is required to: (1) definitively exclude alternative pulmonary vascular diseases; and (2) quantify hemodynamics at baseline, after vasoreactivity testing, or in response to therapy to prognosticate outcome and guide therapeutic escalation.
Collapse
Affiliation(s)
- Bradley A Maron
- Brigham and Women's Hospital and Harvard Medical School, Department of Medicine, Division of Cardiovascular Medicine, 75 Francis St, Boston, and the Department of Cardiology, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA.
| |
Collapse
|
20
|
Ikeda S, Tsuneto A, Kojima S, Koga S, Nakata T, Yoshida T, Eto M, Minami T, Yanagihara K, Maemura K. Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension. Life Sci 2014; 111:12-7. [DOI: 10.1016/j.lfs.2014.06.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 06/05/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
|
21
|
Weismann CG, Bamdad MC, Abraham S, Ghiroli S, Dziura J, Hellenbrand WE. Normal Pediatric Data for Isovolumic Acceleration at the Lateral Tricuspid Valve Annulus-A Heart Rate - Dependent Measure of Right Ventricular Contractility. Echocardiography 2014; 32:541-7. [DOI: 10.1111/echo.12681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Constance G. Weismann
- Division of Pediatric Cardiology; Department of Pediatrics; Yale School of Medicine; New Haven Connecticut
| | - Michaela C. Bamdad
- Division of Pediatric Cardiology; Department of Pediatrics; Yale School of Medicine; New Haven Connecticut
| | - Sharon Abraham
- Pediatric Echocardiography Laboratory; Heart and Vascular Center; Yale New Haven Hospital; New Haven Connecticut
| | - Stephen Ghiroli
- Pediatric Echocardiography Laboratory; Heart and Vascular Center; Yale New Haven Hospital; New Haven Connecticut
| | - James Dziura
- Yale Center for Analytical Sciences; New Haven Connecticut
| | - William E. Hellenbrand
- Division of Pediatric Cardiology; Department of Pediatrics; Yale School of Medicine; New Haven Connecticut
| |
Collapse
|
22
|
Moceri P, Baudouy D, Chiche O, Cerboni P, Bouvier P, Chaussade C, Ferrari E. Imaging in pulmonary hypertension: Focus on the role of echocardiography. Arch Cardiovasc Dis 2014; 107:261-71. [PMID: 24746538 DOI: 10.1016/j.acvd.2014.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
Abstract
Patients with pulmonary hypertension must be evaluated using a multimodality approach to ensure a correct diagnosis and basal evaluation as well as a prognostic assessment. Beyond the assessment of pulmonary pressures, the echocardiographical examination allows the evaluation of right ventricular adaptation to elevated afterload. Numbers of variables are commonly used in the assessment of the pulmonary hypertension patient in order to detect changes in right heart geometry, right-to-left interaction and right ventricular dysfunction. Whereas an isolated change in one echocardiographical variable is not meaningful, multiple echocardiographical variable modifications together provide accurate information. In this review, we will link pulmonary hypertension pathophysiological changes with echocardiographical indices and describe the clinical implications of echocardiographical findings.
Collapse
Affiliation(s)
- Pamela Moceri
- Service de cardiologie, hôpital Pasteur, CHU de Nice, 30, avenue de la Voie-Romaine, BP69, CS 51069, 06001 Nice cedex 1, France.
| | - Delphine Baudouy
- Service de cardiologie, hôpital Pasteur, CHU de Nice, 30, avenue de la Voie-Romaine, BP69, CS 51069, 06001 Nice cedex 1, France
| | - Olivier Chiche
- Service de cardiologie, hôpital Pasteur, CHU de Nice, 30, avenue de la Voie-Romaine, BP69, CS 51069, 06001 Nice cedex 1, France
| | - Pierre Cerboni
- Service de cardiologie, hôpital Pasteur, CHU de Nice, 30, avenue de la Voie-Romaine, BP69, CS 51069, 06001 Nice cedex 1, France
| | - Priscille Bouvier
- Service de cardiologie, hôpital Pasteur, CHU de Nice, 30, avenue de la Voie-Romaine, BP69, CS 51069, 06001 Nice cedex 1, France
| | - Claire Chaussade
- Service de cardiologie, hôpital Pasteur, CHU de Nice, 30, avenue de la Voie-Romaine, BP69, CS 51069, 06001 Nice cedex 1, France
| | - Emile Ferrari
- Service de cardiologie, hôpital Pasteur, CHU de Nice, 30, avenue de la Voie-Romaine, BP69, CS 51069, 06001 Nice cedex 1, France
| |
Collapse
|
23
|
Cetiner MA, Sayin MR, Yildirim N, Karabag T, Dogan SM, Kucuk E, Aydin M. Right Ventricular Isovolumic Acceleration in Acute Pulmonary Embolism. Echocardiography 2014; 31:1253-8. [DOI: 10.1111/echo.12579] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mehmet Ali Cetiner
- Cardiology Department; Karadeniz Eregli State Hospital; Zonguldak Turkey
| | - Muhammet Rasit Sayin
- Cardiology Department; Bulent Ecevit University (formerly Zonguldak Karaelmas University); Zonguldak Turkey
| | - Nesligul Yildirim
- Cardiology Department; Bulent Ecevit University (formerly Zonguldak Karaelmas University); Zonguldak Turkey
| | - Turgut Karabag
- Cardiology Department; Bulent Ecevit University (formerly Zonguldak Karaelmas University); Zonguldak Turkey
| | - Sait Mesut Dogan
- Cardiology Department; Bulent Ecevit University (formerly Zonguldak Karaelmas University); Zonguldak Turkey
| | - Emrah Kucuk
- Cardiology Department; Bulent Ecevit University (formerly Zonguldak Karaelmas University); Zonguldak Turkey
| | - Mustafa Aydin
- Cardiology Department; Bulent Ecevit University (formerly Zonguldak Karaelmas University); Zonguldak Turkey
| |
Collapse
|
24
|
|