scholarly journals A Predictive Model for Dilated Cardiomyopathy With Pulmonary Hypertension

2021 ◽  
Author(s):  
Jiahua Liang ◽  
Ruochen Zhu ◽  
Yi Yang ◽  
Rong Li ◽  
Chuangxiong Hong ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Dilated Cardiomyopathy ◽  
Predictive Model ◽  
External Validation ◽  
Systolic Pressure ◽  
Vital Signs ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Chronic Obstructive ◽  
The Impact

Abstract Background: Dilated cardiomyopathy (DCM) is defined as a serious cardiac disorder caused by the presence of left ventricular dilatation and contractile dysfunction in the absence of severe coronary artery disease and abnormal loading conditions. The incidence of cardiac death is markedly higher in patients with DCM with pulmonary hypertension (PH) than in DCM patients without PH. However, no previous studies have constructed a predictive model to predict PH in patients with DCM.Methods: Data from 218 DCM patients were collected. The diagnostic criterion for PH by echocardiography was a pulmonary artery systolic pressure (PASP) ≥ 40 mmHg. Basic information, vital signs, comorbidities and biochemical data of each patient were determined. The impact of each parameter on PH was analysed by univariable and multivariable analyses, the data from which were employed to establish a predictive model. Finally, the discriminability, calibration ability, and clinical efficacy of the model were verified for both the modelling group and the external validation group.Results: We successfully applied a history of chronic obstructive pulmonary disease (COPD) or chronic bronchitis, systolic murmur (SM) at the tricuspid area, SM at the apex and brain natriuretic peptide (BNP) level to establish a model for predicting PH in DCM. The model was proven to have high accuracy and good discriminability, calibration ability, and clinical application value.Conclusions: A model for predicting PH in patients with DCM was successfully established. The new model is reliable for predicting DCM with PH and has good clinical applicability.

scholarly journals Prevalence of Pulmonary Hypertension in an Unselected Community-Based Population: A Retrospective Echocardiographic Study—RES-PH Study

2021 ◽  
Vol 11 (6) ◽  
pp. 489
Author(s):  
Egidio Imbalzano ◽  
Marco Vatrano ◽  
Alberto Lo Gullo ◽  
Luana Orlando ◽  
Alberto Mazza ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Pulmonary Artery Systolic Pressure ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Equal Distribution ◽  
Ventricular Ejection Fraction

Introduction. The actual prevalence of pulmonary hypertension (PH) in Italy is unknown. Echocardiography is useful in the screening of patients with suspected PH by estimation of the pulmonary artery systolic pressure (PASP) from the regurgitant tricuspid flow velocity evaluation, according to the simplified Bernoulli equation. Objectives. We aimed to evaluate the frequency of suspected PH among unselected patients. Methods. We conducted a retrospective cross-sectional database search of 7005 patients, who underwent echocardiography, to estimate the prevalence of PH, between January 2013 and December 2014. Medical and echocardiographic data were collected from a stratified etiological group of PH, using criteria of the European Society of Cardiology classifications. Results. The mean age of the study population was 57.1 ± 20.5 years, of which 55.3% were male. The prevalence of intermediate probability of PH was 8.6%, with nearly equal distribution between men and women (51.3 vs. 48.7%; p = 0.873). The prevalence of high probability of PH was 4.3%, with slightly but not significant higher prevalence in female patients (43.2 vs. 56.8%; p = 0.671). PH is predominant in patients with chronic obstructive pulmonary disease (COPD) or left ventricle (LV) systolic dysfunction and related with age. PASP was significantly linked with left atrial increase and left ventricular ejection fraction. In addition, an increased PASP was related to an enlargement of the right heart chamber. Conclusions. PH has a frequency of 4.3% in our unselected population, but the prevalence may be more relevant in specific subgroups. A larger epidemiological registry could be an adequate strategy to increase quality control and identify weak points in the evaluation and treatment of these patients.

Abstract 15388: Persistent Pulmonary Hypertension After Transcatheter Aortic Valve Implantation: Impact on Mortality

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Maria Drakopoulou ◽  
Konstantinos Stathogiannis ◽  
Konstantinos Toutouzas ◽  
George Latsios ◽  
Andreas Synetos ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Pulmonary Artery ◽  
Severe Aortic Stenosis ◽  
Systolic Pressure ◽  
Right Atrial ◽  
Pulmonary Artery Systolic Pressure ◽  
End Point ◽  
The Right ◽  
The Impact

Objective: Severe aortic stenosis leads to increased pulmonary arterial systolic pressure. A controversy still remains regarding the impact of persistent pulmonary hypertension (PHT) on prognosis of patients undergoing transcatheter aortic valve implantation (TAVI). We sought to investigate the impact of persistent PHT on 2-year all-cause mortality of patients with severe aortic stenosis following TAVI. Methods: Patients with severe and symptomatic aortic stenosis (effective orifice area [EOA]≤1 cm 2 ) who were scheduled for TAVI with a self-expanding valve at our institution were prospectively enrolled. Prospectively collected echocardiographic data before and after TAVI were retrospectively analyzed in all patients. Pulmonary artery systolic pressure was estimated as the sum of the right ventricular to the right atrial gradient during systole and the right atrial pressure. PHT following TAVI was classified as absent if <35 mmHg and persistent if ≥35 mmHg. Primary clinical end-point was 2-year all-cause mortality defined according to the criteria proposed by the Valve Academic Research Consortium-2. Results: Hundred and forty patients (mean age: 82±9 years) were included in the study. The primary clinical end point occurred in 17 patients (12%) during a median follow-up period of 2 years. Mean pulmonary artery systolic pressure was reduced in all patients following TAVI (45±9 versus 41±6 mmHg, p<0.01). Mortality rate was higher in patients with persistent PHT compared to patients with normal pulmonary artery systolic pressure following TAVI (26% versus 14 %, p<0.01). Patients that reached the primary clinical end point had a higher post procedural mean systolic pulmonary pressure (43±9 versus 39±6 mmHg, p=0.02). In multivariate regression analysis, persistence of PHT (OR: 2.51, 95% CI: 1.109-7.224, p=0.01) was an independent predictor of long-term mortality. Conclusions: The persistence of pulmonary hypertension after TAVI is associated with long term mortality. Identifying the population that will clearly benefit from TAVI is still need to be validated by larger trials.

scholarly journals Degree of Pulmonary Hypertension in Patients of COPD Attending a Tertiary Care Hospital

2021 ◽  
Vol 6 (05) ◽  
pp. 312-315
Author(s):  
Afshan Ali Shaik ◽  
Durga Lawande
Keyword(s):  
Pulmonary Hypertension ◽  
Tertiary Care ◽  
Systolic Pressure ◽  
Biomass Fuel ◽  
Pulmonary Artery Systolic Pressure ◽  
Chronic Obstructive ◽  
Pulmonary Medicine ◽  
Care Hospital ◽  
Copd Patients ◽  
Increased Risk

Introduction: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in India. The development of pulmonary hypertension (PH) in COPD adversely affects survival and exercise capacity and is associated with an increased risk of severe acute exacerbation. Aims and Objectives: Present study aimed to describe the distribution of echocardiographically assessed pulmonary artery systolic pressure in the COPD patients attending pulmonary medicine OPD, to estimate the proportion of PH among such patients and to identify associated factors. Methodology: This Cross sectional study was done on 145 patients of COPD fulfilling the inclusion criteria were included in this study. These patients were evaluated for the presence of PH using chest X-ray, 2D-Echocrdiography and electrocardiogram. Results: Pulmonary hypertension was present in 17 (29.8%) patients with moderate, 36 (60%) with severe and 18 (72%) with very severe COPD. Mild PH was seen in 52(73%), moderate in 11(15.4%) and severe in 8(11.2%) patients. Patient exposed to both smoking and biomass fuel smoke had more frequent occurrence of PH (56.8%) as compared to exposure to single risk factor of either tobacco smoke (47.1%) or biomass fuel (52.4%). Thus overall proportion of PH among reported cases of COPD patients was 48.6% in our study. Conclusion: With the increase in severity of COPD the proportion of PH rises. This study emphasizes the early detection of COPD and the importance of screening for PH through clinical assessment and non- invasive techniques 2-D Echocardiography.

Pulmonary Venous Hypertension: A Pulmonologist's Perspective

2011 ◽  
Vol 10 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Francisco Soto
Keyword(s):  
Pulmonary Hypertension ◽  
Systolic Function ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Venous Hypertension ◽  
Systemic Hypertension ◽  
Pulmonary Artery Systolic Pressure ◽  
Obstructive Sleep ◽  
Group 2 ◽  
Group 1

Increased pulmonary hypertension (PH) awareness in the general public and among health providers has led to an increase in referral of patients who are found to have elevated estimates of pulmonary artery systolic pressure (PASP) on a transthoracic echocardiogram (TTE), without other strong features suggestive of precapillary PH (pulmonary arterial hypertension; PAH). Some of these patients undergo TTE as part of their workup for unexplained dyspnea that appears out of proportion to their other comorbidities. Many of these patients are older individuals with underlying conditions such as systemic hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), and obstructive sleep apnea (OSA). While some of them may have PAH, accumulated experience in the PH community suggests that many of these patients will be ultimately found to have elevated left ventricular (LV) filling pressures and impaired LV relaxation as the cause of their dyspnea and elevation of pulmonary pressures on TTE.12 These findings are consistent with a form of Group 2 PH termed LV diastolic dysfunction, more recently termed heart failure with preserved left ventricular systolic function (HFpEF) (Table 1).2 Other forms of Group 2 PH, defined as “pulmonary hypertension owing to left-sided heart disease,” include LV systolic dysfunction or left-sided valvular disease.2 For the purpose of this article, the term pulmonary venous hypertension (PVH) will be used to refer to Group 2 PH, HFpEF. Being able to accurately discriminate PAH (precapillary; Group 1 PH) from PVH (postcapillary; Group 2 PH) is critical to determine and apply the appropriate treatment course. This is a difficult, yet frequently encountered clinical dilemma, which can fall into a “gray zone” with respect to clinical classification. We will provide important clinical features that should heighten the clinician's awareness and suspicion of this rapidly growing phenomenon. These features are critical when trying to differentiate PAH (Group 1 PH) from PVH (Group 2 PH).

Utility Of Pre-Chemotherapy Echocardiograms

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2950-2950
Author(s):  
John Allen Steuter ◽  
Philip Bierman ◽  
R. Gregory Bociek ◽  
Martin Bast
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Function ◽  
Chemotherapy Regimen ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Valvular Disease ◽  
Pulmonary Artery Systolic Pressure ◽  
Severe Pulmonary Hypertension ◽  
History Of ◽  
Cardiac Diagnosis

Abstract Anthracycline-based chemotherapy is widely used in a variety of regimens for Hodgkin’s Lymphoma (HL) and Non-Hodgkin’s Lymphoma (NHL). Unfortunately this agent is associated with cardiotoxicity, especially in larger cumulative doses. Doxorubicin cardiotoxicity is characterized by a dose-dependent decline in mitochondrial oxidative phosphorylation. Reactive oxygen species, generated by the interaction of doxorubicin with iron, can then damage the myocytes causing myofibrillar loss, cytoplasmic vacuolization, and apoptosis. Current NCCN guidelines for HL and NHL state that left ventricle function is recommended in patients who will receive such chemotherapy. Subsequent evaluations are recommended at a cumulative dose of doxorubicin of at least 300 mg/m² and periodically thereafter during the course of therapy. Despite these recommendations, there is little literature about the usefulness of this approach, the rate of abnormal findings, and whether routine testing changes management. A list of patients with HL or NHL treated with anthracycline-based chemotherapy from the University of Nebraska Medical Center from August 2004-May 2012 was obtained from our Lymphoma Registry. Baseline characteristics of age, disease diagnosis, gender, and prior history of cardiac diagnosis were collected. Prior cardiac diagnosis specified as patients with a past history of atrial fibrillation/flutter, supraventricular tachycardia, heart block requiring pacemaker implantation, coronary artery disease, valvular disease, pulmonary hypertension, or cardiomyopathy. Charts were reviewed for pre-chemotherapy evaluation of left ventricular function and the method of evaluation (echocardiogram, nuclear, cardiac MRI were included). Additionally, post treatment evaluation of cardiac function was evaluated for any change. The individual therapy for each patient was reviewed to determine if findings from the cardiac evaluation modified treatment regimens. A left ventricular function less than 50% was considered abnormal. Echocardiogram findings of moderate to severe valvular disease, diastolic dysfunction (grade 1-3), and moderate or severe pulmonary hypertension (moderate = pulmonary artery systolic pressure of 45-60, severe = pulmonary artery systolic pressure of > 60) were collected. We identified 309 patients from the UNMC lymphoma database. Of these 219 (71%) had an echocardiogram performed prior to therapy and documented in the patient record. Their mean age was 54.2 years of age with 53% of them being male and 47% female. 188 of the 219 (86%) had no prior cardiac diagnosis as defined previously. From this group 22 of the 188 (10%) had a pre-chemotherapy echocardiogram that demonstrated one of the following: moderate-severe valvular disease, diastolic dysfunction, moderate-severe pulmonary hypertension or abnormal EF (<50%). However, none of these findings altered the chemotherapy regimen for the 22 patients. 31 of the 219 patients with echocardiograms carried a prior cardiac diagnosis. 4 of the 31 had an alteration in their chemotherapy regimen as a result. Post therapy echocardiograms showed no change in cardiac function. 5 of the 219 patients were diagnosed with adriamycin induced cardiomyopathy following treatment. All 5 patients had no prior cardiac history and pre-chemotherapy echocardiograms were normal. These finding suggest that current methods of evaluating cardiac function prior to chemotherapy and risk stratifying patients are inadequate and do not alter patient outcomes. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Three-Dimensional Right Ventriculo-Arterial Coupling as an Independent Correlate of Severe Heart Failure Symptoms in Patients with Dilated Cardiomyopathy

2021 ◽  
Author(s):  
Aura Vijiiac ◽  
Sebastian Onciul ◽  
Silvia Deaconu ◽  
Radu Vatasescu ◽  
Claudia Guzu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Dilated Cardiomyopathy ◽  
Three Dimensional ◽  
Severe Heart Failure ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Characteristic Analysis

Background: Right ventricular-pulmonary artery coupling (RVPAC) is a predictor of outcome in pulmonary hypertension. However, the role of this parameter in dilated cardiomyopathy (DCM) remains to be established. The aim of this study was to assess the contribution of RVPAC to the occurrence of severe heart failure (HF) symptoms in patients with DCM using three-dimensional (3D) echocardiography. Methods: We prospectively screened 139 outpatients with DCM, 105 of whom were enrolled and underwent 3D echocardiographic assessment. RVPAC was estimated non-invasively as the 3D right ventricular stroke volume (SV) to end-systolic volume (ESV) ratio. Severe HF symptoms were defined by New York Heart Association (NYHA) class III or IV. We evaluated differences in RVPAC across NYHA classes and the ability of RVPAC to predict severe symptoms. Results: Mean left ventricular (LV) ejection fraction was 28±7%. Mean RVPAC was 0.77±0.30 and it was significantly more impaired with increasing symptom severity (p=0.001). RVPAC was the only independent correlate of severe HF symptoms, after adjusting for age, diuretic use, LV systolic function, LV diastolic function and pulmonary artery systolic pressure (OR 0.035 [95% CI, 0.004 – 0.312], p=0.003). By receiver-operating characteristic analysis, the RVPAC cut-off value for predicting severely symptomatic status was 0.54 (area under the curve=0.712, p<0.001). Conclusion: 3D echocardiographic SV/ESV ratio is an independent correlate of severe HF symptoms in patients with DCM. 3D RVPAC might prove to be a useful risk stratification tool for these patients, should it be further validated in larger studies.

scholarly journals The Circulating MicroRNA-206 Level Predicts the Severity of Pulmonary Hypertension in Patients with Left Heart Diseases

2017 ◽  
Vol 41 (6) ◽  
pp. 2150-2160 ◽  
Author(s):  
Peng Jin ◽  
Wenzhu Gu ◽  
Yayu Lai ◽  
Wei Zheng ◽  
Qi Zhou ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Heart Diseases ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Pulmonary Artery Systolic Pressure ◽  
Circulating Microrna ◽  
Left Heart ◽  
Ventricular Ejection Fraction

Background: MicroRNA-206 (miR-206), a muscle-specific miRNA, regulates the growth of cardiac myocytes and pulmonary artery smooth muscle cells. However, it remains unknown whether miR-206 is involved in pulmonary hypertension (PH) due to left heart diseases (PH-LHD). This study was designed to investigate the correlation between miR-206 and PH in patients with LHD. Methods: In 82 consecutively enrolled LHD patients, we examined the serum levels of miR-206 and analyzed its correlations with pulmonary artery systolic pressure (PASP) and cardiac function. Another 36 age- and sex-matched subjects served as healthy controls. Results: The patients were divided into the LHD group (n=47, PASP<50 mmHg) and the PH-LHD group (n=35, PASP≥50 mmHg). The level of miR-206 was significantly decreased in the PH-LHD group compared with that of the LHD and healthy control groups. In addition, the miR-206 level was correlated with PASP (r=-0.305, p<0.001) but not with systemic blood pressure. Univariate analyses showed that miR-206, brain natriuretic peptide (BNP), left ventricular ejection fraction and left atrial longitudinal diameter (LAD) were significantly related to PASP. Multivariate regression analysis identified miR-206 as an independent predictive factor for PH. MiR-206 alone (cut-off <0.66) demonstrated a sensitivity of 68.60% and a specificity of 65.80% in predicting PH. Moreover, the combination of miR-206, BNP and LAD (cut-off 0.21) showed a sensitivity of 97.10% and a specificity of 80.30% in predicting PH in LHD patients. Conclusion: A decreased circulating miR-206 level was associated with increased PASP in LHD patients. Thus, the level of miR-206, especially combined with BNP and LAD, might be helpful in the detection of PH in LHD patients.

Abstract 14264: The Impact of Bariatric Surgery on Echocardiographic Features of Cardiac Remodeling and Diastolic Function

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Raj K Dalsania ◽  
Kaitlyn Ibrahim ◽  
Rohit Soans ◽  
Abdullah Haddad ◽  
Vikram J Eddy ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Cardiac Remodeling ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Pulmonary Artery Systolic Pressure ◽  
Increased Risk ◽  
Lv Mass ◽  
The Impact

Introduction: Candidates for bariatric surgery are at increased risk for cardiovascular disease and often develop adverse cardiac remodeling as a result of obesity. Bariatric surgery can alter cardiac structure and function in these patients; however, this has not been fully investigated. Hypothesis: We hypothesized that patients undergoing bariatric surgery would demonstrate favorable cardiac remodeling and improvement in diastolic parameters according to the American Society of Echocardiography (ASE) guidelines. Methods: All patients undergoing bariatric surgery at our institution from 2014-2018 were reviewed. In patients with pre- and post-operative echocardiograms, the following were measured: left ventricular (LV) size, pulmonary artery systolic pressure (PASP), LV mass, mitral E/A, LV ejection fraction (EF), medial and lateral E/e’, medial e’ and a’, lateral e’ and a’, tricuspid regurgitation (TR) velocity, left atrial volume index (LAVI), degree of LV hypertrophy, and relative wall thickness (RWT). The grade of diastolic dysfunction (DD) was calculated according to ASE guidelines. Results: A total of 69 patients met criteria for inclusion, with 77% (n=53) female, 87% (n=60) non-white, and mean age 49±10.7. Mean decrease in BMI one year post-operatively was 14.6±5.7 kg/m 2 . Median time between bariatric surgery and post-operative echocardiogram was 21.8 months. Post-operatively, there was a mean 17.8 cm/s decrease in TR velocity (p=0.0064) and 4.2 mmHg decrease in PASP (p=0.02). LAVI increased by 3.4 mL/m 2 (p=0.048). There was no significant change in LV size, LV mass, LVEF, LV hypertrophy, or RWT. Out of the 29 patients with pre-existing DD (grade 1, n=20; grade 2, n=8; grade 3, n=1), 45% (n=13) demonstrated improvement in grade of DD. When compared to pre-operative DD, post-operatively, 5 of 20 patients with G1DD had no DD, 2 of 8 patients with G2DD had no DD, 5 of 8 patients with G2DD had G1DD, and 1 patient with G3DD had G1DD. This was driven by a decrease in TR velocity and medial E/e’. Conclusions: In patients undergoing bariatric surgery, TR velocity and PASP improved while LAVI paradoxically increased. Patients with pre-existing DD demonstrated improvement in diastology, driven by changes in TR velocity and medial E/e’.

scholarly journals The association of left ventricular histologically verified myocardial fibrosis with pulmonary hypertension in severe aortic stenosis

Perfusion ◽  
2021 ◽  
pp. 026765912110427
Author(s):  
Birute Gumauskiene ◽  
Egle Drebickaite ◽  
Dalia Pangonyte ◽  
Jolanta Justina Vaskelyte ◽  
Lina Padervinskiene ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Myocardial Fibrosis ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Functional Markers ◽  
2D Echocardiography

Objectives: To evaluate the association between histologically verified left ventricular (LV) myocardial fibrosis (MF) and its bio- and functional markers with pulmonary hypertension (PH) in severe aortic stenosis (AS). Methods: About 34 patients with isolated severe AS underwent 2D echocardiography, cardiac magnetic resonance (CMR) imaging, and plasma NT-proBNP evaluation before aortic valve replacement (AVR). LV measurements were analyzed by CMR and LV strain using feature tracking software (Medis Suite QStrain 2.0). Myocardial biopsy sampled at the time of AVR was assessed by a histomorphometric analysis. PH was defined as pulmonary artery systolic pressure (PASP) ⩾ 45 mm Hg. Results: Patients with severe AS and PH (mean PASP 53 ± 3.7 mm Hg) had higher extent of diffuse MF versus patients without PH (12 (10.4–12.7)% vs 6.6 (4.6–8.2)% (p = 0.00)). The extent of diffuse MF correlated with LV dilatation ( r = 0.7, p = 0.02), indices of LV dysfunction (lower ejection fraction ( r = −0.6, p < 0.001), global longitudinal ( r = −0.5, p = 0.02) and circumferential strain ( r = −0.5, p = 0.05), elevated NT-proBNP ( r = 0.5, p = 0.005) and elevated PASP ( r = 0.6, p < 0.001)). Histological MF > 10% (AUC 94.9%), LV global longitudinal strain > −15.5% (AUC 86.3%), and NT-proBNP > 2090 ng/l (AUC 85.1%) were independent predictors of PH in severe AS. Conclusions: The extent of diffuse myocardial fibrosis in combination with reduced longitudinal left ventricular strain and increased plasma levels of NT-proBNP relates to pulmonary hypertension in severe aortic stenosis.

Sign in / Sign up

Export Citation Format

Share Document