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Left Ventricular Multi-Directional Deformation and Coronary Microvascular Dysfunction in Patients With Angina With No Obstructive Coronary Artery Disease: A Comprehensive Analysis From the Two-Dimensional Speckle-Tracking Echocardiography 无阻塞性冠状动脉疾病的心绞痛患者左心室多向变形和冠状动脉微血管功能障碍:二维斑点跟踪超声心动图综合分析
IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-15 DOI: 10.1111/echo.70375
Yuhui Yang, Ying Li, Zaihan Zhu, Xingyu Fang, Anxiang Sha, Yupeng Wu, Dandan Sun

Objective

The aim of this study was to investigate the relationship between coronary microvascular dysfunction (CMD) and left ventricular multi-directional deformation in patients with angina with no obstructive coronary artery disease (ANOCA).

Methods

This study retrospectively analyzed patients who were clinically diagnosed with ANOCA in our hospital from September 2018 to September 2024. Coronary flow velocity reserve (CFVR) was measured using adenosine stress echocardiography to evaluate CMD. Patients were divided into two groups: the CMD group (CFVR 2.0) and the control group (CFVR > 2.0). The global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) of the left ventricle were analyzed by two-dimensional speckle tracking imaging (2D-STI).

Results

This study included 69 patients in the CMD group and 75 individuals in the control group. Compared to the control group, the CMD group showed a lower absolute value of GLS and a higher absolute value of GCS. After adjusting for confounding factors, multivariate logistic regression analysis revealed that GLS (β: −1.119, OR: 0.327, 95% CI: 0.223–0.478, p < 0.001), GCS (β: 0.464, OR: 1.591, 95% CI: 1.239–2.042, p < 0.001) were independent predictors of CMD in ANOCA patients. The areas under the ROC curve of GLS, GCS, GRS, and the combination of GLS and GCS were 0.858, 0.687, 0.519, and 0.901, respectively. The results of Pearson correlation analysis showed that CFVR was negatively correlated with GCS, with r values of −0.264 (p < 0.001). The correlation coefficient between CFVR and GLS was positive, with r values of 0.562 (p < 0.001).

Conclusion

The findings showed that when ANOCA patients developed CMD, the absolute value of GLS decreased, and the absolute value of GCS increased. The combination of GLS and GCS demonstrated strong predictive value and diagnostic efficiency for CMD in ANOCA patients. Our study is beneficial for the early detection of CMD in ANOCA patients and the development of intervention strategies.

目的:探讨无阻塞性冠状动脉疾病(ANOCA)心绞痛患者冠状动脉微血管功能障碍(CMD)与左室多向变形的关系。方法:回顾性分析2018年9月至2024年9月我院临床诊断为ANOCA的患者。采用腺苷应激超声心动图检测冠状动脉血流速度储备(CFVR)评价CMD。患者分为两组:CMD组(CFVR≤2.0)和对照组(CFVR > 2.0)。采用二维散斑跟踪成像(2D-STI)对左心室整体纵向应变(GLS)、整体周向应变(GCS)和整体径向应变(GRS)进行分析。结果:本研究纳入CMD组69例,对照组75例。与对照组相比,CMD组GLS绝对值较低,GCS绝对值较高。校正混杂因素后,多因素logistic回归分析显示:GLS (β: -1.119, OR: 0.327, 95% CI: 0.223-0.478, p)。结论:ANOCA患者发生CMD时,GLS绝对值降低,GCS绝对值升高。GLS和GCS联合应用对ANOCA患者的CMD具有较强的预测价值和诊断效率。我们的研究有助于ANOCA患者CMD的早期发现和干预策略的制定。
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引用次数: 0
The Role of Stress Echocardiography in Patients With Anomalous Aortic Origin of Coronary Arteries: Two Tertiary Cardiac Centers’ Experience 应激超声心动图在冠状动脉主动脉起源地异常患者中的作用:两个三级心脏中心的经验。
IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-15 DOI: 10.1111/echo.70371
Oleksandr Danylenko, Myo Thidar Lwin, Ioannis Kasouridis, Abigail Masding, Katherine Von Klemperer, Rebecca Macrae, Ricardo Prista Monteiro, Roxy Senior, Wei Li

Aims

The objective of our study was to establish the prevalence of ischemia during exercise stress echocardiography (ESE) in patients with anomalous aortic origin of coronary arteries (AAOCA).

Methods and results

A cohort of 46 patients with AAOCA was retrospectively included in this study. Treadmill/bike exercise stress echo tests for ischemia assessment were performed and analyzed according to ESC guidelines. Computed tomography coronary angiography (CTCA), cardiac magnetic resonance, myocardial perfusion scintigraphy and invasive angiography with intravascular ultrasound if needed were used for coronary artery (CA) morphology and myocardial perfusion assessment. Most patients (70%) were overall symptomatic at rest, 57% reported chest pain and 2% had cardiac arrest before the ESE. By contrast, only 2% of patients reported chest pain during ESE. CTCA revealed that 70% of patients had an inter-arterial course, 17% were found to have an intramural course and 24% had a slit-like ostium of their anomalous CA. Other high-risk features were less frequent findings. All myocardial perfusion studies were negative and only one patient with AAOCA developed ischemia during ESE. Following investigations, four patients were eligible for surgical interventions and were operated on while the remaining patients were followed up for a median of 3 years with no adverse cardiovascular events.

Conclusions

Incidence of ischemia on exercise stress echo is extremely low among middle-aged patients with AAOCA despite symptoms at rest and malignant anatomical features. A good short-term outcome in unoperated AAOCA patients following negative exercise stress echocardiography has been shown.

目的:我们研究的目的是确定运动应激超声心动图(ESE)在冠状动脉异常主动脉起源(AAOCA)患者中的缺血发生率。方法和结果:回顾性研究了46例AAOCA患者。根据ESC指南进行缺血评估的跑步机/自行车运动应激回声试验和分析。ct冠状动脉造影(CTCA)、心脏磁共振、心肌灌注显像及有创血管造影(必要时血管内超声)评估冠状动脉(CA)形态及心肌灌注。大多数患者(70%)在休息时总体症状,57%报告胸痛,2%在ESE前发生心脏骤停。相比之下,只有2%的患者在ESE期间报告胸痛。CTCA显示70%的患者为动脉间病变,17%为动脉内病变,24%为异常CA的狭缝样开口。其他高危特征较少发现。所有心肌灌注研究均为阴性,只有1例AAOCA患者在ESE期间出现缺血。调查后,4例患者符合手术干预条件并进行手术治疗,其余患者随访中位数为3年,无不良心血管事件。结论:中年AAOCA患者运动应激回声缺血发生率极低,尽管有休息时的症状和恶性解剖特征。未手术的AAOCA患者在负运动应激超声心动图检查后有良好的短期预后。
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引用次数: 0
The Prognosis of Males and Females With Moderate or Severe Secondary Mitral Valve Regurgitation and Avenues for Improvement 男女中度或重度二尖瓣返流的预后及改善途径。
IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-15 DOI: 10.1111/echo.70370
Jelle P. Man, Berto J. Bouma, M. A. Molenaar, Steven A. J. Chamuleau, Mark J. Schuuring

Aims

To understand prognostic differences between sexes in (subtypes of) secondary mitral valve regurgitation (SMR) and to identify avenues for improvement.

Method and results

In this retrospective study, all consecutive patients diagnosed with moderate or severe SMR by echocardiographic assessment between January 1, 2014, and June 1, 2021 were included. Sex-specific analyses were performed using Cox proportional hazards analysis, adjusted for significant covariates. A total of 1245 patients with SMR (43% female) were included. Females more often had atrial SMR (233 (29%) females vs. 200 (21%) males, p < 0.01), males more often ischemic SMR (100 females (12%) vs. 245 males (25%), p < 0.01), and there were no significant differences between sexes in the proportion of non-ischemic SMR (199 (25%) females vs. 268 (28%) males, p = 0.99). The estimated 5-year survival was 70% (CI = 68%, 73%). Median follow-up was 4.3 years [2.7–6.2], 236 males and 128 females died during follow-up. Females had a better survival than males in a multivariable Cox model (HR = 0.67, p < 0.01).

Conclusion

Overall survival in patients with SMR was low with an estimated 5-year survival of 70%. Females had a better survival in patients with SMR than males. The lower survival in males with SMR might be due to a larger proportion of atrial SMR in females, fewer patients with ischemic SMR, and lower ejection fractions in males with non-ischemic SMR. The current focus on rapid heart failure medication optimization may improve the prognosis of the most vulnerable group; future studies can be directed to see whether this will be the case.

目的:了解二次二尖瓣反流(SMR)(亚型)的性别预后差异,并确定改善途径。方法和结果:在这项回顾性研究中,纳入了2014年1月1日至2021年6月1日期间所有经超声心动图评估诊断为中重度SMR的连续患者。采用Cox比例风险分析进行性别分析,并对显著协变量进行校正。共纳入1245例SMR患者(43%为女性)。女性更常发生心房SMR(女性233例(29%),男性200例(21%),p结论:SMR患者的总生存率较低,估计5年生存率为70%。SMR患者中女性的生存率高于男性。男性SMR患者较低的生存率可能是由于女性心房SMR比例较大,缺血性SMR患者较少,非缺血性SMR男性的射血分数较低。目前对心力衰竭药物快速优化的关注可能会改善最弱势群体的预后;未来的研究可以直接观察这种情况是否会发生。
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引用次数: 0
Clinical, Echocardiographic, and Socioeconomic Predictors of Progression and Outcomes in Patients With Moderate Aortic Stenosis 中度主动脉瓣狭窄患者的临床、超声心动图和社会经济预测进展和结局。
IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-15 DOI: 10.1111/echo.70288
Alex D'Amico, Paul Nona, Loren Wagner, Miguel R. Sotelo, Chris Rogers, Navin Nanda, Julian Booker, Efstathia Andrikopoulou

Background

Despite increased awareness of its clinical consequences, personalized risk stratification in patients with moderate aortic stenosis (AS) remains ambiguous. We studied predictors of progression and clinical outcomes in moderate AS to improve risk stratification and add to the existing literature.

Methods

Data collected through the Tempus Next care pathway intelligence platform at our tertiary referral center were retrospectively analyzed. The reports of echocardiograms performed from October 2017 to January 2020 were screened for descriptive or quantitative evidence of moderate AS. Follow-up extended until January 2022. Clinical data were extracted following manual chart review. Socioeconomic variables were collected based on zip-code–aggregated United States census data. The endpoints were progression from moderate to severe valvular AS, all-cause mortality, all-cause hospitalization, and heart failure (HF) hospitalization. The final multivariable model was selected using a variable selection algorithm inspired by greedy causal discovery algorithms.

Results

A total of 34 450 echocardiograms (N = 25 204 patients) were screened during the inclusion period; 367 patients met inclusion criteria and were included in the final analysis. Progression to severe AS was noted in 172 patients (median time to progression 16 months). The final predictive models after variable selection exhibited modest predictive power: progression to severe AS, AUC = 0.68; all-cause mortality, 0.797; all-cause hospitalization, 0.629; heart failure hospitalization, 0.744. Variables predictive for the endpoints included comorbidities, echocardiographic variables, and demographics.

Conclusion

Our findings support further work and exploration of a paradigm shift in the assessment and management of AS, moving beyond traditional measures to a multiparametric model incorporating a broader spectrum of clinical, echocardiographic, and socioeconomic variables.

背景:尽管人们对中度主动脉瓣狭窄(AS)临床后果的认识有所提高,但对中度主动脉瓣狭窄(AS)患者的个性化风险分层仍然不明确。我们研究了中度AS进展和临床结果的预测因素,以改善风险分层并补充现有文献。方法:回顾性分析我院三级转诊中心通过Tempus Next护理路径智能平台收集的数据。筛选2017年10月至2020年1月进行的超声心动图报告,以寻找中度AS的描述性或定量证据。后续工作延长至2022年1月。临床资料提取后,手工图表审查。社会经济变量是根据邮政编码汇总的美国人口普查数据收集的。终点是中度到重度瓣膜性AS的进展、全因死亡率、全因住院和心力衰竭住院。最后采用一种受贪婪因果发现算法启发的变量选择算法选择多变量模型。结果:纳入期内共筛查超声心动图34 450张(N = 25 204例);367例患者符合纳入标准,纳入最终分析。172例患者进展为严重AS(进展的中位时间为16个月)。变量选择后的最终预测模型表现出适度的预测能力:进展到严重AS, AUC = 0.68;全因死亡率,0.797;全因住院,0.629;心力衰竭住院率为0.744。预测终点的变量包括合并症、超声心动图变量和人口统计学。结论:我们的研究结果支持进一步的工作和探索AS评估和管理的范式转变,超越传统的测量方法,采用包含更广泛的临床、超声心动图和社会经济变量的多参数模型。
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引用次数: 0
A Pathway for Improving Performance and Interpretation of Strain in a Pediatric Echocardiography Laboratory 提高儿童超声心动图实验室应变表现和解释的途径
IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-11 DOI: 10.1111/echo.70369
Shivani Patel, Nazia Husain, Jennifer Acevedo, Stefani Samples, Amanda Hauck

Background

Echocardiographic quantification of myocardial deformation is a valuable tool to assess left ventricular systolic function in children at risk for systolic dysfunction. Since clinical utility is dependent on accurate and reproducible data, pediatric echo labs should establish a process to ensure high quality strain performance and interpretation. We describe our institutional experience of a successful strain implementation pathway.

Methods

Starting in 2016, various plan-do-study-act cycles were implemented, including a comprehensive echocardiography function protocol, knowledge and skill-based education, updated equipment and software to optimize acquisition, reporting, and billing for global longitudinal strain (GLS). We reviewed a sample of echocardiograms annually from 2019 to 2023 on children at risk for chemotherapy related cardiotoxicity (CTRCD). We calculated the percentage of echocardiograms that performed and reported GLS, reviewing for accuracy.

Results

From 2019 to 2023, 685 echocardiograms were reviewed. GLS reporting increased from 39% in 2019 to 76% in 2023 and accuracy improved from 57% to 72% (p < 0.001). Reasons for inaccurate GLS included poor 2D image quality (24%), endocardial border tracing errors despite good image quality (45%) or both (21%). In almost half the studies where GLS was measurable but not reported [99/214; 46%], GLS had not been performed on the echo cart. Reporting of GLS improved from 27% in 2019 to 66% in 2023 with on-cart automation and easier post-processing; and other interventions, including iterative education.

Conclusions

Implementation of administrative, technological, and educational interventions helps to establish a pathway of consistent, high-quality performance and accurate reporting of GLS in pediatric echocardiography labs.

背景超声心动图量化心肌变形是评估有收缩功能障碍危险儿童左心室收缩功能的一种有价值的工具。由于临床应用依赖于准确和可重复的数据,儿科回声实验室应该建立一个过程,以确保高质量的应变性能和解释。我们描述了我们成功的应变实施途径的机构经验。方法从2016年开始,实施各种计划-研究-行动周期,包括全面的超声心动图功能协议、知识和技能教育、更新设备和软件,以优化全球纵向应变(GLS)的采集、报告和计费。我们回顾了2019年至2023年每年对有化疗相关心脏毒性(CTRCD)风险的儿童的超声心动图样本。我们计算了执行和报告GLS的超声心动图的百分比,以评估其准确性。结果2019 - 2023年共收集超声心动图685张。GLS报告从2019年的39%增加到2023年的76%,准确性从57%提高到72% (p < 0.001)。导致GLS不准确的原因包括2D图像质量差(24%)、心内膜边界跟踪错误(45%)或两者兼而有之(21%)。在几乎一半的研究中,GLS是可测量的,但没有报告[99/214;46%),未在超声车上进行GLS。通过车载自动化和更简单的后处理,GLS报告从2019年的27%提高到2023年的66%;以及其他干预措施,包括迭代式教育。结论实施行政、技术和教育干预措施有助于在儿童超声心动图实验室建立一致、高质量的GLS表现和准确报告的途径。
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引用次数: 0
Late Gadolinium Enhancement in Takotsubo Syndrome: Mechanism and Its Clinical Significance Takotsubo综合征晚期钆增强:机制及临床意义
IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-11 DOI: 10.1111/echo.70321
Riccardo Cau, Jasjit S. Suri, Luca Saba

Takotsubo syndrome (TS) is an acute and reversible form of myocardial dysfunction characterized by distinctive left ventricular (LV) wall motion abnormalities that typically extend beyond the distribution of a single epicardial coronary artery. Cardiovascular magnetic resonance (CMR) has emerged as a key non-invasive imaging modality for the evaluation of TS, offering a comprehensive assessment of myocardial function and tissue characterization. Among CMR techniques, late gadolinium enhancement (LGE) is a cornerstone for the diagnosis and risk stratification of various cardiopathies, primarily identifying areas of myocardial fibrosis or expansion of the interstitial space. In TS, the typical CMR profile includes myocardial edema in the absence of corresponding LGE, a finding often used to support the diagnosis. However, emerging evidence has reported the presence of LGE in a subset of TS patients, raising questions about its prevalence, underlying mechanisms, and clinical significance. This narrative review aims to explore current evidence on LGE in TS, examining its pathophysiological basis, diagnostic value, and potential prognostic implications.

Takotsubo综合征(TS)是一种急性和可逆的心肌功能障碍形式,其特征是明显的左心室(LV)壁运动异常,通常超出单个心外膜冠状动脉的分布。心血管磁共振(CMR)已成为评估TS的关键非侵入性成像方式,提供心肌功能和组织特征的全面评估。在CMR技术中,晚期钆增强(LGE)是各种心脏病诊断和风险分层的基础,主要是识别心肌纤维化或间质空间扩张的区域。在TS中,典型的CMR特征包括心肌水肿,但没有相应的LGE,这一发现通常用于支持诊断。然而,新出现的证据已经报道了一部分TS患者中存在LGE,这对其患病率、潜在机制和临床意义提出了疑问。本文旨在探讨目前关于TS中LGE的证据,探讨其病理生理基础、诊断价值和潜在的预后意义。
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引用次数: 0
Left Ventricular Mass Index and Relative Wall Thickness Predict Atrial High-Rate Episodes in Patients With Pacemaker Implantation 左心室质量指数和相对壁厚预测心脏起搏器植入患者心房高发生率发作。
IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-10 DOI: 10.1111/echo.70363
Qin Zhang, Limin Xiang, Gege Zhao, Enbo Zhan, Jiali Tian
<div> <section> <h3> Background</h3> <p>Previous studies have shown that atrial high-rate episodes (AHREs) after cardiac device implantation are associated with the occurrence of stroke. This study aimed to explore the predictive value of echocardiographic indices, namely left ventricular mass index (LVMI) and relative wall thickness (RWT), for AHREs following implantation of a cardiac implantable electronic device (CIED).</p> </section> <section> <h3> Methods</h3> <p>This was a single-center retrospective study. Patients who underwent initial dual-chamber permanent pacemaker implantation at the Fifth Affiliated Hospital of Sun Yat-sen University from January 1, 2020 to March 30, 2025, were included. Routine postoperative pacemaker programming was performed, and the occurrence of AHREs was set as the study endpoint. Based on whether AHREs were recorded in pacemaker programming, patients were divided into the AHREs group and non-AHREs group. Clinical baseline data, serological indicators, and echocardiographic indices were compared between the two groups. Spearman correlation analysis was used to evaluate the correlations between echocardiographic indices and permanent pacemaker implantation parameters (pacemaker threshold, pacemaker sensing, atrial output voltage). Cox regression analysis was conducted to identify independent predictors of AHREs. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of these indices for AHREs. Additionally, Kaplan–Meier survival analysis was used to compare the cumulative incidence of AHREs among groups with different levels of RWT and LVMI.</p> </section> <section> <h3> Results</h3> <p>A total of 122 patients were included, and 45 patients developed AHREs during the follow-up period. Early diastolic mitral inflow E-wave velocity (<i>r</i> = 0.297, <i>p</i> < 0.001) and right atrial parameters (<i>r</i> = 0.280, <i>p</i> = 0.002) were positively correlated with pacemaker sensing parameters, with statistically significant yet weak correlations. Univariate Cox regression analysis revealed significant correlations between the occurrence of AHREs and early diastolic tricuspid inflow E-wave velocity, fractional shortening (FS), RWT, diastolic wall strain (DWS), LVMI, and type of cardiac remodeling (all <i>p</i> < 0.05). Multivariate Cox regression analysis demonstrated that lower RWT (<i>B</i> = −7.576, <i>p</i> = 0.007) and higher LVMI (<i>B</i> = 0.013, <i>p</i> = 0.003) were associated with an increased risk of AHREs. ROC curve analysis showed that the area under the curve (AUC) of LVMI and RWT for predicting AHREs were 0.722 and 0.716, respectively. Kaplan–Meier su
背景:既往研究表明,心脏装置植入后心房高率发作(AHREs)与卒中的发生有关。本研究旨在探讨超声心动图指标左室质量指数(LVMI)和相对壁厚(RWT)对心脏植入式电子装置(CIED)植入后AHREs的预测价值。方法:本研究为单中心回顾性研究。纳入2020年1月1日至2025年3月30日在中山大学第五附属医院首次行双腔永久性起搏器植入的患者。术后进行常规起搏器编程,以AHREs的发生为研究终点。根据起搏器编程中是否记录AHREs,将患者分为AHREs组和非AHREs组。比较两组患者的临床基线资料、血清学指标和超声心动图指标。采用Spearman相关分析评价超声心动图指标与永久性起搏器植入参数(起搏器阈值、起搏器感知、心房输出电压)的相关性。采用Cox回归分析确定AHREs的独立预测因素。采用受试者工作特征(ROC)曲线分析评价这些指标对AHREs的预测价值。此外,采用Kaplan-Meier生存分析比较不同RWT和LVMI水平组AHREs的累积发生率。结果:共纳入122例患者,45例患者在随访期间发生AHREs。结论:超声心动图指标与永久性起搏器植入参数之间存在相关性。LVMI和RWT是AHREs的独立预测因子。LVMI≥114.930或RWT的患者
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引用次数: 0
Detection of Tricuspid Valve Neoplasm 18 Months Post-Annuloplasty 环成形术后18个月三尖瓣肿瘤的检测
IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-06 DOI: 10.1111/echo.70315
Junyi Gao, Yafeng He, Xiaojing Ma, Juan Xia, Qian song, Chen chen

This article presents a case of a papillary fibroelastoma of the tricuspid valve discovered 18 months after tricuspid valve surgery. Through multimodal imaging, a relatively complete diagnosis and differential diagnosis of the tumor can be made.

本文报告一例在三尖瓣手术18个月后发现的三尖瓣乳头状纤维弹性瘤。通过多模态成像,可以对肿瘤进行较为完整的诊断和鉴别诊断。
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引用次数: 0
Reply to “Effect of Cardioprotection on Right Ventricular Function in Breast Cancer Patients Receiving Potentially Cardiotoxic Therapy—A Letter to the Editor” 回复“心脏保护对接受潜在心脏毒性治疗的乳腺癌患者右心室功能的影响——致编辑的一封信”
IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-06 DOI: 10.1111/echo.70367
Maria Riccarda Del Bene, Icro Meattini, Giuseppe Barletta
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引用次数: 0
Thinking Beyond the Plane: How Three-Dimensional Echocardiography Is Redefining Peri-Device Leak Assessment After Left Atrial Appendage Occlusion 超越平面的思考:三维超声心动图如何重新定义左心耳闭塞后装置周围泄漏评估
IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-06 DOI: 10.1111/echo.70366
Gianpiero D'Amico, Antonella Carvelli
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引用次数: 0
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Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques
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