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المؤلفون: Raymond H. Chan, Barry J. Maron, Harry Rakowski, Kimia Fardfini, Arnon Adler, Manhal Habib, Kate Hanneman, Martin S. Maron, Sara Hoss, Ethan J. Rowin
المصدر: JACC: Cardiovascular Imaging. 14:947-958
مصطلحات موضوعية: medicine.medical_specialty, business.industry, Hypertrophic cardiomyopathy, Patient characteristics, 030204 cardiovascular system & hematology, medicine.disease, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Fibrosis, Internal medicine, Heart failure, cardiovascular system, Cardiology, Medicine, Late gadolinium enhancement, Radiology, Nuclear Medicine and imaging, Myocardial fibrosis, In patient, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Cardiac magnetic resonance
الوصف: Objectives This study examined fibrosis progression in hypertrophic cardiomyopathy (HCM) patients, as well as its relationship to patient characteristics, clinical outcomes, and its effect on clinical decision making. Background Myocardial fibrosis, as quantified by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR), provides valuable prognostic information in patients with HCM. Methods A total of 157 patients with HCM were enrolled in this study, with 2 sequential CMR scans separated by an interval of 4.7 ± 1.9 years. Results At the first CMR session (CMR-1), 70% of patients had LGE compared with 85% at CMR-2 (p = 0.001). The extent of LGE extent increased between the 2 CMR procedures, from 4.0 ± 5.6% to 6.3 ± 7.4% (p 8% of LV mass, indexed LV mass >100 g/m2, maximal wall thickness ≥20 mm, LVEF ≤60%, and apical aneurysm. There was a significant correlation between the magnitude of LGE progression and future implantation of insertable cardioverter-defibrillators (p = 0.004), EF deterioration to ≤50% (p Conclusions Myocardial fibrosis in patients with HCM is a slowly progressive process. Progression of LGE is significantly correlated with a number of clinical outcomes such as progression to EF ≤50% and heart failure admission. Judicious use of serial CMR with LGE can provide valuable information to help patient management.
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المؤلفون: Adaya Weissler-Snir, Paul Dorian, Harry Rakowski, Melanie Care, Danna A. Spears
المصدر: Heart Rhythm. 18:63-70
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Time Factors, 030204 cardiovascular system & hematology, Ventricular tachycardia, Risk Assessment, Sudden cardiac death, 03 medical and health sciences, 0302 clinical medicine, Heart Rate, Risk Factors, Physiology (medical), Internal medicine, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Retrospective Studies, Ontario, Framingham Risk Score, business.industry, Incidence (epidemiology), Hypertrophic cardiomyopathy, Atrial fibrillation, Cardiomyopathy, Hypertrophic, Middle Aged, Prognosis, medicine.disease, Defibrillators, Implantable, Primary Prevention, Survival Rate, Death, Sudden, Cardiac, Ventricular fibrillation, Tachycardia, Ventricular, cardiovascular system, Cardiology, Antitachycardia Pacing, Equipment Failure, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
الوصف: Identifying patients with hypertrophic cardiomyopathy (HCM) who warrant a primary prevention implantable cardioverter-defibrillator (ICD) is crucial. ICDs are effective in terminating life-threatening arrhythmias; however, ICDs carry risks of complications.The purpose of this study was to assess the incidence and predictors of appropriate ICD therapies, inappropriate shocks, and device-related complications in patients with HCM and primary prevention ICDs.All patients with HCM who underwent primary prevention ICD implantation at Toronto General Hospital between September 2000 and December 2017 were identified. Therapies (shocks or antitachycardia pacing) for ventricular tachycardia180 beats/min or ventricular fibrillation were considered appropriate.Three hundred two patients were followed for a mean 6.1 ± 4.3 years (1801 patient-years of follow-up). Thirty-eight patients (12.6%) received at least 1 appropriate ICD therapy (2.3%/y); the 5-year cumulative probability of receiving appropriate ICD therapy was 9.6%. None of the conventional risk factors nor the European Society of Cardiology risk score was associated with appropriate ICD therapy. In multivariable analysis, age40 years at implantation and atrial fibrillation were independent predictors of appropriate ICD therapy. In a subgroup of patients who had undergone cardiac magnetic resonance imaging before ICD implantation, severe late gadolinium enhancement was the strongest predictor of appropriate ICD therapies. ICD-related complications or inappropriate shocks occurred in 87 patients (28.8%), with an inappropriate shock rate of 2.1%/y; the 5-year cumulative probability was 10.7%.The incidence of appropriate ICD therapies in patients with HCM and primary prevention ICDs is lower than previously reported; a high proportion of patients suffer from an ICD-related complication. Traditional risk factors have low predictive utility. Severe late gadolinium enhancement, atrial fibrillation, and young age are important predictors of ventricular tachyarrhythmias in HCM.
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المؤلفون: Kimia Sheikholeslami, Arnon Adler, Karthik Viswanathan, Adrian Suszko, Danna A. Spears, Harry Rakowski, Anna Woo, Praloy Chakraborty, Vijay S. Chauhan
المصدر: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 23 (2021)
مصطلحات موضوعية: medicine.medical_specialty, Precordial examination, QRS complex, Risk Factors, Internal medicine, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, In patient, ventricular arrhythmia, End point, alternans, business.industry, Proportional hazards model, ECG, Hazard ratio, Hypertrophic cardiomyopathy, risk assessment, Arrhythmias, Cardiac, Ventricular pacing, Cardiomyopathy, Hypertrophic, medicine.disease, hypertrophic cardiomyopathy, RC666-701, Cardiology, Cardiology and Cardiovascular Medicine, business
الوصف: Background Unlike T‐wave alternans (TWA), the relation between QRS alternans (QRSA) and ventricular arrhythmia (VA) risk has not been evaluated in hypertrophic cardiomyopathy (HCM). We assessed microvolt QRSA/TWA in relation to HCM risk factors and late VA outcomes in HCM. Methods and Results Prospectively enrolled patients with HCM (n=130) with prophylactic implantable cardioverter‐defibrillators underwent digital 12‐lead ECG recordings during ventricular pacing (100–120 beats/min). QRSA/TWA was quantified using the spectral method. Patients were categorized as QRSA+ and/or TWA+ if sustained alternans was present in ≥2 precordial leads. The VA end point was appropriate implantable cardioverter‐defibrillator therapy over 5 years of follow‐up. QRSA+ and TWA+ occurred together in 28% of patients and alone in 7% and 7% of patients, respectively. QRSA magnitude increased with pacing rate (1.9±0.6 versus 6.2±2.0 µV; P =0.006). Left ventricular thickness was greater in QRSA+ than in QRSA− patients (22±7 versus 20±6 mm; P =0.035). Over 5 years follow‐up, 17% of patients had VA. The annual VA rate was greater in QRSA+ versus QRSA− patients (5.8% versus 2.0%; P =0.006), with the QRSA+/TWA− subgroup having the greatest rate (13.3% versus 2.6%; P P =0.001). Separate Cox models revealed QRSA+ (hazard ratio [HR], 2.9 [95% CI, 1.2–7.0]; P =0.019) and QRSA+/TWA− (HR, 7.9 [95% CI, 2.9–21.7]; P Conclusions In HCM, microvolt QRSA is a novel, rate‐dependent phenomenon that can exist without TWA and is associated with greater left ventricular thickness. QRSA increases VA risk 3‐fold in all patients, whereas the absence of QRSA confers low VA risk in patients with Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02560844.
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المؤلفون: Manhal Habib, Beata Bruchal-Garbicz, Lynne Williams, Arnon Adler, Harry Rakowski, Raymond H. Chan, Sara Hoss
المصدر: International Journal of Cardiology. 297:75-82
مصطلحات موضوعية: Male, Alcohol septal ablation, medicine.medical_specialty, 030204 cardiovascular system & hematology, Ventricular Function, Left, Ventricular Outflow Obstruction, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Left atrial, Internal medicine, Humans, Medicine, In patient, 030212 general & internal medicine, Aged, Voltage-Gated Sodium Channel Blockers, Mitral regurgitation, Ejection fraction, business.industry, Hypertrophic cardiomyopathy, Stroke Volume, Cardiomyopathy, Hypertrophic, Middle Aged, Atrial Function, medicine.disease, Treatment Outcome, Echocardiography, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Wall thickness, Disopyramide, medicine.drug
الوصف: Background Significant left-ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) may result in symptoms and is associated with adverse outcomes. Although disopyramide can reduce resting gradients, nearly 30% of HCM patients do not respond. We sought to study the clinical and echocardiographic variables associated with disopyramide-induced LVOT-gradient reduction. Methods Forty-one disopyramide-treated HCM patients (average daily-dose 305 mg) were subdivided into two groups: (1) nineteen responders, with a reduction of LVOT-gradients of at least 30% from baseline, and (2) twenty-two non-responders, in whom LVOT-gradients did not change or increased following treatment. All patients had a thorough clinical and echocardiographic assessment pre- and post-treatment initiation. Results Patients who responded to disopyramide had better pretreatment left ventricular (LV) systolic function (LV ejection fraction of 67.9 ± 5.6% vs. 59.7 ± 5.8%, p = 0.0001), better LV global longitudinal strain (−17.9 ± 2.3% vs. −16.1 ± 2.5%, p = 0.048), less mitral regurgitation, smaller LV size (indexed LV end-systolic volume of 16.2 ± 5.1 ml/m2 vs. 23.2 ± 6.8 ml/m2, p = 0.001), and lower LV maximal wall thickness (17.2±3 mm vs.19.2 ± 3.4 mm, p = 0.046). Baseline left atrial (LA) volumes were significantly lower in the responders, with higher indices of LA ejection fraction (62 ± 11.2% vs. 50.5 ± 12.2%, p = 0.005), systolic LA strain (34 ± 12.4% vs. 25.8 ± 10.6%, p = 0.04), and LA strain-rate (1.34 ± 0.49%/sec vs. 0.99 ± 0.24%/sec, p = 0.012). In multivariable analysis, the presence of reduced LV systolic function and systolic LA strain-rate remained independently associated with poor response to disopyramide. Conclusions Obstructive HCM patients with more severe disease at baseline tend to respond less to disopyramide treatment. In those patients, early referral for alcohol septal ablation or myectomy surgery should be considered.
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المؤلفون: Elsie T Nguyen, Harry Rakowski, Deacon Z. J. Lee
المصدر: JAMA cardiology. 6(12)
مصطلحات موضوعية: Presyncope, Pediatrics, medicine.medical_specialty, Atrial Septum, business.industry, Biopsy, Myocardium, MEDLINE, Middle Aged, medicine.disease, Lymphoma, Diagnosis, Differential, Heart Neoplasms, Medicine, Humans, Female, Middle-aged adult, Lymphoma, Large B-Cell, Diffuse, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5cc2f0e79059ffae8bacaa57ec683212
https://pubmed.ncbi.nlm.nih.gov/34550302 -
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المؤلفون: Barry J. Maron, Harry Rakowski, Jennifer Drummond, Dou Huang, Richard T. Carrick, Sara Hoss, Arnon Adler, Raymond H. Chan, Ethan J. Rowin, Benjamin S. Wessler, Craig Cooper, Aadhavi Sridharan, Martin S. Maron
المصدر: Circulation: Arrhythmia and Electrophysiology. 14
مصطلحات موضوعية: Male, medicine.medical_specialty, Magnetic Resonance Imaging, Cine, Risk Assessment, Text mining, Heart Conduction System, Risk Factors, Physiology (medical), Internal medicine, Atrial Fibrillation, Humans, Medicine, cardiovascular diseases, Retrospective Studies, Ontario, business.industry, Incidence, Hypertrophic cardiomyopathy, Atrial fibrillation, Cardiomyopathy, Hypertrophic, Middle Aged, Prognosis, medicine.disease, Embolic stroke, Echocardiography, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
الوصف: Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), associated with impaired quality of life, risk for embolic stroke, and unpredictable onset. We sought to create a predictive model to identify risk for AF development in HCM. Methods: A cohort of 1900 patients with HCM followed for newly diagnosed AF in the Tufts HCM center was used for model development. A cohort of 387 patients from Toronto General Hospital was used for external validation. Data in the development cohort generated the HCM-AF score, a point score to predict AF probability at 2 and 5 years: left atrial dimension (+2 points per 6 mm increase), age at clinical evaluation (+3 points per 10-year increase), age at initial HCM diagnosis (−2 points per 10-year increase), and heart failure symptoms (+3 points if symptomatic). Results: The HCM-AF score stratifies risk as low (2.0%/y; score ≥22) for AF development for individual patients. Concordance of the HCM-AF score was 0.70 in the development cohort and 0.68 in the external validation cohort. In the development cohort, 17.2% of high-risk patients developed AF (rate 3.4%/y), while only 3.3% of low-risk patients developed AF (rate 0.7%/y) at 5 years ( P Conclusions: The HCM-AF score is a novel externally validated predictive tool to identify AF risk in HCM. This score can reliably stratify patients with HCM to risk of newly diagnosed AF and offers the opportunity to inform expectations regarding future clinical course.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::7c89889725dcba544e142b442a762651
https://doi.org/10.1161/circep.120.009796 -
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المؤلفون: Raymond H. Chan, Mahdi Montazeri, Sara Hoss, Harry Rakowski, Elsie T Nguyen, Deacon Z. J. Lee, Arnon Adler
المصدر: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 34(12)
مصطلحات موضوعية: medicine.medical_specialty, Population, Aneurysm, Cardiac magnetic resonance imaging, Interquartile range, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, education, Aged, Retrospective Studies, education.field_of_study, medicine.diagnostic_test, business.industry, Hypertrophic cardiomyopathy, Magnetic resonance imaging, Gold standard (test), Cardiomyopathy, Hypertrophic, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Echocardiography, Contrast echocardiography, cardiovascular system, Cardiology, Cardiology and Cardiovascular Medicine, business
الوصف: Background Left ventricular (LV) apical aneurysm is a unique morphological entity and novel adverse risk marker existing within the broad phenotypic spectrum of hypertrophic cardiomyopathy (HCM). Its true prevalence in the HCM population is likely underestimated because of inherent limitations of conventional noncontrast echocardiography. The authors hypothesized that contrast echocardiography is a reliable imaging technique compared with cardiovascular magnetic resonance (CMR) for the detection of apical aneurysms. The aim of this study was to assess the effectiveness of contrast echocardiography in the detection of LV apical aneurysms in patients with HCM in comparison with the gold standard, CMR. Methods One hundred twelve patients with HCM identified from an institutional clinical database, who underwent echocardiographic and CMR examinations within 12 months and had LV apical aneurysms identified on either or both imaging modalities, were retrospectively analyzed. Discordant cases were reviewed by an expert panel, and a consensus was reached regarding the presence or absence of an apical aneurysm. The reason for any discrepancy was recorded. Results The mean age of the patients was 59 ± 13 years, and 73% were men. Sixty-four (57%) underwent contrast echocardiography. The median interval between echocardiography and CMR was 118 days (interquartile range, 61–237 days). Thirty-nine patients (35%) had discordance between echocardiographic and CMR findings, of whom 20 had aneurysms reported on echocardiography but not CMR and 19 vice versa. Upon reanalysis by the expert panel, aneurysms were initially missed on CMR in 16 patients (80%), largely because of interpretation error secondary to small aneurysms, with a mean aneurysm size of 0.82 ± 0.38 cm in these cases. Before secondary review by the expert panel, contrast echocardiography had sensitivity of 97% compared with 85% for CMR (P = .0198) and 64% for noncontrast echocardiography (P = .0001). After secondary review, contrast echocardiography had sensitivity of 98% compared with 67% for noncontrast echocardiography (P = .0001) and 97% for CMR (P = 1.00). Conclusions Contrast echocardiography has high sensitivity for detecting LV apical aneurysms and should be used routinely in the evaluation and risk stratification of patients with HCM.
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المؤلفون: Waseem Hindieh, Harry Rakowski, Arnon Adler, Danna A. Spears, Adaya Weissler-Snir, Raymond H. Chan
المصدر: Journal of Cardiovascular Electrophysiology. 30:651-657
مصطلحات موضوعية: Adult, Gadolinium DTPA, Male, medicine.medical_specialty, Time Factors, Contrast Media, Magnetic Resonance Imaging, Cine, 030204 cardiovascular system & hematology, Ventricular tachycardia, Ventricular Function, Left, Sudden cardiac death, 03 medical and health sciences, 0302 clinical medicine, Heart Rate, Predictive Value of Tests, Risk Factors, Physiology (medical), Internal medicine, medicine, Humans, Late gadolinium enhancement, cardiovascular diseases, 030212 general & internal medicine, Aged, Retrospective Studies, Univariate analysis, Ejection fraction, Ventricular Remodeling, business.industry, Hypertrophic cardiomyopathy, Atrial fibrillation, Atrial Remodeling, Cardiomyopathy, Hypertrophic, Middle Aged, medicine.disease, Fibrosis, medicine.anatomical_structure, Ventricle, Electrocardiography, Ambulatory, Tachycardia, Ventricular, cardiovascular system, Cardiology, Atrial Function, Left, Female, Cardiology and Cardiovascular Medicine, business
الوصف: OBJECTIVES To examine the relationship between late gadolinium enhancement (LGE) extent and nonsustained ventricular tachycardia (NSVT) characteristics in patients with hypertrophic cardiomyopathy (HCM). BACKGROUND NSVT has been shown to be independently associated with sudden cardiac death (SCD) in HCM. Previous studies have found LGE on cardiac magnetic resonance (CMR) to be independently associated with NSVT. METHODS Seventy-three patients who had 14-day Holter monitoring for either risk stratification for SCD (n = 62) or evaluation of atrial fibrillation (n = 11) on a CMR study were included. Areas of LGE in left ventricle (LV) were visually identified and analyzed quantitatively for both high (≥6 SD above the mean signal intensity of normal myocardium) and intermediate (≥4 but
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المؤلفون: Gil Moravsky, Shemy Carasso, Harry Rakowski, Adaya Weissler-Snir, Anthony Ralph-Edwards, Waseem Hindieh, Lynne Williams
المصدر: Echocardiography. 36:276-284
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Diastole, Speckle tracking echocardiography, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Left atrial, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Heart Atria, 030212 general & internal medicine, Myopathy, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Hypertrophic cardiomyopathy, Atrial fibrillation, Atrial Remodeling, Cardiomyopathy, Hypertrophic, Middle Aged, Atrial Function, medicine.disease, Septal myectomy, Echocardiography, Cardiology, Female, medicine.symptom, Obstructive hypertrophic cardiomyopathy, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
الوصف: BACKGROUND Septal myectomy relieves left ventricular outflow obstruction (LVOTO) and is associated with excellent long-term outcomes. LVOTO is associated with diastolic dysfunction and increased left atrial (LA) size. We sought to investigate the changes in LA volumes and function postmyectomy and the association between these changes with clinical outcomes postmyectomy. METHODS Sixty-six hypertrophic cardiomyopathy patients undergoing myectomy were retrospectively studied. Preprocedural and 6- to 18-month postmyectomy follow-up transthoracic echocardiographic images were obtained. LA volumes and strain were assessed by two-dimensional speckle-tracking echocardiography. RESULTS Left atrial volumes, that is, indexed maximal, minimal, and pre-A volumes reduced postmyectomy, yet remained increased compared to controls (105.6 ± 34.5 mL vs 84.9 ± 26.7 mL, 45.2 ± 25.7 mL vs 35.4 ± 22.6 mL, 70.1 ± 31.4 mL vs 35.4 ± 22.6 mL, respectively, P
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المؤلفون: Timothy J. Bradley, Andrew M. Crean, Simon Winther, Lynne Williams, Harry Rakowski, Kim A. Connelly, Michelle Keir
المصدر: Winther, S, Williams, L K, Keir, M, Connelly, K A, Bradley, T J, Rakowski, H & Crean, A M 2019, ' Cardiovascular Magnetic Resonance Provides Evidence of Abnormal Myocardial Strain and Primary Cardiomyopathy in Marfan syndrome ', Journal of Computer Assisted Tomography, vol. 43, no. 3, pp. 410-415 . https://doi.org/10.1097/RCT.0000000000000863
مصطلحات موضوعية: Male, Marfan syndrome, RECOMMENDATIONS, strain imaging, Marfan Syndrome, 030218 nuclear medicine & medical imaging, Cohort Studies, Ventricular Dysfunction, Left, 0302 clinical medicine, echocardiography, ejection fraction, Ejection fraction, medicine.diagnostic_test, Genetic disorder, IMPAIRMENT, Middle Aged, Connective tissue disease, Echocardiography, Cohort, cardiovascular system, Cardiology, Female, Cardiomyopathies, circulatory and respiratory physiology, Adult, DIMENSIONS, medicine.medical_specialty, Magnetic Resonance Imaging, Cine, Reference range, Primary cardiomyopathy, cardiovascular magnetic resonance, Young Adult, 03 medical and health sciences, LEFT-VENTRICULAR FUNCTION, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, business.industry, Magnetic resonance imaging, ADULTS, FIBRILLIN-1, medicine.disease, DYSFUNCTION, MECHANICS, business, cardiomyopathy, 030217 neurology & neurosurgery
الوصف: OBJECTIVE: Marfan syndrome is an autosomal-dominant genetic disorder caused by mutations in the fibrillin-1 gene. The condition is a connective tissue disease that frequently involves the cardiovascular system. The existence of a primary cardiomyopathy in Marfan syndrome, however, is controversial. The aims of this study were to investigate the prevalence of left ventricular dysfunction with both transthoracic echocardiography and cardiovascular magnetic resonance (CMR) in a cohort of Marfan syndrome patients and to investigate patterns of myocardial strain across the cohort.METHODS: We used an institutional database to identify all patients with a firm diagnosis of Marfan syndrome based on Ghent criteria. Inclusion required left ventricular ejection fraction (LVEF) to have been measured by both CMR and transthoracic echocardiography within 12 months of each other. Normal LVEF was defined as a value of >55% when measured by CMR. Velocity vector imaging was used to measure left ventricular longitudinal strain patterns by application of feature tracking to cine magnetic resonance images. Results were compared with data from 20 age-matched control subjects.RESULTS: Sixty-nine Marfan syndrome patients met the inclusion criteria. The mean age was 35.4 ± 15.0 years, and 56.5% were male. The mean LVEF was 59.0% ± 7.0% by CMR and 59.1% ± 5.8% by echo. One-fifth of Marfan syndrome patients (15/69; 21.7%) had reduced function with LVEF ≤55% by CMR, but only 5 of these were identified by echo. Furthermore, echo identified 5 Marfan syndrome patients as having reduced LVEF in the presence of a normal LVEF by CMR. Some Marfan syndrome patients had abnormal longitudinal strain patterns even with LVEF within the reference range.CONCLUSIONS: These data provide support for a primary cardiomyopathy in some Marfan syndrome patients. Cardiovascular magnetic resonance is more sensitive than echo for identifying cases with mild systolic dysfunction. Strain analysis may be more sensitive than simple LVEF assessment for identifying at-risk individuals.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b3d66ed76d2bf6b0c88db21a963173ca
https://doi.org/10.1097/rct.0000000000000863
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