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Publisher: Oxford University Press   (Total: 370 journals)

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Showing 1 - 200 of 370 Journals sorted alphabetically
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 6, SJR: 0.881, h-index: 38)
Adaptation     Hybrid Journal   (Followers: 9, SJR: 0.111, h-index: 4)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.538, h-index: 35)
African Affairs     Hybrid Journal   (Followers: 59, SJR: 1.512, h-index: 46)
Age and Ageing     Hybrid Journal   (Followers: 85, SJR: 1.611, h-index: 107)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 17, SJR: 0.935, h-index: 80)
American Entomologist     Full-text available via subscription   (Followers: 6)
American Historical Review     Hybrid Journal   (Followers: 149, SJR: 0.652, h-index: 43)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 39, SJR: 1.441, h-index: 77)
American J. of Epidemiology     Hybrid Journal   (Followers: 172, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 25, SJR: 1.397, h-index: 111)
American J. of Jurisprudence     Hybrid Journal   (Followers: 18)
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Analysis     Hybrid Journal   (Followers: 23)
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Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.213, h-index: 9)
Biostatistics     Hybrid Journal   (Followers: 16, SJR: 1.955, h-index: 55)
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Brain     Hybrid Journal   (Followers: 63, SJR: 6.097, h-index: 264)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 46, SJR: 4.086, h-index: 73)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 50)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 35, SJR: 1.267, h-index: 38)
British J. of Aesthetics     Hybrid Journal   (Followers: 27, SJR: 0.217, h-index: 18)
British J. of Criminology     Hybrid Journal   (Followers: 548, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 85, SJR: 0.771, h-index: 53)
British Medical Bulletin     Hybrid Journal   (Followers: 7, SJR: 1.391, h-index: 84)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 27)
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Cambridge J. of Economics     Hybrid Journal   (Followers: 59, SJR: 0.957, h-index: 59)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 10, SJR: 1.067, h-index: 22)
Cambridge Quarterly     Hybrid Journal   (Followers: 11, SJR: 0.1, h-index: 7)
Capital Markets Law J.     Hybrid Journal   (Followers: 1)
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.439, h-index: 167)
Cardiovascular Research     Hybrid Journal   (Followers: 12, SJR: 2.897, h-index: 175)
Cerebral Cortex     Hybrid Journal   (Followers: 43, SJR: 4.827, h-index: 192)
CESifo Economic Studies     Hybrid Journal   (Followers: 17, SJR: 0.501, h-index: 19)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.436, h-index: 76)
Children and Schools     Hybrid Journal   (Followers: 6, SJR: 0.211, h-index: 18)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 3)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 21, SJR: 0.737, h-index: 11)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 9, SJR: 1.238, h-index: 15)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 11, SJR: 0.191, h-index: 8)
Classical Receptions J.     Hybrid Journal   (Followers: 24, SJR: 0.1, h-index: 3)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 60, SJR: 4.742, h-index: 261)
Clinical Kidney J.     Open Access   (Followers: 4, SJR: 0.338, h-index: 19)
Community Development J.     Hybrid Journal   (Followers: 24, SJR: 0.47, h-index: 28)
Computer J.     Hybrid Journal   (Followers: 8, SJR: 0.371, h-index: 47)
Conservation Physiology     Open Access   (Followers: 2)
Contemporary Women's Writing     Hybrid Journal   (Followers: 11, SJR: 0.111, h-index: 3)
Contributions to Political Economy     Hybrid Journal   (Followers: 5, SJR: 0.313, h-index: 10)
Critical Values     Full-text available via subscription  
Current Legal Problems     Hybrid Journal   (Followers: 26)
Current Zoology     Full-text available via subscription   (Followers: 1, SJR: 0.999, h-index: 20)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 11, SJR: 1.068, h-index: 24)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 13)
Diplomatic History     Hybrid Journal   (Followers: 20, SJR: 0.296, h-index: 22)
DNA Research     Open Access   (Followers: 4, SJR: 2.42, h-index: 77)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 3)
Early Music     Hybrid Journal   (Followers: 15, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 37, SJR: 2.052, h-index: 52)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 1.26, h-index: 23)
English Historical Review     Hybrid Journal   (Followers: 51, SJR: 0.311, h-index: 10)
English: J. of the English Association     Hybrid Journal   (Followers: 13, SJR: 0.144, h-index: 3)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.791, h-index: 66)
Environmental Epigenetics     Open Access   (Followers: 1)
Environmental History     Hybrid Journal   (Followers: 28, SJR: 0.197, h-index: 25)
EP-Europace     Hybrid Journal   (Followers: 2, SJR: 2.201, h-index: 71)
Epidemiologic Reviews     Hybrid Journal   (Followers: 10, SJR: 3.917, h-index: 81)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 16, SJR: 0.1, h-index: 6)
European Heart J.     Hybrid Journal   (Followers: 50, SJR: 6.997, h-index: 227)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 8, SJR: 2.044, h-index: 58)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 1)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. Supplements     Hybrid Journal   (Followers: 7, SJR: 0.152, h-index: 31)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 8, SJR: 1.568, h-index: 104)
European J. of Intl. Law     Hybrid Journal   (Followers: 169, SJR: 0.722, h-index: 38)
European J. of Orthodontics     Hybrid Journal   (Followers: 4, SJR: 1.09, h-index: 60)
European J. of Public Health     Hybrid Journal   (Followers: 23, SJR: 1.284, h-index: 64)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 11, SJR: 1.549, h-index: 42)
European Review of Economic History     Hybrid Journal   (Followers: 28, SJR: 0.628, h-index: 24)
European Sociological Review     Hybrid Journal   (Followers: 41, SJR: 2.061, h-index: 53)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 12, SJR: 1.048, h-index: 77)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 9, SJR: 1.687, h-index: 115)
Fems Microbiology Letters     Hybrid Journal   (Followers: 21, SJR: 1.126, h-index: 118)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 26, SJR: 7.587, h-index: 150)
Fems Yeast Research     Hybrid Journal   (Followers: 13, SJR: 1.213, h-index: 66)
Foreign Policy Analysis     Hybrid Journal   (Followers: 22, SJR: 0.859, h-index: 10)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 16, SJR: 0.903, h-index: 44)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.108, h-index: 6)
French History     Hybrid Journal   (Followers: 32, SJR: 0.123, h-index: 10)
French Studies     Hybrid Journal   (Followers: 20, SJR: 0.119, h-index: 7)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.102, h-index: 3)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 12, SJR: 3.22, h-index: 39)
Geophysical J. Intl.     Hybrid Journal   (Followers: 34, SJR: 1.839, h-index: 119)
German History     Hybrid Journal   (Followers: 26, SJR: 0.437, h-index: 13)
GigaScience     Open Access   (Followers: 3)
Global Summitry     Hybrid Journal  
Glycobiology     Hybrid Journal   (Followers: 14, SJR: 1.692, h-index: 101)
Health and Social Work     Hybrid Journal   (Followers: 51, SJR: 0.505, h-index: 40)
Health Education Research     Hybrid Journal   (Followers: 13, SJR: 0.814, h-index: 80)
Health Policy and Planning     Hybrid Journal   (Followers: 21, SJR: 1.628, h-index: 66)
Health Promotion Intl.     Hybrid Journal   (Followers: 21, SJR: 0.664, h-index: 60)
History Workshop J.     Hybrid Journal   (Followers: 27, SJR: 0.313, h-index: 20)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 26, SJR: 0.115, h-index: 13)
Human Molecular Genetics     Hybrid Journal   (Followers: 9, SJR: 4.288, h-index: 233)
Human Reproduction     Hybrid Journal   (Followers: 79, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 17, SJR: 4.678, h-index: 128)
Human Rights Law Review     Hybrid Journal   (Followers: 61, SJR: 0.7, h-index: 21)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 54, SJR: 1.233, h-index: 88)
ICSID Review     Hybrid Journal   (Followers: 11)
ILAR J.     Hybrid Journal   (Followers: 1, SJR: 1.099, h-index: 51)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.329, h-index: 26)
IMA J. of Management Mathematics     Hybrid Journal   (Followers: 1, SJR: 0.351, h-index: 20)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.661, h-index: 28)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 2.032, h-index: 44)
Industrial and Corporate Change     Hybrid Journal   (Followers: 7, SJR: 1.37, h-index: 81)
Industrial Law J.     Hybrid Journal   (Followers: 32, SJR: 0.184, h-index: 15)
Information and Inference     Free  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 8, SJR: 1.911, h-index: 90)
Interacting with Computers     Hybrid Journal   (Followers: 10, SJR: 0.529, h-index: 59)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 5, SJR: 0.743, h-index: 35)
Intl. Affairs     Hybrid Journal   (Followers: 52, SJR: 1.264, h-index: 53)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 30)
Intl. Health     Hybrid Journal   (Followers: 5, SJR: 0.835, h-index: 15)
Intl. Immunology     Hybrid Journal   (Followers: 3, SJR: 1.613, h-index: 111)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 34, SJR: 1.593, h-index: 69)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 60, SJR: 0.613, h-index: 19)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 149, SJR: 4.381, h-index: 145)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 4, SJR: 0.247, h-index: 8)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 29, SJR: 0.307, h-index: 15)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 8, SJR: 0.404, h-index: 18)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.457, h-index: 12)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.69, h-index: 79)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 9, SJR: 0.906, h-index: 33)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 34, SJR: 0.231, h-index: 21)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 13, SJR: 0.833, h-index: 12)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.052, h-index: 42)
Intl. Political Sociology     Hybrid Journal   (Followers: 31, SJR: 1.339, h-index: 19)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 18, SJR: 0.539, h-index: 17)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 7, SJR: 0.998, h-index: 28)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 40, SJR: 2.184, h-index: 68)
Intl. Studies Review     Hybrid Journal   (Followers: 18, SJR: 0.783, h-index: 38)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 1, SJR: 0.155, h-index: 4)
ITNOW     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 4)
J. of African Economies     Hybrid Journal   (Followers: 15, SJR: 0.647, h-index: 30)
J. of American History     Hybrid Journal   (Followers: 44, SJR: 0.286, h-index: 34)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 13, SJR: 1.038, h-index: 60)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 13, SJR: 2.157, h-index: 149)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 3, SJR: 0.563, h-index: 43)
J. of Biochemistry     Hybrid Journal   (Followers: 42, SJR: 1.341, h-index: 96)
J. of Chromatographic Science     Hybrid Journal   (Followers: 17, SJR: 0.448, h-index: 42)
J. of Church and State     Hybrid Journal   (Followers: 11, SJR: 0.167, h-index: 11)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 36, SJR: 0.442, h-index: 16)
J. of Complex Networks     Hybrid Journal   (Followers: 1, SJR: 1.165, h-index: 5)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 13, SJR: 0.196, h-index: 15)
J. of Consumer Research     Full-text available via subscription   (Followers: 43, SJR: 4.896, h-index: 121)
J. of Crohn's and Colitis     Hybrid Journal   (Followers: 10, SJR: 1.543, h-index: 37)
J. of Cybersecurity     Hybrid Journal   (Followers: 3)
J. of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 9, SJR: 0.69, h-index: 36)
J. of Design History     Hybrid Journal   (Followers: 16, SJR: 0.166, h-index: 14)
J. of Economic Entomology     Full-text available via subscription   (Followers: 6, SJR: 0.894, h-index: 76)
J. of Economic Geography     Hybrid Journal   (Followers: 24, SJR: 2.909, h-index: 69)
J. of Environmental Law     Hybrid Journal   (Followers: 24, SJR: 0.457, h-index: 20)
J. of European Competition Law & Practice     Hybrid Journal   (Followers: 20)
J. of Experimental Botany     Hybrid Journal   (Followers: 14, SJR: 2.798, h-index: 163)
J. of Financial Econometrics     Hybrid Journal   (Followers: 22, SJR: 1.314, h-index: 27)
J. of Global Security Studies     Hybrid Journal   (Followers: 4)
J. of Heredity     Hybrid Journal   (Followers: 4, SJR: 1.024, h-index: 76)
J. of Hindu Studies     Hybrid Journal   (Followers: 7, SJR: 0.186, h-index: 3)
J. of Hip Preservation Surgery     Open Access  
J. of Human Rights Practice     Hybrid Journal   (Followers: 20, SJR: 0.399, h-index: 10)
J. of Infectious Diseases     Hybrid Journal   (Followers: 39, SJR: 4, h-index: 209)
J. of Insect Science     Open Access   (Followers: 9, SJR: 0.388, h-index: 31)

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Journal Cover European Heart Journal - Cardiovascular Imaging
  [SJR: 2.044]   [H-I: 58]   [8 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 2047-2404 - ISSN (Online) 2047-2412
   Published by Oxford University Press Homepage  [370 journals]
  • Standardization of adult transthoracic echocardiography reporting in
           agreement with recent chamber quantification, diastolic function, and
           heart valve disease recommendations: an expert consensus document of the
           European Association of Cardiovascular Imaging
    • Authors: Galderisi M; Cosyns B, Edvardsen T, et al.
      Pages: 1301 - 1310
      Abstract: AimsThis European Association Cardiovascular Imaging (EACVI) Expert Consensus document aims at defining the main quantitative information on cardiac structure and function that needs to be included in standard echocardiographic report following recent ASE/EACVI chamber quantification, diastolic function, and heart valve disease recommendations. The document focuses on general reporting and specific pathological conditions such as heart failure, coronary artery and valvular heart disease, cardiomyopathies, and systemic diseases.Methods and resultsDemographic data (age, body surface area, blood pressure, and heart rhythm and rate), type (vendor and model) of ultrasound system used and image quality need to be reported. In addition, measurements should be normalized for body size. Reference normal values, derived by ASE/EACVI recommendations, shall always be reported to differentiate normal from pathological conditions. This Expert Consensus document suggests avoiding the surveillance of specific variable using different ultrasound techniques (e.g. in echo labs with high expertise in left ventricular ejection fraction by 3D and not by 2D echocardiography). The report should be also tailored in relation with different cardiac pathologies, quality of images, and needs of the caregivers.ConclusionThe conclusion should be concise reflecting the status of left ventricular structure and function, the presence of left atrial and/or aortic dilation, right ventricular dysfunction, and pulmonary hypertension, leading to an objective communication with the patient health caregiver. Variation over time should be considered carefully, taking always into account the consistency of the parameters used for comparison.
      PubDate: 2017-10-17
      DOI: 10.1093/ehjci/jex244
      Issue No: Vol. 18, No. 12 (2017)
       
  • A manifesto for cardiovascular imaging: addressing the human factor
           †
    • Authors: Fraser A.
      Pages: 1311 - 1321
      Abstract: Our use of modern cardiovascular imaging tools has not kept pace with their technological development. Diagnostic errors are common but seldom investigated systematically. Rather than more impressive pictures, our main goal should be more precise tests of function which we select because their appropriate use has therapeutic implications which in turn have a beneficial impact on morbidity or mortality. We should practise analytical thinking, use checklists to avoid diagnostic pitfalls, and apply strategies that will reduce biases and avoid overdiagnosis. We should develop normative databases, so that we can apply diagnostic algorithms that take account of variations with age and risk factors and that allow us to calculate pre-test probability and report the post-test probability of disease. We should report the imprecision of a test, or its confidence limits, so that reference change values can be considered in daily clinical practice. We should develop decision support tools to improve the quality and interpretation of diagnostic imaging, so that we choose the single best test irrespective of modality. New imaging tools should be evaluated rigorously, so that their diagnostic performance is established before they are widely disseminated; this should be a shared responsibility of manufacturers with clinicians, leading to cost-effective implementation. Trials should evaluate diagnostic strategies against independent reference criteria. We should exploit advances in machine learning to analyse digital data sets and identify those features that best predict prognosis or responses to treatment. Addressing these human factors will reap benefit for patients, while technological advances continue unpredictably.
      PubDate: 2017-09-28
      DOI: 10.1093/ehjci/jex216
      Issue No: Vol. 18, No. 12 (2017)
       
  • The year 2015–16 in the European Heart Journal —
           Cardiovascular Imaging . Part II
    • Authors: Edvardsen T; Gerber B, Donal E, et al.
      Pages: 1322 - 1330
      Abstract: The multi-modality cardiovascular imaging journal, European Heart Journal—Cardiovascular Imaging, was created in 2012. It has gained an impressive impact factor of 5.99 during its first 5 years and is now the most important imaging journal in Europe. The most important studies from the journal’s fourth and fifth years will be highlighted in two reports. Part I of the review will focus on studies in myocardial function, myocardial ischaemia, and emerging techniques in cardiovascular imaging and Part II will focus on valvular heart diseases, heart failure, cardiomyopathies, and congenital heart diseases.
      PubDate: 2017-10-23
      DOI: 10.1093/ehjci/jex237
      Issue No: Vol. 18, No. 12 (2017)
       
  • Quantitative global plaque characteristics from coronary computed
           tomography angiography for the prediction of future cardiac mortality
           during long-term follow-up
    • Authors: Hell M; Motwani M, Otaki Y, et al.
      Pages: 1331 - 1339
      Abstract: AimsAdverse plaque characteristics determined by coronary computed tomography angiography (CTA) have been associated with future cardiac events. Our aim was to investigate whether quantitative global per-patient plaque characteristics from coronary CTA can predict subsequent cardiac death during long-term follow-up.Methods and resultsOut of 2748 patients without prior history of coronary artery disease undergoing CTA with dual-source CT, 32 patients suffered cardiac death (mean follow-up of 5 ± 2 years). These patients were matched to 32 controls by age, gender, risk factors, and symptoms (total 64 patients, 59% male, age 69 ± 10 years). Coronary CTA data sets were analysed by semi-automated software to quantify plaque characteristics over the entire coronary tree, including total plaque volume, volumes of non-calcified plaque (NCP), low-density non-calcified plaque (LD-NCP, attenuation <30 Hounsfield units), calcified plaque (CP), and corresponding burden (plaque volume × 100%/vessel volume), as well as stenosis and contrast density difference (CDD, maximum percent difference in luminal attenuation/cross-sectional area compared to proximal cross-section). In patients who died from cardiac cause, NCP, LD-NCP, CP and total plaque volumes, quantitative stenosis, and CDD were significantly increased compared to controls (P < 0.025 for all). NCP > 146 mm³ [hazards ratio (HR) 2.24; 1.09–4.58; P = 0.027], LD-NCP > 10.6 mm³ (HR 2.26; 1.11–4.63; P = 0.025), total plaque volume > 179 mm³ (HR 2.30; 1.12–4.71; P = 0.022), and CDD > 35% in any vessel (HR 2.85;1.4–5.9; P = 0.005) were associated with increased risk of future cardiac death, when adjusted for segment involvement score.ConclusionAmong quantitative global plaque characteristics, total, non-calcified, and low-density plaque volumes as well as CDD predict cardiac death in long-term follow-up.
      PubDate: 2017-07-29
      DOI: 10.1093/ehjci/jex183
      Issue No: Vol. 18, No. 12 (2017)
       
  • Atherosclerotic plaque characterization: a need for a paradigm shift for
           prediction of risk
    • Authors: Min J.
      Pages: 1340 - 1341
      Abstract: Nearly 30 years ago, Muller and Stone introduced the concept of the vulnerable plaque, which was defined the proclivity of a plaque towards rupture. In this formative paper, they proposed plaque vulnerability to be ‘presumably a dynamic, potentially reversible disorder caused by changes in the constituents of the plaque, its blood supply through vasa vasorum, or the functional integrity of the overlying endothelium’.1 In the ensuing years, this notion was supported by a series of elegant pathologic and invasive imaging evaluations of patients presenting with sudden coronary death or acute myocardial infarction (AMI), wherein distinctive anatomic features of coronary atherosclerotic plaque were often implicated at the time of or after these adverse clinical events occurred.2
      PubDate: 2017-10-09
      DOI: 10.1093/ehjci/jex229
      Issue No: Vol. 18, No. 12 (2017)
       
  • The need for a new tricuspid regurgitation grading scheme
    • Authors: Hahn R; Zamorano J.
      Pages: 1342 - 1343
      Abstract: The adverse effects of severe tricuspid regurgitation (TR) on long-term outcomes has now been reported in a number of natural history studies.1,2 Current treatment for TR is primarily with optimal medical therapy involving diuretics, or surgery.3 Surgical mortality for isolated tricuspid valve interventions however, remains higher than for any other single valve surgery.4,5 Despite the low risk of added tricuspid repair at the time of the left-sided disease surgery,6 and the current guideline recommendation to intervene with annular dilation even in the absence of severe TR,3,7 combined left and right heart valve surgery remains underutilized. In addition, as more left-sided valve disease is treated with transcatheter therapies, the negative impact of TR on survival in these patients has underscored the importance of developing transcatheter solutions to this disease.8,9
      PubDate: 2017-07-13
      DOI: 10.1093/ehjci/jex139
      Issue No: Vol. 18, No. 12 (2017)
       
  • Prognostic utility of the Perugini grading of 99m Tc-DPD scintigraphy in
           transthyretin (ATTR) amyloidosis and its relationship with skeletal muscle
           and soft tissue amyloid
    • Authors: Hutt D; Fontana M, Burniston M, et al.
      Pages: 1344 - 1350
      Abstract: AimsHigh-grade (Perugini grade 2 or 3) cardiac uptake on bone scintigraphy with 99mTechnetium labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) has lately been confirmed to have high diagnostic sensitivity and specificity for cardiac transthyretin (ATTR) amyloidosis. We sought to determine whether patient stratification by Perugini grade on 99mTc-DPD scintigraphy has prognostic significance in ATTR amyloidosis.Methods and resultsPatient survival from time of 99mTc-DPD scintigraphy was determined in 602 patients with ATTR amyloidosis, including 377 with wild-type ATTR (ATTRwt) and 225 with mutant ATTR (ATTRm) amyloidosis. Patients were stratified according to Perugini grade (0-3) on 99mTc-DPD scan. The prognostic significance of additional patient and disease-related factors at baseline were determined. In the whole cohort, the finding of a Perugini grade 0 99mTc-DPD scan (n = 28) was invariably associated with absence of cardiac amyloid according to consensus criteria as well as significantly better patient survival compared to a Perugini grade 1 (n = 28), 2 (n = 436) or 3 (n = 110) 99mTc-DPD scan (P < 0.005). There were no differences in survival between patients with a grade 1, grade 2 or grade 3 99mTc-DPD scan in ATTRwt (n = 369), V122I-associated ATTRm (n = 92) or T60A–associated ATTRm (n = 59) amyloidosis. Cardiac amyloid burden, determined by equilibrium contrast cardiac magnetic resonance imaging, was similar between patients with Perugini grade 2 and Perugini grade 3 99mTc-DPD scans but skeletal muscle/soft tissue to femur ratio was substantially higher in the latter group (P < 0.001).Conclusion99mTc-DPD scintigraphy is exquisitely sensitive for identification of cardiac ATTR amyloid, but stratification by Perugini grade of positivity at diagnosis has no prognostic significance.
      PubDate: 2017-02-04
      DOI: 10.1093/ehjci/jew325
      Issue No: Vol. 18, No. 12 (2017)
       
  • Impact of left ventricular remodelling patterns on outcomes in patients
           with aortic stenosis
    • Authors: Capoulade R; Clavel M, Le Ven F, et al.
      Pages: 1378 - 1387
      Abstract: AimsThe objective of this study was to examine the association between the different patterns of left ventricular (LV) remodelling/hypertrophy on all-cause and cardiovascular mortality in patients with aortic stenosis (AS).Methods and resultsIn total, 747 consecutive patients (69 ± 14 years, 57% men) with AS and preserved LV ejection fraction were included in this study. According to LV mass index and relative wall thickness, patients were classified into four LV patterns: normal, concentric remodelling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). One hundred and sixteen patients (15%) had normal pattern, 66 (9%) had EH, 169 (23%) had CR, and 396 (53%) had CH. During a median follow-up of 6.4 years, 339 patients died (242 from cardiovascular causes). CH was associated with higher risk of all-cause mortality compared with the three other LV patterns (all P < 0.05). After multivariable adjustment, CH remained associated with higher risk of mortality (HR = 1.27, 95% CI 1.01–1.61, P = 0.046). There was a significant interaction (P < 0.05) between sex and CH with regards to the impact on mortality: CH was associated with worse outcome in women (P = 0.0001) but not in men (P = 0.22). In multivariable analysis, CH remained associated with higher risk of worse outcome in women (HR = 1.56, 95% CI 1.08–2.24, P = 0.018).ConclusionsThis study shows that CH was independently associated with increased risk of mortality in AS patients with preserved ejection fraction. This association was observed in women but not in men. The pattern of LV remodelling/hypertrophy should be integrated in the risk stratification process in patients with AS.
      PubDate: 2017-01-07
      DOI: 10.1093/ehjci/jew288
      Issue No: Vol. 18, No. 12 (2017)
       
  • Large-field intravascular ultrasound for annular sizing and predicting
           paravalvular regurgitation during TAVR: comparisons with multidetector
           computed tomography and transoesophageal echocardiography
    • Authors: Hakim D; Ghimire G, Alli O, et al.
      Pages: 1404 - 1413
      Abstract: AimsThe use of contrast media with multidetector computed tomography (MDCT) may induce acute kidney injury in patients with renal failure undergoing transcatheter aortic valve replacement (TAVR). We investigated the role of large-field intravascular ultrasound (IVUS) vs. MDCT and two-dimensional transoesophageal echocardiography (2D-TEE) for annular sizing and predicting paravalvular regurgitation (PVR) during TAVR.Methods and ResultsThe aortic annulus was measured by large-field IVUS and 2D-TEE, and compared with MDCT in 50 patients undergoing TAVR. The IVUS and MDCT annular areas and diameters were not significantly different (446 ± 87 mm2 and 23.8 ± 84 mm vs. 466 ± 84 mm2 and 24 ± 2.1 mm, respectively; P > 0.05). IVUS and MDCT mean annular diameters were significantly greater than TEE diameter (23.8 ± 2.4 and 24 ± 2.1 vs. 22 ± 0.65 mm, respectively; P < 0.01). PVR ≥ Mild occurred in 13 patients (26%); 5 patients required post-dilation and 2 patients a second valve. Receiver operating characteristic analyses showed that transcatheter heart valve (THV) area − IVUS or MDCT areas equally predicted of ≥ mild PVR (areas under the curve [AUC] 0.79 and 0.81, respectively; P < 0.001), and were greater than THV diameter-TEE diameter (AUC 0.79 and 0.81 vs. 0.56, respectively; P < 0.05).ConclusionsThe aortic annular measurements and predicting PVR by large field IVUS were not significantly different from those of MDCT, but were greater than those of TEE. Large filed IVUS can be reliably used in lieu of MDCT for annular sizing in patients with aortic stenosis and renal failure or suboptimal MDCT images.
      PubDate: 2017-02-06
      DOI: 10.1093/ehjci/jew322
      Issue No: Vol. 18, No. 12 (2017)
       
  • Bioprosthetic degeneration after bioprosthetic thrombosis: apparently
           unrelated
    • Authors: Petrescu I; Ionescu F, Michelena H, et al.
      Pages: 1413 - 1413
      Abstract: A 35-year-old woman with a history of multiple valvular interventions presented with severe dyspnoea with minimal exertion. In 2010, she underwent tricuspid and mitral valve replacement with bioprostheses (personal choice) after an episode of endocarditis. In 2012, she presented with thrombosis of the mitral bioprosthesis. Typical soft echodense material was present on the ventricular side (top left: diastolic frame; see Supplementary dataSupplementary data online, Movie S1Movie S1) of the antero-lateral and antero-medial cusps, which were rendered immobile (bottom left: 3D diastolic frame). Bioprosthetic thrombosis was confirmed by resolution of echocardiographic findings after 1 month of warfarin anticoagulation; recurrent endocarditis was ruled out by inflammatory markers and serial blood cultures, and no antibiotic therapy was given.
      PubDate: 2017-07-31
      DOI: 10.1093/ehjci/jex197
      Issue No: Vol. 18, No. 12 (2017)
       
  • Myocardial contraction fraction derived from cardiovascular magnetic
           resonance cine images—reference values and performance in patients with
           heart failure and left ventricular hypertrophy
    • Authors: Arenja N; Fritz T, Andre F, et al.
      Pages: 1414 - 1422
      Abstract: AimsLeft ventricular hypertrophy (LVH) has strong prognostic implications and is associated with heart failure. Recently, myocardial contraction fraction (MCF) was identified as a useful marker for specifically identifying cardiac amyloidosis (CA). The purpose of this study was to evaluate the diagnostic accuracy of MCF for the discrimination of different forms of LVH.Methods and resultsWe analysed cardiovascular magnetic resonance (CMR) scans of patients with CA (n = 132), hypertrophic cardiomyopathy (HCM, n = 60), hypertensive heart disease (HHD, n = 38) and in 100 age- and gender-matched healthy controls. MCF was calculated by dividing left ventricular (LV) stroke volume by LV myocardial volume. The diagnostic accuracy of MCF was compared to that of LV ejection fraction (EF) and the mass index (MI). Compared with controls (136.3 ± 24.4%, P < 0.05), mean values for MCF were significantly reduced in LVH (HHD:92.6 ± 20%, HCM:80 ± 20.3%, transthyretin CA:74.9 ± 32.2% and light-chain (AL) CA:50.5 ± 21.4%). MCF performed better than LVEF (AUC = 0.96 vs. AUC = 0.6, P < 0.001) and was comparable to LVMI (AUC = 0.95, P = 0.4) in discriminating LVH from controls. There was a significant yet weak correlation between MCF and LVEF (r = 0.43, P < 0.0001). MCF outperformed LVEF and LVMI in discriminating between different etiologies of LVH and between AL and other forms of LVH (AUC = 0.84, P < 0.0001). Moreover, cut-off values for MCF <50% and LVEF <60% allowed to identify patients with high probability for CA.ConclusionIn patients with heart failure MCF discriminates CA from other forms of LVH. As it can easily be derived from standard, non-contrast cine images, it may be a very useful marker in the diagnostic workup of patients with LVH.
      PubDate: 2017-02-06
      DOI: 10.1093/ehjci/jew324
      Issue No: Vol. 18, No. 12 (2017)
       
  • Right ventricular tuberculous granuloma
    • Authors: Bachani N; Bera D, Jankharia B, et al.
      Pages: 1422 - 1422
      Abstract: A 24-year-old man was referred to us with a history of rapid palpitations, since 3 months, with documented incessant atrial flutter. His echocardiogram showed a large mass obliterating the apex of the right ventricle (Panels A and B, see Supplementary dataSupplementary data online, Videos S1Videos S1 and S2S2). The differential diagnoses were endomyocardial fibrosis, thrombus, tumour and granuloma. The chamber size and contractility were normal, hence the first two possibilities were highly unlikely. There was no colour flow inside the mass. So, the possibility of it being a vascular tumour was ruled out. Two differential diagnoses remained: a non-vascular tumour (such as fibroma) or a granulomatous lesion.
      PubDate: 2017-08-28
      DOI: 10.1093/ehjci/jex207
      Issue No: Vol. 18, No. 12 (2017)
       
  • Isolated uveal melanoma metastases to the heart: take a look at chest
           X-ray!
    • Authors: Besnard A; Paul J, Thiesse P, et al.
      Pages: 1423 - 1423
      Abstract: An asymptomatic 52-year-old woman was referred to our institution for cardiac evaluation of a 65 mm mass fortuitously discovered on routine chest X-ray (PanelB).
      PubDate: 2017-08-09
      DOI: 10.1093/ehjci/jex196
      Issue No: Vol. 18, No. 12 (2017)
       
  • An unexpected guest in the right heart
    • Authors: Kadosh B; Jacobson J, Eltom A, et al.
      Pages: 1424 - 1424
      PubDate: 2017-07-28
      DOI: 10.1093/ehjci/jex199
      Issue No: Vol. 18, No. 12 (2017)
       
  • An unsual cause of haemoptysis
    • Authors: Khanna R; Kumar V, Singh V, et al.
      Pages: 1425 - 1425
      Abstract: An 18-years-old male presented with recurrent episodes of haemoptysis for past 7 years. His clinical examination and electrocardiogram were unremarkable. Chest X-ray revealed haziness in left lung field with normal cardiac shadow. Two-dimensional echocardiogram showed normal cardiac chamber analysis. There were three pulmonary vein (white arrow) visualized draining into left atrium with stenosis of one pulmonary vein (red arrow) (Panel A). Turbulence was noted at opening of left pulmonary vein into left atrium (Panel B, arrows, Supplementary dataSupplementary data online, Video S1Video S1) with continuous gradient across it; peak gradient of 16 mmHg (Panel C). Computed tomography (CT) thorax showed ground glass appearance of left lung field with normal right lung field (Panel D, arrow). The left superior and inferior pulmonary veins were combining into single vein with narrowing at junction of left pulmonary vein and left atrium (Panel E, arrows). Patient was taken for cardiac catheterization for pressure data analysis and possible pulmonary vein stenting. Pressure analysis revealed normal pulmonary artery pressure with raised pulmonary capillary wedge pressure (PCWP) in left lung (PCWP mean 20 mmHg) and normal PCWP in right lung. Levophase of pulmonary angiogram in left pulmonary artery showed severe stenosis at opening of left pulmonary vein (Panel F, arrows, Supplementary dataSupplementary data online, Videos S2Videos S2 and S3S3). Due to inability of entering the left pulmonary vein because of extreme narrowing, pulmonary vein stenting was not possible. Patient was referred for pulmonary vein correction surgery. We describe a rare case of recurrent haemoptysis due to isolated left pulmonary vein stenosis with normal pulmonary artery pressure diagnosed on echocardiography.
      PubDate: 2017-08-09
      DOI: 10.1093/ehjci/jex202
      Issue No: Vol. 18, No. 12 (2017)
       
  • Delayed-onset lung injury after balloon pulmonary angioplasty for chronic
           thromboembolic pulmonary hypertension—a case report
    • Authors: Hosokawa K; Yamamoto T, Abe K, et al.
      Pages: 1426 - 1426
      Abstract: A 35-year-old woman presenting pulmonary hypertension was referred to our hospital. She had no medical history of venous thrombosis or no evidence of thrombophilia on blood tests. Lung ventilation/perfusion scan showed segmental perfusion defect and chest computed tomography (CT) showed mosaic perfusion pattern without any parenchymal abnormalities, suggesting chronic thromboembolic pulmonary hypertension (CTEPH) (PanelsA and B). Cardiac catheterization presented extremely high pulmonary arterial pressure of 112/40 (mean 71) mmHg, low cardiac index of 1.54 L/min/m2, and multiple organized thrombotic pulmonary artery stenosis/occlusion (PanelA), confirming the diagnosis of CTEPH. We carefully performed balloon pulmonary angioplasty (BPA) using an undersized balloon to the right pulmonary arteries to avoid extensive reperfusion pulmonary oedema (PanelA, yellow square). We successfully finished the session without any angiographic complications. However, then after, her oxygen saturation was gradually worsened (PanelE). The urgent CT revealed multiple patchy lung injury including non-BPA area, corresponding to the prior relatively perfused area (PanelC, yellow and red arrowheads indicate BPA area and non-BPA area, respectively). We started non-invasive positive airway pressure ventilation and the lung injury was immediately resolved (PanelsD and E).
      PubDate: 2017-10-17
      DOI: 10.1093/ehjci/jex210
      Issue No: Vol. 18, No. 12 (2017)
       
  • Right ventricular thickening and extensive late gadolinium enhancement in
           a patient with rare case of isolated cardiac sarcoidosis and initially
           negative biopsy
    • Authors: Ueberham L; Paetsch I, Jahnke C, et al.
      Pages: 1427 - 1428
      Abstract: We describe a case of 42-year-old man with an exertional syncope, right bundle branch block and prolonged PR interval. Hypertrophic cardiomyopathy was suspected due to asymmetrical thickening of the ventricular septum in echocardiography. Further evaluation with cardiac magnetic resonance (CMR) revealed massive late gadolinium enhancement involving predominantly the right ventricle and basal septum (Figure 1, PanelsA, B, D, and E). The extensive diagnostic work-up ruled out secondary cardiac involvement by infiltrative, lymphoproliferative, and autoimmune diseases. The inflammatory reaction in the cardiac biopsies and the diffuse abnormal myocardial metabolism in positron-emission tomography (Figure 1, Panel C) suggested acute myocarditis. In the course of the disease, a sustained ventricular tachycardia (VT) occurred and the repeated CMR showed patchy gadolinium enhancement in both ventricles as well as biventricular dilatation and dysfunction. A new biopsy showed non-caseating granulomas and was confirmatory for cardiac sarcoidosis (Figure 1, PanelsI, J, and K). Due to refractory VT, the patient was referred for catheter ablation. The electro-anatomical mapping revealed extensive right ventricular areas of low-amplitude and fragmented signals (Figure 1,PanelsF, G, and H). Finally, we implanted a cardioverter-defibrillator and started immunosuppressive therapy.
      PubDate: 2017-09-28
      DOI: 10.1093/ehjci/jex226
      Issue No: Vol. 18, No. 12 (2017)
       
  • Clinical significance of septal deformation patterns in heart failure
           patients receiving cardiac resynchronization therapy
    • Authors: Menet A; Bernard A, Tribouilloy C, et al.
      Abstract: AimsSpecific septal motion related to dyssynchrony is strongly linked to reverse remodelling, in patients with systolic heart failure (HF) receiving cardiac resynchronization therapy (CRT). We aimed to investigate the relationship between septal deformation patterns studied by longitudinal speckle tracking and clinical outcome following CRT.Methods and resultsA total of 284 CRT candidates from two centres (HF NYHA classes II–IV, ejection fraction < 35%, QRS ≥ 120 ms) were prospectively included. Longitudinal strain of the septum in the apical four-chamber view determined three patterns of septal contraction. The endpoints were overall mortality, cardiovascular mortality, and hospitalization for HF. Compared with patterns 1 or 2, pattern 3 was associated with an increased risk for both overall and cardiovascular mortality [hazard ratio (HR) = 3.78, 95% confidence interval (CI): 1.85–7.75, P < 0.001 and HR = 3.84, 95% CI: 1.45–10.16, P = 0.007, respectively] and HF hospitalization (HR = 4.41, 95% CI: 2.18–8.90, P < 0.001). Addition of septal patterns to multivariable models, including baseline QRS width and presence of left bundle branch block, improved risk prediction, and discrimination. In patients with intermediate QRS duration (120–150 ms), pattern 3 remained associated with a worse outcome than pattern 1 or 2 (P < 0.05 for all endpoints).ConclusionThe identification of septal deformation patterns provides important prognostic information in CRT candidates in addition to ordinary clinical, electrocardiographic, and echocardiographic predictors of outcome in HF patients. This parameter may be particularly useful in patients with intermediate QRS duration in whom the benefit of CRT remains uncertain.
      PubDate: 2016-12-30
       
  • Hypertrophic cardiomyopathy with aortic dilation: a novel observation
    • Authors: Yousefzai R; Agarwal A, Fuad Jan M, et al.
      Abstract: AimsOur goal was to identify the prevalence of aortic dilation in patients with hypertrophic cardiomyopathy (HCM), the most prevalent (0.2%) heritable, genetic cardiovascular disease. Aortic dilation also represents a spectrum of familial inheritance. However, data regarding the prevalence of aortic dilation in HCM patients is lacking.Methods and resultsThis is an observational retrospective study of all patients referred to our HCM centre. Aortic dilation was defined based on recent American Society of Echocardiography and European Association of Cardiovascular Imaging published guidelines. Of the 201 HCM patients seen between Jan. 1, 2011 and March 31, 2014, 18 (9.0%) met the definition of aortic dilation. Mean age was 56.3 ± 9.3 years, 77.8% were male, mean ascending aorta diameter was 4.0 ± 0.4 cm in males and 3.8 ± 0.2 cm in females, mean sinuses of Valsalva diameter was 4.2 ± 0.2 cm in males and 3.8 ± 0.4 cm in females, and 13 (72.2%) had left ventricular outflow tract obstruction. HCM patients with dilated aorta were more likely males, less likely hypertensive and had larger left ventricle diameter and more aortic valve regurgitation; remaining characteristics were similar.ConclusionWe report a novel observation with 9.0% prevalance of dilated aorta in HCM patients. Further studies are needed to help define the genetic and pathophysiologic basis as well as the clinical implications of this association in a larger group of HCM patients.
      PubDate: 2016-12-26
       
  • Fractional flow reserve derived from coronary computed tomography
           
    • Authors: Eftekhari A; Min J, Achenbach S, et al.
      Abstract: AimsFractional flow reserve (FFR) derived from coronary computed tomography (FFRCT) has high diagnostic performance in stable coronary artery disease (CAD). The diagnostic performance of FFRCT in patients with hypertension (HTN) and diabetes (DM), who are at risk of microvascular impairment, is not known.Methods and resultsWe analysed the diagnostic performance of FFRCT, in patients (vessels) with DM (n = 16), HTN (n = 186), DM + HTN (n = 58) vs. controls (n = 107) with or with suspected CAD. Patients (vessels) were further divided according to left ventricular mass index (LVMI) tertiles. Reference standard was invasively measured FFR ≤0.80. Per-patient diagnostic accuracy (95% CI) in control patients was 71.7% (61.6–81.8) vs. 79.3 (74.0–85.0) (P = 0.12), 75.0% (47.6–92.7) (P = 0.52), and 75.9% (62.8–86.1) (P = 0.39) in patients with HTN, DM, and HTM + DM, respectively. There was no difference in discrimination of ischaemia by FFRCT between groups. On a per-vessel level, there was no significant difference in diagnostic performance or discrimination of ischaemia by FFRCT between groups. There was a decline in both per-patient and -vessel diagnostic specificity of FFRCT in the upper LVMI tertile when compared with lower tertiles; however, discrimination of ischaemia by FFRCT was unaltered across LVMI tertiles.ConclusionThe diagnostic performance of FFRCT is independent of the presence of HTN and DM. FFRCT is a robust method in a broad stable CAD population, including patients at high risk for microvascular disease.
      PubDate: 2016-12-24
       
  • CT sizing for left atrial appendage closure is associated with favourable
           outcomes for procedural safety
    • Authors: Rajwani A; Nelson A, Shirazi M, et al.
      Abstract: AimsWe evaluated the utility of computerized tomography (CT) with respect to sizing work-up for percutaneous left atrial appendage (LAA) closure, and implications for procedural safety and outcomes.Methods and resultsContrast-enhanced multi-detector CT was routinely conducted to guide sizing for LAA closure in addition to transoesophageal echocardiography (TOE). Procedural safety and efficacy were prospectively assessed. Across 73 consecutive cases there were no device-related procedural complications, and no severe leaks. Systematic bias in orifice sizing by TOE vs. CT was significant on retrospective analysis (bias −3.0 mm vs. maximum diameter on CT; bias −1.1 mm vs. mean diameter on CT). Importantly, this translated to an altered device size selection in more than half of all cases, and median size predicted by CT was one interval greater than that predicted by TOE (27 mm vs. 24 mm). Of particular note, gross sizing error by TOE vs. CT was observed in at least 3.4% of cases. Degree of discrepancy between TOE and CT was correlated with LAA orifice eccentricity, orifice size, and left atrial volume. Mean orifice size by CT had the greatest utility for final Watchman device-size selection.ConclusionsIn this single-centre registry of LAA closure, routine incorporation of CT was associated with excellent outcomes for procedural safety and absence of major residual leak. Mean orifice size may be preferable to maximum orifice size. A particular value of CT may be the detection and subsequent avoidance of gross sizing error by 2D TOE that occurs in a small but important proportion of cases.
      PubDate: 2016-12-24
       
  • Heart mechanics at high altitude: 6 days on the top of Europe
    • Authors: Maufrais C; Rupp T, Bouzat P, et al.
      Abstract: AimsThe aim of this study was to analyse the underlying mechanisms of left and right ventricular (LV and RV) functional alterations during several days in high-altitude hypoxia.Methods and resultsResting evaluations of LV and RV function and mechanics were assessed by Speckle Tracking Echocardiography on 11 subjects at sea level (SLPRE), 3 ± 2 h after helicopter transport to high altitude (D0), at day 2 (D2), day 4 (D4) and day 6 (D6) at 4350 m and 5 ± 2 h after return to sea level (SLPOST). Subjects experienced acute mountain sickness (AMS) during the first days at 4350 m. LV systolic function, RV systolic and diastolic function, LV and RV strains and LV synchrony were unchanged at high altitude. Peak twist was increased at D0, continued to increase until D6 (SLPRE: 9.0 ± 5.1deg; D6: 13.0 ± 4.0deg, P < 0.05), but was normalized at SLPOST. Early filling decreased at high altitude with a nadir at D2 (SLPRE: 78 ± 13 cm s−1; D2: 66 ± 11 cm s−1, P < 0.05). LV filling pressures index was decreased at high altitude with the minimum value obtained at D2 and remained reduced at SLPOST. Untwisting, an important factor of LV filling, was not decreased but was delayed at 4350 m.ConclusionsHigh-altitude exposure impaired LV diastolic function with the greatest effect observed at D2, concomitantly with the occurrence of AMS. The LV early filling impairments resulted from an increased RV afterload, a decrease in LV filling pressure and a delayed LV untwist. However, the increased LV twist probably acted as a compensatory mechanism to maintain cardiac performance during high-altitude hypoxia.
      PubDate: 2016-12-22
       
 
 
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