Introduction: Tuberculosis (TB) is a serious disease in developing countries. Tuberculous pericarditis is a rare but life-threatening condition and may lead to cardiac tamponade and constrictive pericarditis. Case Presentation: An 82-year-old man was referred for cardiac consultation. He was suffering from dyspnea, malaise, weight loss, night sweat, and fever for four months duration. Discussion: Transthoracic echocardiography disclosed massive pericardial effusion, respiratory variation in mitral and tricuspid inflow E velocity, increased diastolic flow reversal with expiration in the hepatic vein, septum deviation in inspiration toward the left ventricle (LV), preserved LV function, and inferior vena caval (IVC) dilation without any collapse in inspiration. Chest computed tomography (CT) revealed a large amount of pericardial effusion and bilateral pleural effusion.
{"title":"Tuberculous effusive-constrictive pericarditis","authors":"M. Kyavar, N. Akiash","doi":"10.5812/acvi.14557","DOIUrl":"https://doi.org/10.5812/acvi.14557","url":null,"abstract":"Introduction: Tuberculosis (TB) is a serious disease in developing countries. Tuberculous pericarditis is a rare but life-threatening condition and may lead to cardiac tamponade and constrictive pericarditis. Case Presentation: An 82-year-old man was referred for cardiac consultation. He was suffering from dyspnea, malaise, weight loss, night sweat, and fever for four months duration. Discussion: Transthoracic echocardiography disclosed massive pericardial effusion, respiratory variation in mitral and tricuspid inflow E velocity, increased diastolic flow reversal with expiration in the hepatic vein, septum deviation in inspiration toward the left ventricle (LV), preserved LV function, and inferior vena caval (IVC) dilation without any collapse in inspiration. Chest computed tomography (CT) revealed a large amount of pericardial effusion and bilateral pleural effusion.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133547913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sleep apnea undoubtedly stands among the most influential diseases in cardiovascular medicine. Albeit simply characterized by frequent pauses in breathing or instances of shallow or infrequent breathing during sleep, it usually goes overlooked since the patient is rarely aware of having difficulty breathing, until the sequelae put a big burden on the cardiovascular system. In their article, Moshkani et al. (1) have taken an in-depth look into echocardiographic findings regarding sleep apnea patients. Fifty-five sleep apneic patients diagnosed by standard polysomnographic study were examined and analyzed in three groups of mild, moderate, and severe sleep apnea, based on the apnea-hypopnea index value (5-15, 15-30, and > 30, respectively). Though exposed to significant confounders and not revealing any information about the clinical findings, the authors have shown very similar echo indices on the left and right ventricles: left ventricular ejection fraction (LVEF); right and left Tei index; pulmonary artery pressure (PAP); and strain and strain rate in a row of right and left ventricular segments. The authors have also been extremely comprehensive in their discussion, yet there seems to be a great deal missing in looking at the echocardiography of sleep apnea patients. There is a significant body of literature supporting the association between sleep apnea and LV diastolic dysfunction. Sleep apnea literally comes with a state of sympathetic overactivity, with a resultant rise in systemic blood pressure. Obesity, a common comorbidity seen in obstructive sleep apnea, adds to the risk of hypertension and diastolic dysfunction. Many investigators have proved the presence of significant diastolic dysfunction, which is responsive to the treatment of sleep apnea, pointing to the benefits of therapy in terms of cardiovascular morbidity and mortality (2-4). The impact of sleep apnea on pulmonary circulation is certainly a turning point in the field of pulmonary hypertension. Investigators are nowadays making their ways toward better explanation of pulmonary hypertension in sleep apnea patients. The interesting point is that many sleep apnea patients are found to have significant pulmonary hypertension, yet they are classified as having a mild disease regarding their apnea-hypopnea index, posing the question of coincidence. More important than the true relation between these entities is the dramatic subjective and objective improvement of pulmonary hypertension after implementing the treatment of sleep apnea (5, 6). Moshkani and colleagues have shown significant differences in strain and strain rate of the basal septal segment between different degrees of sleep apnea. Despite the fact that this can be considered a marker of abnormal septal motion with degrees of right ventricular dysfunction, it certainly needs to be analyzed in the context of other right ventricular contractility indices as well as clinical findings of these patients. Lack of the integrat
{"title":"Echocardiography in sleep apnea patients: A long way to go","authors":"A. Amin","doi":"10.5812/acvi.15174","DOIUrl":"https://doi.org/10.5812/acvi.15174","url":null,"abstract":"Sleep apnea undoubtedly stands among the most influential diseases in cardiovascular medicine. Albeit simply characterized by frequent pauses in breathing or instances of shallow or infrequent breathing during sleep, it usually goes overlooked since the patient is rarely aware of having difficulty breathing, until the sequelae put a big burden on the cardiovascular system. In their article, Moshkani et al. (1) have taken an in-depth look into echocardiographic findings regarding sleep apnea patients. Fifty-five sleep apneic patients diagnosed by standard polysomnographic study were examined and analyzed in three groups of mild, moderate, and severe sleep apnea, based on the apnea-hypopnea index value (5-15, 15-30, and > 30, respectively). Though exposed to significant confounders and not revealing any information about the clinical findings, the authors have shown very similar echo indices on the left and right ventricles: left ventricular ejection fraction (LVEF); right and left Tei index; pulmonary artery pressure (PAP); and strain and strain rate in a row of right and left ventricular segments. The authors have also been extremely comprehensive in their discussion, yet there seems to be a great deal missing in looking at the echocardiography of sleep apnea patients. There is a significant body of literature supporting the association between sleep apnea and LV diastolic dysfunction. Sleep apnea literally comes with a state of sympathetic overactivity, with a resultant rise in systemic blood pressure. Obesity, a common comorbidity seen in obstructive sleep apnea, adds to the risk of hypertension and diastolic dysfunction. Many investigators have proved the presence of significant diastolic dysfunction, which is responsive to the treatment of sleep apnea, pointing to the benefits of therapy in terms of cardiovascular morbidity and mortality (2-4). The impact of sleep apnea on pulmonary circulation is certainly a turning point in the field of pulmonary hypertension. Investigators are nowadays making their ways toward better explanation of pulmonary hypertension in sleep apnea patients. The interesting point is that many sleep apnea patients are found to have significant pulmonary hypertension, yet they are classified as having a mild disease regarding their apnea-hypopnea index, posing the question of coincidence. More important than the true relation between these entities is the dramatic subjective and objective improvement of pulmonary hypertension after implementing the treatment of sleep apnea (5, 6). Moshkani and colleagues have shown significant differences in strain and strain rate of the basal septal segment between different degrees of sleep apnea. Despite the fact that this can be considered a marker of abnormal septal motion with degrees of right ventricular dysfunction, it certainly needs to be analyzed in the context of other right ventricular contractility indices as well as clinical findings of these patients. Lack of the integrat","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128300526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Left atrial thrombi are present in one third of patients with severe rheumatic mitral stenosis and atrial fibrillation. A left atrial mass can be diagnosed as a thrombus by transthoracic echocardiography in the presence of the predisposing factors for a thrombus such as mitral stenosis and atrial fibrillation. The sensitivity of transthoracic echocardiography for detecting left atrial appendage thrombi is low, and only a few case reports have been described in the literature. Case Presentation: This report describes the case of a 65-year-old female with severe rheumatic mitral stenosis and chronic atrial fibrillation presenting with congestive heart failure. This patient was shown, by means of transthoracic echocardiography, to have a large immobile left atrium cavity mass (6.5 × 3.4 × 2.3 cm) and a large left atrial appendage mass (1.7 cm) identified as a thrombus. Contrast computed tomography of the chest confirmed the diagnosis. Conclusions: Transthoracic echocardiography was sufficient to establish the diagnosis and to decide its management.
{"title":"Left atrial and left atrial appendage mass diagnosed by cardiac imaging: A case report","authors":"Marija Kotevska-Angjushev, M. Lazarevska","doi":"10.5812/acvi.15633","DOIUrl":"https://doi.org/10.5812/acvi.15633","url":null,"abstract":"Introduction: Left atrial thrombi are present in one third of patients with severe rheumatic mitral stenosis and atrial fibrillation. A left atrial mass can be diagnosed as a thrombus by transthoracic echocardiography in the presence of the predisposing factors for a thrombus such as mitral stenosis and atrial fibrillation. The sensitivity of transthoracic echocardiography for detecting left atrial appendage thrombi is low, and only a few case reports have been described in the literature. Case Presentation: This report describes the case of a 65-year-old female with severe rheumatic mitral stenosis and chronic atrial fibrillation presenting with congestive heart failure. This patient was shown, by means of transthoracic echocardiography, to have a large immobile left atrium cavity mass (6.5 × 3.4 × 2.3 cm) and a large left atrial appendage mass (1.7 cm) identified as a thrombus. Contrast computed tomography of the chest confirmed the diagnosis. Conclusions: Transthoracic echocardiography was sufficient to establish the diagnosis and to decide its management.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"997 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123319217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Farahani, E. Vahedi, I. Lotfian, Mahdi Motashaker-Arani
Background: Obstructive sleep apnea (OSA) is a common sleep disease. It is associated not only with hypertension but also with other cardiac complications. Thus, the early detection of cardiac disorders is very useful. Objectives: We sought to evaluate different echocardiographic parameters. Patients and Methods: This cross-sectional study was done on 55 patients with OSA. The patients were divided into three groups: mild, moderate, and severe according to the apnea hypopnea index (AHI) and all underwent echocardiography. Analysis was done by SPSS 18 as well as the chi-squared and one-way ANOVA tests. Results: The mean age of the study population was 51.16 ± 12.88 years old and 36 (65.5%) patients were male. Right Tei index mean was 0.383 ± 0.213, which was abnormal in 19.1% of the patients. Left Tei index mean was 0.378 ± 0.230 and was abnormal in 52.9% of the patients. Pulmonary artery pressure mean was 18.32 ± 8.91 and was normal in 39 (70.9%) patients. Only basal septum strain (P = 0.015) and basal septum strain rate (P = 0.005) changes were associated with OSA severity. Conclusions: The main findings of this study were relative left ventricular systolic and diastolic dysfunction as well as dysfunction in some parameters of the right ventricle. The prevalence of these disorders and what constitutes the best echocardiographic parameter for their diagnosis are controversial and require further research.
{"title":"Echocardiographic abnormalities in patients with sleep apnea syndrome","authors":"M. Farahani, E. Vahedi, I. Lotfian, Mahdi Motashaker-Arani","doi":"10.5812/acvi.14534","DOIUrl":"https://doi.org/10.5812/acvi.14534","url":null,"abstract":"Background: Obstructive sleep apnea (OSA) is a common sleep disease. It is associated not only with hypertension but also with other cardiac complications. Thus, the early detection of cardiac disorders is very useful. Objectives: We sought to evaluate different echocardiographic parameters. Patients and Methods: This cross-sectional study was done on 55 patients with OSA. The patients were divided into three groups: mild, moderate, and severe according to the apnea hypopnea index (AHI) and all underwent echocardiography. Analysis was done by SPSS 18 as well as the chi-squared and one-way ANOVA tests. Results: The mean age of the study population was 51.16 ± 12.88 years old and 36 (65.5%) patients were male. Right Tei index mean was 0.383 ± 0.213, which was abnormal in 19.1% of the patients. Left Tei index mean was 0.378 ± 0.230 and was abnormal in 52.9% of the patients. Pulmonary artery pressure mean was 18.32 ± 8.91 and was normal in 39 (70.9%) patients. Only basal septum strain (P = 0.015) and basal septum strain rate (P = 0.005) changes were associated with OSA severity. Conclusions: The main findings of this study were relative left ventricular systolic and diastolic dysfunction as well as dysfunction in some parameters of the right ventricle. The prevalence of these disorders and what constitutes the best echocardiographic parameter for their diagnosis are controversial and require further research.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"42 9-10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114123471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Pulmonary artery hypertension is the presentation of various types of cardiovascular and systematic diseases. There are different kinds of noninvasive methods to determine right ventricular function, pulmonary artery pressure, and effect of pulmonary hypertension on right ventricular function. These methods include the tissue Doppler imaging (TDI) of the tricuspid annulus and the longitudinal deformation indices of the right ventricular free wall. Objectives: In some patients, the echocardiogram cannot help estimate pulmonary artery pressure. In this study, we evaluated the effect of pulmonary hypertension on the TDI of the tricuspid annulus and the longitudinal strain and strain rate of the basal segment of the right ventricular free wall in patients with left-sided valvular heart disease and pulmonary hypertension. Indeed, we sought to investigate whether we can guess the presence of pulmonary hypertension through the measurement of the TDI of the tricuspid annulus and the deformity indices of the basal segment of the right ventricular free wall. Patients and Methods: Eighty consecutive patients with left-sided valvular disease and pulmonary artery hypertension (V/PH Group) and 80 healthy matched controls (H Group) were enrolled in this research. The TDI parameters were obtained in the tissue velocity imaging mode during systole (S, S VTI), early relaxation (E), atrial systole (A), and isovolemic relaxation time (IVRT). The deformation indices included peak systolic longitudinal strain and strain rate measured from the basal segment of the right ventricular free wall and were calculated as the relative magnitude of segmental deformation. Results: S, E, and S VTI were reduced significantly in the V/PH Group, and there was a significant negative correlation between S velocity, S VTI with pulmonary artery systolic pressure (PASP), and right ventricular diameter (RVD). According to the ROC curve, S velocity <10.5 cm/s had 65% sensitivity and 40% specificity for the prediction of pulmonary hypertension. E velocity had only a negative significant correlation with RVD and no significant correlation with tricuspid annular plane systolic excursion (TAPSE) and PASP. There was no significant difference in A velocity and E/A ratio between the two groups (P = 0.455 and P = 0.070, respectively), and these parameters had no significant correlation with RVD and TAPSE. IVRT was significantly increased in the V/PH Group versus the H Group, and IVRT > 40 ms had 78% sensitivity and 67% specificity for the prediction of pulmonary hypertension. In comparison with the H Group, RV longitudinal peak systolic strain (-14/35 ± 4%) and strain rate (-0.65 ± 0.12) at the basal segment of the right ventricular free wall were significantly lower in the V/PH Group (P < 0.001 and P < 0.001). Conclusions: We observed a significant reduction in S, E velocity, and S VTI of the tricuspid annulus. Moreover, the strain/strain rate of the basal segment of the right ventric
{"title":"Assessment of right ventricular function by tissue doppler, strain and strain rate imaging in patients with left-sided valvular heart disease and pulmonary hypertension","authors":"L. Bigdelu, A. Azari, A. Fazlinezhad","doi":"10.5812/acvi.13737","DOIUrl":"https://doi.org/10.5812/acvi.13737","url":null,"abstract":"Background: Pulmonary artery hypertension is the presentation of various types of cardiovascular and systematic diseases. There are different kinds of noninvasive methods to determine right ventricular function, pulmonary artery pressure, and effect of pulmonary hypertension on right ventricular function. These methods include the tissue Doppler imaging (TDI) of the tricuspid annulus and the longitudinal deformation indices of the right ventricular free wall. Objectives: In some patients, the echocardiogram cannot help estimate pulmonary artery pressure. In this study, we evaluated the effect of pulmonary hypertension on the TDI of the tricuspid annulus and the longitudinal strain and strain rate of the basal segment of the right ventricular free wall in patients with left-sided valvular heart disease and pulmonary hypertension. Indeed, we sought to investigate whether we can guess the presence of pulmonary hypertension through the measurement of the TDI of the tricuspid annulus and the deformity indices of the basal segment of the right ventricular free wall. Patients and Methods: Eighty consecutive patients with left-sided valvular disease and pulmonary artery hypertension (V/PH Group) and 80 healthy matched controls (H Group) were enrolled in this research. The TDI parameters were obtained in the tissue velocity imaging mode during systole (S, S VTI), early relaxation (E), atrial systole (A), and isovolemic relaxation time (IVRT). The deformation indices included peak systolic longitudinal strain and strain rate measured from the basal segment of the right ventricular free wall and were calculated as the relative magnitude of segmental deformation. Results: S, E, and S VTI were reduced significantly in the V/PH Group, and there was a significant negative correlation between S velocity, S VTI with pulmonary artery systolic pressure (PASP), and right ventricular diameter (RVD). According to the ROC curve, S velocity <10.5 cm/s had 65% sensitivity and 40% specificity for the prediction of pulmonary hypertension. E velocity had only a negative significant correlation with RVD and no significant correlation with tricuspid annular plane systolic excursion (TAPSE) and PASP. There was no significant difference in A velocity and E/A ratio between the two groups (P = 0.455 and P = 0.070, respectively), and these parameters had no significant correlation with RVD and TAPSE. IVRT was significantly increased in the V/PH Group versus the H Group, and IVRT > 40 ms had 78% sensitivity and 67% specificity for the prediction of pulmonary hypertension. In comparison with the H Group, RV longitudinal peak systolic strain (-14/35 ± 4%) and strain rate (-0.65 ± 0.12) at the basal segment of the right ventricular free wall were significantly lower in the V/PH Group (P < 0.001 and P < 0.001). Conclusions: We observed a significant reduction in S, E velocity, and S VTI of the tricuspid annulus. Moreover, the strain/strain rate of the basal segment of the right ventric","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126614373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The effectiveness of any diagnostic test is dependent upon the ability of the test to accurately detect abnormal-ities. An assumption of reliability and validity underlies all medical tests and echocardiography is no exception. The identification of ‘abnormal’ relies on the definition of ‘normal’ and needs to acknowledge normal physi-ological variation that may arise from factors such as age, body size, gender, and ethnicity (1). So far, the studies that have been designed to obtain the normative values for echocardiographic measurements have related the mea-sured parameters to subjects’ age, height, weight, body surface area and gender. Only a few have taken into ac-count the role of ethnicity. As a result current guidelines for chamber quantification by echocardiography (2) con-tains reference values that have been obtained from Eu-ropean (Western Europe) and American (United States) Caucasian subjects. However, ethnicity is an important factor and studies which have compared measurements performed in Caucasians, Indians, Malaysian and Chi-nese (3, 4), Japanese (5, 6) or African American (7) subjects have shown significant differences in measurements be-tween the different ethnical groups. Therefore, the use of the reference values reported in current guidelines to define normality or abnormality of cardiac chamber size and function in population others than European and White Americans may be misleading and bring to errone-ous conclusions.This is not only a medical problem of the areas of the world non-represented in current guidelines like Middle-East, Asia, Africa or South America but, since more and more people move from their area of origin to different areas of the world for working, tourism or to escape from war or persecution this lack of proper reference values is becoming a worldwide medical problem. Accordingly, several initiatives have been undertaken to collect nor-mative data from larger cohorts of normal subjects who may include different ethnicities (8, 9). The EchoNoRMAL study is an individual person data meta-analysis of echo-cardiographic measurements obtained from healthy subjects aimed to re-define normal echocardiographic reference ranges (for the left heart including dimensions, areas, volumes, and associated calculated variables) for populations across the world, and to do that, the organiz-ing Institution (the University of Auckland, New Zealand) asked data from those populations to the different rease-archers around the world (9). However, when they looked at the data of almost 70,000 healthy subjects collected from several institutions around the world they discov-ered that there were no data about people from South America, Africa and Middle-East (Poppe KK and Whalley G, personal communication).With this background in mind, the study by Sadegh-pour et al. (10) published in the Archives of Cardiovascu-lar Imaging assumes particular scientific relevance. To the best of my knowledge, this is the first report about echoc
任何诊断测试的有效性都取决于该测试准确检测异常的能力。对可靠性和有效性的假设是所有医学检查的基础，超声心动图也不例外。“异常”的识别依赖于“正常”的定义，需要承认可能由年龄、体型、性别和种族等因素引起的正常生理变化(1)。到目前为止，为获得超声心动图测量的正常值而设计的研究已将测量参数与受试者的年龄、身高、体重、体表面积和性别联系起来。只有少数几个考虑到了种族的作用。因此，目前的超声心动图心室量化指南(2)包含了从欧洲(西欧)和美国(美国)高加索受试者中获得的参考值。然而，种族是一个重要的因素，研究比较了高加索人、印度人、马来西亚人和中国人(3,4)、日本人(5,6)或非洲裔美国人(7)受试者的测量结果，发现不同种族群体之间的测量结果存在显著差异。因此，在欧洲和美国白人以外的人群中，使用目前指南中报道的参考值来定义心腔大小和功能的正常或异常可能会产生误导，并得出错误的结论。这不仅是中东、亚洲、非洲或南美洲等现行准则中没有代表的世界地区的医疗问题，而且，由于越来越多的人从原籍地区搬到世界不同地区工作、旅游或逃避战争或迫害，这种缺乏适当参考价值的情况正在成为一个世界性的医疗问题。因此，已经采取了一些措施，从可能包括不同种族的更大的正常受试者队列中收集规范数据(8,9)。EchoNoRMAL研究是对从健康受试者获得的超声心动图测量数据进行个人数据荟萃分析，旨在重新定义世界各地人群的正常超声心动图参考范围(左心包括尺寸、面积、体积和相关计算变量)。为了做到这一点，组织机构(新西兰奥克兰大学)向世界各地的不同研究人员询问了这些人群的数据(9)。然而，当他们查看从世界各地的几个机构收集的近7万名健康受试者的数据时，他们发现没有关于南美、非洲和中东人的数据(Poppe KK和Whalley G，个人交流)。考虑到这一背景，Sadegh-pour等人(10)发表在《心血管成像档案》(Archives of cardiovascular Imaging)上的研究具有特殊的科学意义。据我所知，这是第一篇关于伊朗正常受试者心室超声心动图参考值的报道。由于这些数据是在大量精心筛选的健康受试者中获得的，因此它们肯定会填补我们知识中的现有空白。Sadeghpour等人(10)的研究也很有价值，因为他们使用了最先进的二次谐波成像超声心动图系统，进行了全面的回声研究，包括多普勒血流和组织多普勒分析，并能够提供按性别和年龄分层的结果。总之，他们提供了一个全面的框架，用于区分正常和异常的超声心动图测量的人群。毫不奇怪，他们发现伊朗受试者的心腔更小，正常限度低于现行指南(2)。从临床角度来看，这意味着它的参考值
{"title":"Ethnicity: A missing variable when defining normative values for reporting echocardiographic studies","authors":"L. Badano","doi":"10.5812/acvi.16315","DOIUrl":"https://doi.org/10.5812/acvi.16315","url":null,"abstract":"The effectiveness of any diagnostic test is dependent upon the ability of the test to accurately detect abnormal-ities. An assumption of reliability and validity underlies all medical tests and echocardiography is no exception. The identification of ‘abnormal’ relies on the definition of ‘normal’ and needs to acknowledge normal physi-ological variation that may arise from factors such as age, body size, gender, and ethnicity (1). So far, the studies that have been designed to obtain the normative values for echocardiographic measurements have related the mea-sured parameters to subjects’ age, height, weight, body surface area and gender. Only a few have taken into ac-count the role of ethnicity. As a result current guidelines for chamber quantification by echocardiography (2) con-tains reference values that have been obtained from Eu-ropean (Western Europe) and American (United States) Caucasian subjects. However, ethnicity is an important factor and studies which have compared measurements performed in Caucasians, Indians, Malaysian and Chi-nese (3, 4), Japanese (5, 6) or African American (7) subjects have shown significant differences in measurements be-tween the different ethnical groups. Therefore, the use of the reference values reported in current guidelines to define normality or abnormality of cardiac chamber size and function in population others than European and White Americans may be misleading and bring to errone-ous conclusions.This is not only a medical problem of the areas of the world non-represented in current guidelines like Middle-East, Asia, Africa or South America but, since more and more people move from their area of origin to different areas of the world for working, tourism or to escape from war or persecution this lack of proper reference values is becoming a worldwide medical problem. Accordingly, several initiatives have been undertaken to collect nor-mative data from larger cohorts of normal subjects who may include different ethnicities (8, 9). The EchoNoRMAL study is an individual person data meta-analysis of echo-cardiographic measurements obtained from healthy subjects aimed to re-define normal echocardiographic reference ranges (for the left heart including dimensions, areas, volumes, and associated calculated variables) for populations across the world, and to do that, the organiz-ing Institution (the University of Auckland, New Zealand) asked data from those populations to the different rease-archers around the world (9). However, when they looked at the data of almost 70,000 healthy subjects collected from several institutions around the world they discov-ered that there were no data about people from South America, Africa and Middle-East (Poppe KK and Whalley G, personal communication).With this background in mind, the study by Sadegh-pour et al. (10) published in the Archives of Cardiovascu-lar Imaging assumes particular scientific relevance. To the best of my knowledge, this is the first report about echoc","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116180118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. O. Ojaghi Haghighi, A. Mostafavi, M. Peighambari, A. Alizadehasl, H. Moladust, Hossein Haghighi
Background: The torsional parameters of the left ventricle (LV) are sensitive indicators of the cardiac performance. The torsion/twist of the LV is the wringing motion of the heart around its long axis created by oppositely directed apical and basal rotations and is determined by contracting myofibers in the LV wall which are arranged in opposite directions between the subendocardial and subepicardial layers. This motion is essential for regulating the LV systolic and diastolic functions. Objectives: Recent advances in echocardiography techniques have allowed for quantification of LV mechanics. The aim of the present study was to compare various LV twisting and untwisting parameters in healthy human subjects determined by velocity vector imaging (VVI) and tissue Doppler imaging (TDI) at rest. Patients and Methods: All volunteers (47 healthy subjects in two groups: 24 subjects in VVI group and 23 subjects in TDI group) underwent complete echocardiographic study, and LV torsional parameters were assessed by VVI or TDI methods. In addition, LV torsion and LV twisting/untwisting rate profiles were calculated throughout cardiac cycle. Results: Twist degree was significantly lower in the VVI group than in the TDI group (P = 0.008, r = 0.56). LV torsion was lower in the VVI group but was not significant. (P = 0.13, r = 0.38). Twisting rate (P = 0.004, r = 0.66) and untwisting rate (P = 0.0001, r = 0.61) were lower in the VVI group, but when timing of untwisting rate was normalized by systolic duration, there was no significant difference between the two groups (P = 0.41, r = 0.59). Similarly, when peak untwisting rate was normalized by LV length, there was a significant decline in normalized peak untwisting rate in the VVI group (P = 0.004, r = 0.62), but not in peak twisting rate normalized by LV length (P = 0.12, r = 0.42). Peak untwisting rate normalized by LV torsion was not statistically different between the two groups (P = 0.05, r = 0.53). Conclusions: Results suggest that these methods cannot be interchanged, and VVI showed significantly lower LV peak twist, peak twisting rate and peak untwisting rate. However, when LV twist and LV twisting rates were normalized to LV length, values were comparable for both imaging techniques.
背景:左心室扭转参数是反映心脏功能的敏感指标。左室扭转/扭转是由心内膜下和心外膜下两层间相反方向排列的左室壁肌纤维收缩所引起的心脏绕其长轴的扭曲运动。这种运动对调节左室收缩和舒张功能至关重要。目的:超声心动图技术的最新进展使左室力学的量化成为可能。本研究的目的是比较速度矢量成像(VVI)和组织多普勒成像(TDI)在静止状态下确定的健康人左室扭转和解扭参数。患者和方法:所有志愿者(47例健康受试者，分为两组:VVI组24例，TDI组23例)均行超声心动图检查，采用VVI或TDI方法评估左室扭转参数。此外，计算整个心动周期左室扭转和左室扭转/解扭率曲线。结果:VVI组扭转程度明显低于TDI组(P = 0.008, r = 0.56)。VVI组左室扭转较低，但差异不显著。(P = 0.13, r = 0.38)。VVI组扭转率(P = 0.004, r = 0.66)和解扭率(P = 0.0001, r = 0.61)较低，但以收缩时间归一化解扭时间时，两组间差异无统计学意义(P = 0.41, r = 0.59)。同样，当按左室长度归一化峰值解扭速率时，VVI组的归一化峰值解扭速率显著下降(P = 0.004, r = 0.62)，但按左室长度归一化的峰值解扭速率无显著下降(P = 0.12, r = 0.42)。两组以左室扭转归一化峰值解扭率比较，差异无统计学意义(P = 0.05, r = 0.53)。结论:结果表明，这两种方法不能互换，VVI的LV峰值扭、峰值扭速率和峰值解扭速率均明显降低。然而，当左室扭转和左室扭转率归一化到左室长度时，两种成像技术的值是相当的。
{"title":"Echocardiographic assessment of left ventricular twisting and untwisting rate in normal subjects by tissue doppler and velocity vector imaging: Comparison of two methods","authors":"S. O. Ojaghi Haghighi, A. Mostafavi, M. Peighambari, A. Alizadehasl, H. Moladust, Hossein Haghighi","doi":"10.5812/acvi.14289","DOIUrl":"https://doi.org/10.5812/acvi.14289","url":null,"abstract":"Background: The torsional parameters of the left ventricle (LV) are sensitive indicators of the cardiac performance. The torsion/twist of the LV is the wringing motion of the heart around its long axis created by oppositely directed apical and basal rotations and is determined by contracting myofibers in the LV wall which are arranged in opposite directions between the subendocardial and subepicardial layers. This motion is essential for regulating the LV systolic and diastolic functions. Objectives: Recent advances in echocardiography techniques have allowed for quantification of LV mechanics. The aim of the present study was to compare various LV twisting and untwisting parameters in healthy human subjects determined by velocity vector imaging (VVI) and tissue Doppler imaging (TDI) at rest. Patients and Methods: All volunteers (47 healthy subjects in two groups: 24 subjects in VVI group and 23 subjects in TDI group) underwent complete echocardiographic study, and LV torsional parameters were assessed by VVI or TDI methods. In addition, LV torsion and LV twisting/untwisting rate profiles were calculated throughout cardiac cycle. Results: Twist degree was significantly lower in the VVI group than in the TDI group (P = 0.008, r = 0.56). LV torsion was lower in the VVI group but was not significant. (P = 0.13, r = 0.38). Twisting rate (P = 0.004, r = 0.66) and untwisting rate (P = 0.0001, r = 0.61) were lower in the VVI group, but when timing of untwisting rate was normalized by systolic duration, there was no significant difference between the two groups (P = 0.41, r = 0.59). Similarly, when peak untwisting rate was normalized by LV length, there was a significant decline in normalized peak untwisting rate in the VVI group (P = 0.004, r = 0.62), but not in peak twisting rate normalized by LV length (P = 0.12, r = 0.42). Peak untwisting rate normalized by LV torsion was not statistically different between the two groups (P = 0.05, r = 0.53). Conclusions: Results suggest that these methods cannot be interchanged, and VVI showed significantly lower LV peak twist, peak twisting rate and peak untwisting rate. However, when LV twist and LV twisting rates were normalized to LV length, values were comparable for both imaging techniques.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130630398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Tetralogy of Fallot (TOF) in the absent of pulmonary valve is a rare congenital anomaly (3%of TOF patients). Case Presentation: We are presenting an 18- year-old male with history of dyspnea on exertion and cyanosis since childhood. Despite the diagnosis of congenital heart disease, no intervention was done due to his poor socioeconomic culture. At age of 18, he referred to our center for further evaluation of heart problem. After physical examination and other diagnostic tests, our final diagnosis was tetralogy of fallot, absent pulmonary valve and double-chamber right ventricle. The absence of mature PV tissue leads to severe pulmonary regurgitation, which is often associated with significant dilatation of the pulmonary arteries. After further evaluation of main pulmonary artery, its branches and other abnormalities of the heart, total correction of tetralogy and pulmonary valve replacement was done. His post operation period was uneventful without any complication and he discharged after 10 days. Conclusions: We believe that the prognosis for those patients in this era is good and complete surgical treatment is tolerated well by them.
{"title":"Absent pulmonary valve associated with tetralogy of fallot and double chamber right ventricle","authors":"S. Mohammadzadeh, A. Tabaei, Farhad Mirzaaghayan","doi":"10.5812/acvi.13858","DOIUrl":"https://doi.org/10.5812/acvi.13858","url":null,"abstract":"Introduction: Tetralogy of Fallot (TOF) in the absent of pulmonary valve is a rare congenital anomaly (3%of TOF patients). Case Presentation: We are presenting an 18- year-old male with history of dyspnea on exertion and cyanosis since childhood. Despite the diagnosis of congenital heart disease, no intervention was done due to his poor socioeconomic culture. At age of 18, he referred to our center for further evaluation of heart problem. After physical examination and other diagnostic tests, our final diagnosis was tetralogy of fallot, absent pulmonary valve and double-chamber right ventricle. The absence of mature PV tissue leads to severe pulmonary regurgitation, which is often associated with significant dilatation of the pulmonary arteries. After further evaluation of main pulmonary artery, its branches and other abnormalities of the heart, total correction of tetralogy and pulmonary valve replacement was done. His post operation period was uneventful without any complication and he discharged after 10 days. Conclusions: We believe that the prognosis for those patients in this era is good and complete surgical treatment is tolerated well by them.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131130109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Sadeghpour, M. Shahrabi, H. Bakhshandeh, N. Naderi
Background: Echocardiography is widely used to diagnose or exclude cardiac disease. The reports on reference values based on an Asian population are limited. Objectives: We conducted a study to determine normal values for two-dimensional, M-mode, and Doppler echocardiographic measurements and evaluate the relationship between these parameters and age and gender in a large, healthy Iranian population. Patients and Methods: Among a total of 400 volunteers in a cross-sectional study, 368 healthy individuals aged between 30 and 70 years [171 males at a mean age of 47.6 (9.9) and 197 females at a mean age of 47.6 (9.5)] were enrolled. Standard comprehensive transthoracic echocardiography (TTE) was performed based on the guidelines of the American Society of Echocardiography. The normal limits are presented as mean (SD) and are also indexed to body surface area (BSA). Results: There was no significant difference between the men and women regarding left ventricular (LV) ejection fraction (57.97% vs. 57.99%). The mean of LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), interventricular septum (IVS), posterior wall (PW) thickness, and right ventricular diastolic diameter (RVDd) was significantly greater in the men than in the women. However, there was an inverse relationship when LVEDD, RVDd, and left atrial (LA) diameter and area were indexed to BSA. There was no significant difference in the mean of LA area between the males and females (14.28 vs. 13.6 cm2). The LV diastolic parameters correlated negatively with age. A peakE /A velocity ratio <1 was found in the subjects over 50 years old. The mean of all the measurements in our study was less than the reference values in the published guidelines. Conclusions: Our study, the first and largest investigation of its kind, provides reference values for the echocardiographic evaluation of the cardiac size and function of Iranian healthy individuals. The mean of our measurements was significantly less than that reported in the published guidelines.
背景:超声心动图被广泛用于诊断或排除心脏疾病。基于亚洲人口的参考值报告是有限的。目的:我们进行了一项研究，以确定二维、m型和多普勒超声心动图测量的正常值，并评估这些参数与伊朗大量健康人群的年龄和性别之间的关系。患者和方法:在一项横断面研究中，共有400名志愿者入选368名年龄在30 - 70岁之间的健康个体[171名男性，平均年龄47.6(9.9)岁，197名女性，平均年龄47.6(9.5)岁]。标准全面经胸超声心动图(TTE)是根据美国超声心动图学会的指南进行的。正常极限以平均值(SD)表示，也与体表面积(BSA)相关。结果:男性和女性左室射血分数无显著差异(57.97% vs. 57.99%)。男性左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、室间隔(IVS)、后壁(PW)厚度和右室舒张末期内径(RVDd)的平均值明显大于女性。然而，当LVEDD、RVDd和左房(LA)直径和面积与BSA指数呈反比关系。男性和女性的平均LA面积没有显著差异(14.28 cm2比13.6 cm2)。左室舒张参数与年龄呈负相关。在50岁以上的受试者中发现峰值/流速比<1。我们研究中所有测量值的平均值小于已发表的指南中的参考值。结论:本研究为伊朗健康人心脏大小和功能的超声心动图评价提供了参考价值。我们测量的平均值明显小于已发表的指南中报道的平均值。
{"title":"Normal echocardiographic values of 368 Iranian healthy subjects","authors":"A. Sadeghpour, M. Shahrabi, H. Bakhshandeh, N. Naderi","doi":"10.5812/acvi.15662","DOIUrl":"https://doi.org/10.5812/acvi.15662","url":null,"abstract":"Background: Echocardiography is widely used to diagnose or exclude cardiac disease. The reports on reference values based on an Asian population are limited. Objectives: We conducted a study to determine normal values for two-dimensional, M-mode, and Doppler echocardiographic measurements and evaluate the relationship between these parameters and age and gender in a large, healthy Iranian population. Patients and Methods: Among a total of 400 volunteers in a cross-sectional study, 368 healthy individuals aged between 30 and 70 years [171 males at a mean age of 47.6 (9.9) and 197 females at a mean age of 47.6 (9.5)] were enrolled. Standard comprehensive transthoracic echocardiography (TTE) was performed based on the guidelines of the American Society of Echocardiography. The normal limits are presented as mean (SD) and are also indexed to body surface area (BSA). Results: There was no significant difference between the men and women regarding left ventricular (LV) ejection fraction (57.97% vs. 57.99%). The mean of LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), interventricular septum (IVS), posterior wall (PW) thickness, and right ventricular diastolic diameter (RVDd) was significantly greater in the men than in the women. However, there was an inverse relationship when LVEDD, RVDd, and left atrial (LA) diameter and area were indexed to BSA. There was no significant difference in the mean of LA area between the males and females (14.28 vs. 13.6 cm2). The LV diastolic parameters correlated negatively with age. A peakE /A velocity ratio <1 was found in the subjects over 50 years old. The mean of all the measurements in our study was less than the reference values in the published guidelines. Conclusions: Our study, the first and largest investigation of its kind, provides reference values for the echocardiographic evaluation of the cardiac size and function of Iranian healthy individuals. The mean of our measurements was significantly less than that reported in the published guidelines.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127614658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Esmaeilzadeh., F. Vakilian, M. Maleki, A. Amin, S. Taghavi, H. Bakhshandeh
Background: Two-dimensional (2D) Strain is a new reproducible technique for assessing regional myocardial function; however, its application for evaluation of left atrium (LA) function is less studied. Objectives: We sought to assess LA function in heart failure patients using velocity vector imaging (VVI). Patients and Methods: Thirty five patients (mean age: 43.34 ± 18.1 years, 59.3% male) with systolic dysfunction [left ventricle ejection fraction (LVEF) < 35%] enrolled. Standard Doppler echocardiography and 2D strain were performed on all subjects. Strain measurements were obtained from apical views. Results: A significant differences in LA volume index (LAVI) and strain were found in patients with systolic heart failure (SHF) versus normal subjects (23.8 ± 4.1 versus 57.8 ± 19.7 ml/m2, P < 0.001 and 39.6 ± 10.6 versus 8.2 ± 5.3%, P < 0.001). Multivariate analysis of separate walls revealed significant inverse relationship between LA size and volume with total and regional (2-ch view) 2D strains of LA. Significant inverse relationship were also detected between pulmonary artery systolic pressure and both total LA strain (22 ± 8 versus 42 ± 10 mmHg, r = -0.4, P < 0.001) and LA strain in 2-chamber (r = -0.5, P < 0.001). A cutoff value of total average LA strain (≥ 23.28%) can differentiate normal and abnormal LA function with a sensitivity of 93% and specificity of 100% and a cutoff value of total LA strain (in average) of 17.2% can differentiate mild and moderate and severe diastolic dysfunction with a sensitivity of 100% and a specificity of 97%. Conclusions: LA strain seems to be a better determinant for diagnosis of abnormal LA function and the degree of diastolic dysfunction in SHF.
背景:二维应变是评估局部心肌功能的一种可重复的新技术;但其在左心房功能评价中的应用研究较少。目的:利用速度矢量成像(velocity vector imaging, VVI)评估心力衰竭患者的LA功能。患者和方法:纳入35例(平均年龄:43.34±18.1岁，男性59.3%)伴有收缩功能障碍[左心室射血分数(LVEF) < 35%]的患者。所有受试者均行标准多普勒超声心动图和二维应变。应变测量是从顶点视图获得的。结果:收缩期心力衰竭(SHF)患者的LA容积指数(LAVI)和应变与正常人相比有显著差异(23.8±4.1 vs 57.8±19.7 ml/m2, P < 0.001; 39.6±10.6 vs 8.2±5.3%，P < 0.001)。多因素分析显示，LA的大小和体积与LA的总菌株和区域(2-ch视图)2D菌株呈显著负相关。肺动脉收缩压与总LA应变(22±8 vs 42±10 mmHg, r = -0.4, P < 0.001)和2室LA应变(r = -0.5, P < 0.001)均呈显著负相关。总平均LA菌株的临界值(≥23.28%)区分正常与异常LA功能的灵敏度为93%，特异性为100%;总平均LA菌株的临界值(平均17.2%)区分轻、中、重度舒张功能不全的灵敏度为100%，特异性为97%。结论:LA菌株可能是诊断SHF患者LA功能异常和舒张功能不全程度的较好决定因素。
{"title":"Evaluation of left atrial two-dimensional strain in patients with systolic heart failure using velocity vector imaging","authors":"M. Esmaeilzadeh., F. Vakilian, M. Maleki, A. Amin, S. Taghavi, H. Bakhshandeh","doi":"10.5812/acvi.14486","DOIUrl":"https://doi.org/10.5812/acvi.14486","url":null,"abstract":"Background: Two-dimensional (2D) Strain is a new reproducible technique for assessing regional myocardial function; however, its application for evaluation of left atrium (LA) function is less studied. Objectives: We sought to assess LA function in heart failure patients using velocity vector imaging (VVI). Patients and Methods: Thirty five patients (mean age: 43.34 ± 18.1 years, 59.3% male) with systolic dysfunction [left ventricle ejection fraction (LVEF) < 35%] enrolled. Standard Doppler echocardiography and 2D strain were performed on all subjects. Strain measurements were obtained from apical views. Results: A significant differences in LA volume index (LAVI) and strain were found in patients with systolic heart failure (SHF) versus normal subjects (23.8 ± 4.1 versus 57.8 ± 19.7 ml/m2, P < 0.001 and 39.6 ± 10.6 versus 8.2 ± 5.3%, P < 0.001). Multivariate analysis of separate walls revealed significant inverse relationship between LA size and volume with total and regional (2-ch view) 2D strains of LA. Significant inverse relationship were also detected between pulmonary artery systolic pressure and both total LA strain (22 ± 8 versus 42 ± 10 mmHg, r = -0.4, P < 0.001) and LA strain in 2-chamber (r = -0.5, P < 0.001). A cutoff value of total average LA strain (≥ 23.28%) can differentiate normal and abnormal LA function with a sensitivity of 93% and specificity of 100% and a cutoff value of total LA strain (in average) of 17.2% can differentiate mild and moderate and severe diastolic dysfunction with a sensitivity of 100% and a specificity of 97%. Conclusions: LA strain seems to be a better determinant for diagnosis of abnormal LA function and the degree of diastolic dysfunction in SHF.","PeriodicalId":429543,"journal":{"name":"Archives of Cardiovascular Imaging","volume":"67 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114112439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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