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Analysis of the 60/60 Sign and Other Right Ventricular Parameters by 2D Transthoracic Echocardiography as Adjuncts to Diagnosis of Acute Pulmonary Embolism.

Cureus 2021 Mar 10;13(3):e13800. Epub 2021 Mar 10.

Interventional Cardiology, Apex Heart Institute, Ahmedabad, IND.

Introduction The 60/60 sign in 2D transthoracic echocardiography (TTE) - a combination of pulmonary acceleration time (PAT) less than 60 milliseconds and tricuspid regurgitation (TR) jet gradient of less than 60 mmHg - has been found to be specific for the diagnosis of pulmonary embolism (PE). Materials and methods An observational prospective analysis was carried out on cases of suspected PE presenting to the emergency room (ER). TTE was performed on all cases with suspected PE prior to computed tomography pulmonary angiography (CTPA). Read More

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Echocardiographic assessment of right ventricular systolic function in healthy Beagle dogs compared to high field cardiac magnetic resonance imaging.

Vet J 2021 May 6;271:105653. Epub 2021 Mar 6.

Department of Clinical Diagnostics and Services, Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.

Ten healthy Beagle dogs were used to compare selected echocardiographic parameters of right ventricular (RV) systolic function with high field cardiac magnetic resonance imaging (MRI). All dogs underwent complete transthoracic echocardiography before and during anesthesia, as well as cardiac MRI with determination of morphology-based ejection fraction, and phase contrast angiography-derived stroke volume. A correlation analysis was carried out between echocardiographic and MRI parameters. Read More

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Ratio between vena contracta width and tricuspid annular diameter: prognostic value in secondary tricuspid regurgitation.

J Am Soc Echocardiogr 2021 Apr 8. Epub 2021 Apr 8.

Department of Cardiology, Leiden University Medical Center, 2300RC Leiden, The Netherlands. Electronic address:

Background: Conventional approaches for the assessment of secondary tricuspid regurgitation (STR) severity do not correct for right heart dimensions. We hypothesized that STR severity can be proportional or disproportional to the dilation of the tricuspid annulus (TA) and we investigated the prognostic impact of this novel definition.

Methods: A total of 334 patients with moderate-to-severe STR and preserved left ventricular systolic function were included. Read More

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Iron deficiency is associated with impaired biventricular reserve and reduced exercise capacity in patients with unexplained dyspnea.

J Card Fail 2021 Apr 7. Epub 2021 Apr 7.

Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.

Background: Iron deficiency (ID) is frequent and associated with diminished exercise capacity in heart failure (HF), but its contribution to unexplained dyspnea without a HF diagnosis at rest remains unclear.

Methods: Consecutive patients with unexplained dyspnea and normal echocardiography and pulmonary function tests at rest underwent prospective standardized cardiopulmonary exercise testing with echocardiography (CPETecho) in a tertiary care dyspnea clinic. ID was defined as ferritin <300µg/l and transferrin saturation (TSAT)<20% and its impact on peak oxygen uptake (peakVO), biventricular response to exercise, and peripheral oxygen extraction was assessed. Read More

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Pulmonary haemodynamic response to exercise in highlanders lowlanders.

ERJ Open Res 2021 Apr 6;7(2). Epub 2021 Apr 6.

Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland.

The aim of the study was to investigate the pulmonary haemodynamic response to exercise in Central Asian high- and lowlanders. This was a cross-sectional study in Central Asian highlanders (living >2500 m) compared with lowlanders (living <800 m), assessing cardiac function, including tricuspid regurgitation pressure gradient (TRPG), cardiac index and tricuspid annular plane systolic excursion (TAPSE) by echocardiography combined with heart rate and oxygen saturation measured by pulse oximetry ( ) during submaximal stepwise cycle exercise (10 W increase per 3 min) at their altitude of residence (at 760 m or 3250 m, respectively). 52 highlanders (26 females; aged 47. Read More

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Echocardiographic assessment of chamber size and ventricular function during the first year after heart transplantation.

Clin Physiol Funct Imaging 2021 Apr 8. Epub 2021 Apr 8.

Lund University, Department of Clinical Sciences Lund, Cardiology, Lund, Sweden.

Aims: Detecting changes in ventricular function after orthotopic heart transplantation (OHT) using transthoracic echocardiography (TTE) is important but interpretation of findings is complicated by lack of data on early graft adaptation. We sought to evaluate echocardiographic measures of ventricular size and function the first year following OHT including speckle tracking derived strain. We also aimed to compare echocardiographic findings to hemodynamic parameters obtained by right heart catheterization (RHC). Read More

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Prognostic value and reversibility of liver stiffness in patients undergoing tricuspid annuloplasty.

Eur Heart J Cardiovasc Imaging 2021 Apr 7. Epub 2021 Apr 7.

Division of Cardiology, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.

Background: Liver stiffness (LS) assessed by transient elastography is associated with adverse events in patients with heart failure. However, the predictive value of LS for adverse outcome is uncertain in patients undergoing tricuspid annuloplasty (TA). This study sought to evaluate the prognostic value and reversibility of LS in patients undergoing TA during left-sided valve surgery. Read More

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Prognostic Role of TAPSE to PASP Ratio in Patients Undergoing MitraClip Procedure.

J Clin Med 2021 Mar 2;10(5). Epub 2021 Mar 2.

Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), 37007 Salamanca, Spain.

Background: Transcatheter mitral valve repair (TMVR) is an effective therapy for high-risk patients with severe mitral regurgitation (MR) but heart failure (HF) readmissions and death remain substantial on mid-term follow-up. Recently, right ventricular (RV) to pulmonary arterial (PA) coupling has emerged as a relevant prognostic predictor in HF. In this study, we aimed to assess the prognostic value of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP) ratio as a non-invasive measure of RV-to-PA coupling in patients undergoing TMVR with MitraClip (Abbott, CA, USA). Read More

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CorMatrix Anterior Leaflet Augmentation of the Tricuspid Valve: Midterm Results.

Heart Surg Forum 2021 03 8;24(2):E261-E266. Epub 2021 Mar 8.

Cardiothoracic Department, Heart and Lung Centre, Royal Wolverhampton NHS Trust, Wolverhampton, UK.

Background: Tricuspid annuloplasty is the most common surgical approach to correct tricuspid regurgitation (TR). In some patients, however, anterior leaflet patch augmentation may be necessary to optimize tricuspid competence. We reviewed our center cohort over the midterm and long term. Read More

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Impact of Right Ventricular Function on Left Ventricular Torsion and Ventricular Deformations in Pulmonary Artery Hypertension Patients.

Cardiovasc Hematol Disord Drug Targets 2021 Apr 1. Epub 2021 Apr 1.

Department of cardiovascular technology, Manipal college of Health professions, Manipal Academy of Higher Education, Manipal. India.

Introduction: Ventricular interdependence in pulmonary arterial hypertension (PAH) by the use of most recent echocardiographic techniques are still rare. The current case-controlled study aims to assess left ventricular (LV) torsion in patients with PAH.

Methods: The study included 42 cases of moderate to severe PAH and 42 age and gender-matched healthy controls between March 2016 and January 2018. Read More

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Multicentre prospective observational study exploring the predictive value of functional echocardiographic indices for early identification of preterm neonates at risk of developing chronic pulmonary hypertension secondary to chronic neonatal lung disease.

BMJ Open 2021 Mar 31;11(3):e044924. Epub 2021 Mar 31.

Paediatrics, Sinai Health System, Toronto, Ontario, Canada

Introduction: Although chronic pulmonary hypertension (cPH) secondary to chronic neonatal lung disease is associated with increased mortality and respiratory and neurodevelopmental morbidities, late diagnosis (typically ≥36 weeks postmenstrual age, PMA) and the use of qualitative echocardiographic diagnostic criterion (flat interventricular septum in systole) remain significant limitations in clinical care. Our objective in this study is to evaluate the utility of relevant quantitative echocardiographic indices to identify cPH in preterm neonates, early in postnatal course and to develop a diagnostic test based on the best combination of markers.

Methods And Analysis: In this ongoing international prospective multicentre observational diagnostic accuracy study, we aim to recruit 350 neonates born <27 weeks PMA and/or birth weight <1000 g and perform echocardiograms in the third week of age and at 32 weeks PMA (early diagnostic assessments, EDA) in addition to the standard diagnostic assessment (SDA) for cPH at 36 weeks PMA. Read More

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Clinical implications of late-onset right ventricular failure after implantation of a continuous-flow left ventricular assist device as bridge to transplantation.

Eur J Cardiothorac Surg 2021 Mar 30. Epub 2021 Mar 30.

Thorax and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, NRW, Ruhr-University Bochum, Germany.

Objectives: The development of late-onset right ventricular failure (LoRVF) that occurs months after a continuous-flow left ventricular assist device (LVAD) is implanted is a clinical problem that warrants investigation. Our goal was to study the incidence, clinical manifestations and prognosis of LoRVF in a population of patients who received an LVAD as bridge to transplantation.

Methods: Data were analysed from 97 consecutive patients who received an LVAD as bridge to transplantation and underwent a right heart catheterization at least 3 months after receiving an LVAD implantation. Read More

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Left ventricular longitudinal wall fractional shortening accurately predicts longitudinal strain in critically ill patients with septic shock.

Ann Intensive Care 2021 Mar 30;11(1):52. Epub 2021 Mar 30.

Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, S-58185, Linköping, Sweden.

Background: Left ventricular longitudinal strain (LVLS) may be a sensitive indicator of left ventricular (LV) systolic function in patients with sepsis, but is dependent on high image quality and analysis software. Mitral annular plane systolic excursion (MAPSE) and the novel left ventricular longitudinal wall fractional shortening (LV-LWFS) are bedside echocardiographic indicators of LV systolic function that are less dependent on image quality. Both are sparsely investigated in the critically ill population, and may potentially be used as surrogates for LVLS. Read More

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What are the Echocardiographic Findings of Acute Right Ventricular Strain that Suggest Pulmonary Embolism?

Anaesth Crit Care Pain Med 2021 Mar 26:100852. Epub 2021 Mar 26.

Department of Emergency Medicine, Rush University Medical Center, 1620 W. Harrison Street, Chicago, IL 60612, USA.

Introduction: Pulmonary embolism (PE) is a potentially fatal disease encountered in the hospital setting. Prompt diagnosis and management can improve outcomes and survival. Unfortunately, a PE may be difficult to diagnose in a timely manner. Read More

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Diastolic and Systolic Cardiac Dysfunction in Pectus Excavatum: Relationship to Exercise and Malformation Severity.

Radiol Cardiothorac Imaging 2020 Oct 15;2(5):e200011. Epub 2020 Oct 15.

Department of Cardiology, Clínica Olivos, Buenos Aires, Argentina (I.M.R.); Department of Cardiology, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina (I.M.R., M.M.); Department of Surgery, Fundación Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina (M.M.F., G.B.M., L.T.); Department of Cardiovascular Imaging, Diagnostico Maipú, Av. Maipú 1668, Vicente López, Buenos Aires, Argentina (C.C., P.C., G.A.R.G.); and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina (G.A.R.G.).

Purpose: To explore stress echocardiographic findings among patients with pectus excavatum (PEX) and their relationship with malformation severity.

Materials And Methods: A prospective registry involving consecutive patients with a diagnosis of isolated PEX referred to undergo chest CT and stress echocardiography to evaluate surgical candidacy and/or to define treatment strategies was developed. Malformation indexes were evaluated using chest CT. Read More

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October 2020

Longitudinal Associations of Fitness and Obesity in Young Adulthood With Right Ventricular Function and Pulmonary Artery Systolic Pressure in Middle Age: The CARDIA Study.

J Am Heart Assoc 2021 Apr 28;10(7):e016968. Epub 2021 Mar 28.

Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.

Background Low cardiorespiratory fitness (CRF) and obesity are risk factors for heart failure but their associations with right ventricular (RV) systolic function and pulmonary artery systolic pressure (PASP) are not well understood. Methods and Results Participants in the CARDIA (Coronary Artery Risk Development in Young Adults) study who underwent maximal treadmill testing at baseline and had a follow-up echocardiographic examination at year 25 were included. A subset of participants had repeat CRF and body mass index (BMI) assessment at year 20. Read More

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Determinants of maximal oxygen uptake in patients with heart failure.

ESC Heart Fail 2021 Mar 27. Epub 2021 Mar 27.

Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Instituto Investigación Biomedica A Coruña, A Coruña, Spain.

Aims: Maximum oxygen uptake (VO ) is an essential parameter to assess functional capacity of patients with heart failure (HF). We aimed to identify clinical factors that determine its value, as they have not been well characterized yet.

Methods: We conducted a retrospective, observational, single-centre study of 362 consecutive patients with HF who underwent cardiopulmonary exercise testing (CPET) as part of standard clinical assessment since 2009-2019. Read More

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Noninvasive Assessment of Right Ventricle Function and Pulmonary Artery Pressure Using Transthoracic Echocardiography in Women With Pre-Eclampsia: An Exploratory Study.

Cureus 2021 Feb 18;13(2):e13419. Epub 2021 Feb 18.

Pediatrics, University of Alabama at Birmingham, Birmingham, USA.

Background and objective Pre-eclampsia (PEC) is associated with the release of anti-angiogenic factors that are incriminated in raising systemic and pulmonary vascular resistance (PVR). Compared to the left heart and systemic circulation, much less attention has been paid to the right heart and pulmonary circulation in patients with PEC. We used transthoracic echocardiography (TTE) to estimate pulmonary artery (PA) pressure and right ventricular (RV) function in women with PEC. Read More

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February 2021

Fibrosis-4 index reflects right ventricular function and prognosis in heart failure with preserved ejection fraction.

ESC Heart Fail 2021 Mar 24. Epub 2021 Mar 24.

Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Pharmaceutical Sciences Medicine, Dentistry, Okayama, Japan.

Aims: Fibrosis-4 index (FIB-4 index), calculated by age, aspartate aminotransferase, alanine aminotransferase, and platelet count, is a simple marker to evaluate liver fibrosis and is associated with right-sided heart failure. However, the clinical relevance of FIB-4 in patients with heart failure with preserved ejection fraction (HFpEF) remains unclear. We investigated the prognostic implication of the FIB-4 index regarding right ventricular dysfunction in patients with HFpEF. Read More

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Indication of the prognosis of pulmonary hypertension by using CMR function parameters.

Eur Radiol 2021 Mar 18. Epub 2021 Mar 18.

Department of Radiology, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China.

Objective: This study aimed to compare the cardiac function among different sub-types of pulmonary hypertension (PH) and to explore the independent predictors of major adverse cardiovascular events (MACE).

Methods: Eighty-seven PH patients diagnosed by right heart catheterization (RHC) were recruited. Patients underwent cardiac magnetic resonance (CMR) and RHC examination within 2 weeks. Read More

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Comparison of Troponin I levels versus myocardial dysfunction on prognosis in sepsis.

Intern Emerg Med 2021 Mar 17. Epub 2021 Mar 17.

High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Firenze, Italy.

In the context of sepsis, we tested the relationship between echocardiographic findings and Troponin, and their impact on prognosis. In this prospective study, we enrolled 325 septic patients (41% with shock), not mechanically ventilated, between October, 2012 and June, 2019 among those admitted to our High-Dependency Unit. By echocardiography within 24 h from the admission, sepsis-induced myocardial dysfunction (SIMD) was defined as left ventricular (LV) systolic dysfunction (speckle-tracking-based global longitudinal peak systolic strain, GLS, >  - 14%) and/or right ventricular (RV) systolic dysfunction (Tricuspid Annular Plane Systolic Excursion, TAPSE < 16 mm). Read More

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Improving adherence to echocardiogram reporting guidelines in patients with repaired tetralogy of fallot: A quality improvement initiative.

Echocardiography 2021 Mar 17. Epub 2021 Mar 17.

Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.

Background: In patients with repaired tetralogy of Fallot (TOF), key echocardiogram report elements have been identified, but poor adherence has been demonstrated, particularly for quantitative assessment. We report a quality improvement effort to improve adherence at our institution, with a focus on increasing quantitative assessment of right ventricular (RV) function.

Methods: Baseline compliance was established by a 3-month retrospective review of outpatient echocardiogram reports. Read More

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Sex differences in congestive markers in patients hospitalized for acute heart failure.

ESC Heart Fail 2021 Mar 11. Epub 2021 Mar 11.

Cardiovascular Division/Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Aims: We sought to examine sex differences in congestion in patients hospitalized for acute heart failure (AHF). Understanding congestive patterns in women and men with AHF may provide insights into sex differences in the presentation and prognosis of AHF patients.

Methods And Results: In a prospective, two-site study in adults hospitalized for AHF, four-zone lung ultrasound (LUS) was performed at the time of echocardiography at baseline (LUS1) and, in a subset, pre-discharge (LUS2). Read More

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Preliminary study on the evaluation of mitral annulus displacement in normal fetuses by automated cardiac motion quantitation.

J Matern Fetal Neonatal Med 2021 Mar 11:1-9. Epub 2021 Mar 11.

Department of Diagnostic Ultrasound and Echocardiography, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China.

Objectives: The aim of this study was to assess the characteristics of mitral annular plane systolic excursion (MAPSE) in different longitudinal directions in normal fetuses using a new method, automatic cardiac motion quantification (aCMQ).

Methods: A cross-sectional study was conducted in 164 fetuses with structurally normal hearts. The time-displacement curves of the septal mitral annulus (SMA) in three directions, including point A, B and C (MAPSE-SMA-A, MAPSE-SMA-B, MAPSE-SMA-C), were recorded by aCMQ. Read More

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Right Ventricular Flow Dynamics in Dilated Right Ventricles: Energy Loss Estimation Based on Blood Speckle Tracking Echocardiography-A Pilot Study in Children.

Ultrasound Med Biol 2021 Jun 6;47(6):1514-1527. Epub 2021 Mar 6.

Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Children's Clinic, St. Olav's University Hospital, Trondheim, Norway.

Using blood speckle tracking (BST) based on high-frame-rate echocardiography (HFRE), we compared right ventricle (RV) flow dynamics in children with atrial septal defects (ASDs) and repaired tetralogy of Fallot (rTOF). Fifty-seven children with rTOF with severe pulmonary insufficiency (PI) (n = 21), large ASDs (n = 11) and healthy controls (CTL, n = 25) were included. Using a flow phantom, we studied the effects of imaging plane and smoothing parameters on 2-D energy loss (EL). Read More

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Comparison of semi-automated versus manual quantitative right ventricular assessment in tetralogy of Fallot.

Cardiol Young 2021 Mar 9:1-7. Epub 2021 Mar 9.

Department of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA.

Background: Tetralogy of Fallot is a congenital heart defect diagnosed in infancy. Assessment of right ventricular size and function is important for evaluation of patients with tetralogy of Fallot, but these quantitative measures are challenging by echocardiography. This study evaluates a semi-automated software (EchoInsight®, Epsilon Imaging) by comparing its measures to manual measures in children with tetralogy of Fallot. Read More

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Right ventricular echocardiographic parameters associated with prothrombotic abnormalities in normotensive patients with acute pulmonary embolism.

Int J Cardiol 2021 Mar 5. Epub 2021 Mar 5.

Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; The John Paul II Hospital, Krakow, Poland.

Background: In acute pulmonary embolism (PE) right ventricular (RV) pressure overload negatively affects prognosis. Recently we have shown that RV dilatation is associated with a prothrombotic state in PE. We investigated which RV echocardiographic parameters best indicate prothrombotic alterations in acute PE. Read More

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Left ventricular reverse remodeling and function by strain analysis in aortic stenosis: A CMR analysis of the EPICHEART study.

Rev Port Cardiol 2021 Mar 3;40(3):153-164. Epub 2021 Mar 3.

Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal.

Introduction And Objectives: In severe aortic stenosis (AS), the impact of aortic valve replacement (AVR) on left ventricular (LV) systolic function assessed by strain and measured by echocardiography or cardiac magnetic resonance (CMR) has been controversial. We aimed to investigate LV systolic myocardial function changes six months after AVR using global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain derived from CMR imaging.

Methods: We included 39 severe AS patients (69. Read More

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Right Ventricular-Pulmonary Arterial Coupling in Secondary Tricuspid Regurgitation.

Am J Cardiol 2021 Mar 3. Epub 2021 Mar 3.

Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address:

Chronic pressure-overload induces right ventricular (RV) adaptation to maintain RV-pulmonary arterial (PA) coupling. RV remodeling is frequently associated with secondary tricuspid regurgitation (TR) which may accelerate uncoupling. Our aim is to determine whether the non-invasive analysis of RV-PA coupling could improve risk stratification in patients with secondary TR. Read More

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Time interval between E and E' waves can predict complicated clinical course in patients with acute pulmonary embolism.

J Clin Ultrasound 2021 Mar 3. Epub 2021 Mar 3.

Department of Cardiology, Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey.

Purpose: Acute pulmonary embolism is a life-threatening cardiothoracic emergency leading to right ventricle systolic and diastolic dysfunction. In the present study, we investigated the right ventricle diastolic function and its predictive value in patients with acute pulmonary embolism.

Material And Methods: Were prospectively recruited in this study 621 patients diagnosed with acute pulmonary embolism between December 2015 and June 2019. Read More

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