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Erschienen in: The International Journal of Cardiovascular Imaging 12/2017

15.07.2017 | Original Paper

Left atrial dysfunction as a determinant of pulmonary hypertension in patients with severe aortic stenosis and preserved left ventricular ejection fraction

verfasst von: Andreea Calin, Anca D. Mateescu, Monica Rosca, Carmen C. Beladan, Roxana Enache, Simona Botezatu, Iulian Cosei, Cosmin Calin, Marian Simion, Carmen Ginghina, Andreea C. Popescu, Bogdan A. Popescu

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 12/2017

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Abstract

In patients with severe aortic stenosis (AS), the presence of pulmonary hypertension (PH) has been linked to a poor prognosis. We aimed to assess the main determinants of PH in patients with severe AS and preserved left ventricular ejection fraction (LVEF). We prospectively enrolled 108 consecutive patients with isolated severe AS (indexed aortic valve area <0.6 cm2/m2) and LVEF >50%, in sinus rhythm. Left atrial (LA) function was assessed using longitudinal deformation parameters (by speckle tracking echocardiography). PH (defined as systolic pulmonary artery pressure >40 mmHg) was present in 20 patients. Patients with severe AS and PH were older (p = 0.05), had higher BNP values (p = 0.05) and a greater degree of LV diastolic dysfunction: higher E/e′ and E/A ratios and lower EDT values (p < 0.03 for all) compared to patients without PH. There were no differences between groups regarding AS severity and LV systolic function parameters. Patients with PH had a more impaired LA function: lower septal and lateral late diastolic peak velocity a′ (p < 0.001 and p = 0.04 respectively) and lower LA peak longitudinal strain and strain rate parameters (p ≤ 0.005 for all). In multivariable analysis, LA late diastolic longitudinal strain rate was the only independent correlate of PH in our patients (p = 0.04). Patients with isolated severe AS, preserved LVEF and PH had larger LA volumes, a more impaired LA function, and higher LV filling pressures compared to those without PH. LA booster pump function, reflected by late diastolic longitudinal strain rate, emerged as an independent correlate of PH in these patients.
Literatur
1.
Zurück zum Zitat Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW et al (2003) A prospective survey of patients with valvular heart disease in Europe: the Euro heart survey on valvular heart disease. Eur Heart J 24:1231–1243CrossRefPubMed Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW et al (2003) A prospective survey of patients with valvular heart disease in Europe: the Euro heart survey on valvular heart disease. Eur Heart J 24:1231–1243CrossRefPubMed
2.
Zurück zum Zitat Faggiano P, Antonini-Canterin F, Ribichini F, D’Aloia A, Ferrero V, Cervesato E et al (2000) Pulmonary artery hypertension in adult patients with symptomatic valvular aortic stenosis. Am J Cardiol 85:204–208CrossRefPubMed Faggiano P, Antonini-Canterin F, Ribichini F, D’Aloia A, Ferrero V, Cervesato E et al (2000) Pulmonary artery hypertension in adult patients with symptomatic valvular aortic stenosis. Am J Cardiol 85:204–208CrossRefPubMed
3.
Zurück zum Zitat O’Sullivan CJ, Wenaweser P, Ceylan O, Rat-Wirtzler J, Stortecky S, Heg D et al (2015) Effect of pulmonary hypertension hemodynamic presentation on clinical outcomes in patients with severe symptomatic aortic valve stenosis undergoing transcatheter aortic valve implantation: insights from the new proposed pulmonary hypertension classification. Circ Cardiovasc Interv 8(7):e002358CrossRefPubMed O’Sullivan CJ, Wenaweser P, Ceylan O, Rat-Wirtzler J, Stortecky S, Heg D et al (2015) Effect of pulmonary hypertension hemodynamic presentation on clinical outcomes in patients with severe symptomatic aortic valve stenosis undergoing transcatheter aortic valve implantation: insights from the new proposed pulmonary hypertension classification. Circ Cardiovasc Interv 8(7):e002358CrossRefPubMed
4.
Zurück zum Zitat D’Onofrio A, Rubino P, Fusari M, Salvador L, Musumeci F, Rinaldi M et al (2011) Clinical and hemodynamic outcomes of “all-comers” undergoing transapical aortic valve implantation: results from the Italian Registry of Trans-Apical Aortic Valve Implantation (I-TA). J Thorac Cardiovasc Surg 142:768–775CrossRefPubMed D’Onofrio A, Rubino P, Fusari M, Salvador L, Musumeci F, Rinaldi M et al (2011) Clinical and hemodynamic outcomes of “all-comers” undergoing transapical aortic valve implantation: results from the Italian Registry of Trans-Apical Aortic Valve Implantation (I-TA). J Thorac Cardiovasc Surg 142:768–775CrossRefPubMed
5.
Zurück zum Zitat Zlotnick DM, Ouellette ML, Malenka DJ, DeSimone JP, Leavitt BJ, Helm RE et al (2013) Effect of preoperative pulmonary hypertension on outcomes in patients with severe aortic stenosis following surgical aortic valve replacement. Am J Cardiol 112:1635–1640CrossRefPubMed Zlotnick DM, Ouellette ML, Malenka DJ, DeSimone JP, Leavitt BJ, Helm RE et al (2013) Effect of preoperative pulmonary hypertension on outcomes in patients with severe aortic stenosis following surgical aortic valve replacement. Am J Cardiol 112:1635–1640CrossRefPubMed
6.
Zurück zum Zitat Melby SJ, Moon MR, Lindman BR, Bailey MS, Hill LL, Damiano RJ Jr (2011) Impact of pulmonary hypertension on outcomes after aortic valve replacement for aortic valve stenosis. J Thorac Cardiovasc Surg 141:1424–1430CrossRefPubMedPubMedCentral Melby SJ, Moon MR, Lindman BR, Bailey MS, Hill LL, Damiano RJ Jr (2011) Impact of pulmonary hypertension on outcomes after aortic valve replacement for aortic valve stenosis. J Thorac Cardiovasc Surg 141:1424–1430CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Sinning J-M, Hammerstingl C, Chin D, Ghanem A, Schueler R, Sedaghat A et al (2014) Decrease of pulmonary hypertension impacts on prognosis after transcatheter aortic valve replacement. Euro-Intervention 9:1042–1049PubMed Sinning J-M, Hammerstingl C, Chin D, Ghanem A, Schueler R, Sedaghat A et al (2014) Decrease of pulmonary hypertension impacts on prognosis after transcatheter aortic valve replacement. Euro-Intervention 9:1042–1049PubMed
8.
Zurück zum Zitat Bishu K, Suri RM, Nkomo VT, Kane GC, Greason KL, Reeder GS et al (2014) Prognostic impact of pulmonary artery systolic pressure in patients undergoing transcatheter aortic valve replacement for aortic stenosis. Am J Cardiol 114:1562–1567CrossRefPubMed Bishu K, Suri RM, Nkomo VT, Kane GC, Greason KL, Reeder GS et al (2014) Prognostic impact of pulmonary artery systolic pressure in patients undergoing transcatheter aortic valve replacement for aortic stenosis. Am J Cardiol 114:1562–1567CrossRefPubMed
9.
Zurück zum Zitat Malouf JF, Enriquez-Sarano M, Pellikka PA, Oh JK, Bailey KR, Chandrasekaran K et al (2002) Severe pulmonary hypertension in patients with severe aortic valve stenosis: clinical profile and prognostic implications. J Am Coll Cardiol 40:789–795CrossRefPubMed Malouf JF, Enriquez-Sarano M, Pellikka PA, Oh JK, Bailey KR, Chandrasekaran K et al (2002) Severe pulmonary hypertension in patients with severe aortic valve stenosis: clinical profile and prognostic implications. J Am Coll Cardiol 40:789–795CrossRefPubMed
10.
Zurück zum Zitat Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H et al (2012) Guidelines on the management of valvular heart disease. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 33:2451–2496CrossRefPubMed Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H et al (2012) Guidelines on the management of valvular heart disease. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 33:2451–2496CrossRefPubMed
11.
Zurück zum Zitat Mutlak D, Aronson D, Carasso S, Lessick J, Reisner SA, Agmon Y (2012) Frequency, determinants and outcome of pulmonary hypertension in patients with aortic valve stenosis. Am J Med Sci 343:397–401CrossRefPubMed Mutlak D, Aronson D, Carasso S, Lessick J, Reisner SA, Agmon Y (2012) Frequency, determinants and outcome of pulmonary hypertension in patients with aortic valve stenosis. Am J Med Sci 343:397–401CrossRefPubMed
12.
Zurück zum Zitat Casaclang-Verzosa G, Nkomo VT, Sarano ME, Malouf JF, Miller FA Jr, Oh JK (2008) E/Ea is the major determinant of pulmonary artery pressure in moderate to severe aortic stenosis. J Am Soc Echocardiogr 21:824–827CrossRefPubMed Casaclang-Verzosa G, Nkomo VT, Sarano ME, Malouf JF, Miller FA Jr, Oh JK (2008) E/Ea is the major determinant of pulmonary artery pressure in moderate to severe aortic stenosis. J Am Soc Echocardiogr 21:824–827CrossRefPubMed
13.
Zurück zum Zitat Ahn HS, Chang SA, Kim HK, Kim SJ, Lee SP, Park SJ et al (2014) Determinants of pulmonary hypertension development in moderate or severe aortic stenosis. Int J Cardiovasc Imaging 30:1519–1528CrossRefPubMed Ahn HS, Chang SA, Kim HK, Kim SJ, Lee SP, Park SJ et al (2014) Determinants of pulmonary hypertension development in moderate or severe aortic stenosis. Int J Cardiovasc Imaging 30:1519–1528CrossRefPubMed
14.
Zurück zum Zitat Dalsgaard M, Egstrup K, Wachtell K, Gerdts E, Cramariuc D, Kjaergaard J et al (2008) Left atrial volume in patients with asymptomatic aortic valve stenosis (the Simvastatin and Ezetimibe in Aortic Stenosis study). Am J Cardiol 101:1030–1034CrossRefPubMed Dalsgaard M, Egstrup K, Wachtell K, Gerdts E, Cramariuc D, Kjaergaard J et al (2008) Left atrial volume in patients with asymptomatic aortic valve stenosis (the Simvastatin and Ezetimibe in Aortic Stenosis study). Am J Cardiol 101:1030–1034CrossRefPubMed
15.
Zurück zum Zitat Zipes DP, Libby P, Bonow RO, Braunwald E (2005) Braunwald’s heart disease: a textbook of cardiovascular medicine. Elsevier Saunders, Philadelphia, pp 1553–1632 Zipes DP, Libby P, Bonow RO, Braunwald E (2005) Braunwald’s heart disease: a textbook of cardiovascular medicine. Elsevier Saunders, Philadelphia, pp 1553–1632
16.
17.
Zurück zum Zitat Capomolla S, Febo O, Guazzotti G, Gnemmi M, Mortara A, Riccardi G et al (2000) Invasive and non-invasive determinants of pulmonary hypertension in patients with chronic heart failure. J Heart Lung Transplant 19:426–438CrossRefPubMed Capomolla S, Febo O, Guazzotti G, Gnemmi M, Mortara A, Riccardi G et al (2000) Invasive and non-invasive determinants of pulmonary hypertension in patients with chronic heart failure. J Heart Lung Transplant 19:426–438CrossRefPubMed
18.
Zurück zum Zitat Zoghbi WA, Farmer KL, Soto JG, Nelson JG, Quinones MA (1986) Accurate noninvasive quantification of stenotic aortic valve area by Doppler echocardiography. Circulation 73:452–459CrossRefPubMed Zoghbi WA, Farmer KL, Soto JG, Nelson JG, Quinones MA (1986) Accurate noninvasive quantification of stenotic aortic valve area by Doppler echocardiography. Circulation 73:452–459CrossRefPubMed
19.
Zurück zum Zitat Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16:233–270CrossRefPubMed Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16:233–270CrossRefPubMed
20.
Zurück zum Zitat Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T et al (2016) Recommendations for the Evaluation of Left Ventricular Diastolic Function by echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 17:1321–1360CrossRefPubMed Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T et al (2016) Recommendations for the Evaluation of Left Ventricular Diastolic Function by echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 17:1321–1360CrossRefPubMed
21.
Zurück zum Zitat Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I et al (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458CrossRefPubMed Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I et al (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458CrossRefPubMed
22.
Zurück zum Zitat Bruch C, Stypmann J, Grude M, Gradaus R, Breithardt G, Wichter T (2004) Tissue doppler imaging in patients with moderate to severe aortic valve stenosis: clinical usefulness and diagnostic accuracy. Am Heart J 148:696–702CrossRefPubMed Bruch C, Stypmann J, Grude M, Gradaus R, Breithardt G, Wichter T (2004) Tissue doppler imaging in patients with moderate to severe aortic valve stenosis: clinical usefulness and diagnostic accuracy. Am Heart J 148:696–702CrossRefPubMed
23.
Zurück zum Zitat Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G et al (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications. Endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 12:167–205CrossRefPubMed Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G et al (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications. Endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 12:167–205CrossRefPubMed
24.
Zurück zum Zitat Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M et al (2009) Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound 7:6CrossRefPubMedPubMedCentral Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M et al (2009) Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound 7:6CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713CrossRefPubMed Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713CrossRefPubMed
26.
Zurück zum Zitat Raina A, Gertz ZM, O’Donnell WT, Herrmann HC, Forfia PR (2015) Pulmonary hypertension is a manifestation of congestive heart failure and left ventricular diastolic dysfunction in octogenarians with severe aortic stenosis. Pulm Circ 5:521–526CrossRefPubMedPubMedCentral Raina A, Gertz ZM, O’Donnell WT, Herrmann HC, Forfia PR (2015) Pulmonary hypertension is a manifestation of congestive heart failure and left ventricular diastolic dysfunction in octogenarians with severe aortic stenosis. Pulm Circ 5:521–526CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat McQuillan BM, Picard MH, Leavitt M, Weyman AE (2001) Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation 104:2797–2802CrossRefPubMed McQuillan BM, Picard MH, Leavitt M, Weyman AE (2001) Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation 104:2797–2802CrossRefPubMed
28.
Zurück zum Zitat Kapoor N, Varadarajan P, Pai R (2007) Echocardiographic predictors of pulmonary hypertension in patients with severe aortic stenosis. Eur J Echocardiogr 9:31–33 Kapoor N, Varadarajan P, Pai R (2007) Echocardiographic predictors of pulmonary hypertension in patients with severe aortic stenosis. Eur J Echocardiogr 9:31–33
29.
Zurück zum Zitat Silver K, Aurigemma G, Krendel S, Barry N, Ockene I, Alpert J (1993) Pulmonary artery hypertension in severe aortic stenosis: incidence and mechanism. Am Heart J 125:146–150CrossRefPubMed Silver K, Aurigemma G, Krendel S, Barry N, Ockene I, Alpert J (1993) Pulmonary artery hypertension in severe aortic stenosis: incidence and mechanism. Am Heart J 125:146–150CrossRefPubMed
30.
Zurück zum Zitat Cam A, Goel SS, Agarwal S, Menon V, Svensson LG, Tuzcu EM, Kapadia SR (2011) Prognostic implications of pulmonary hypertension in patients with severe aortic stenosis. J Thorac Cardiovasc Surg 142:800–808CrossRefPubMed Cam A, Goel SS, Agarwal S, Menon V, Svensson LG, Tuzcu EM, Kapadia SR (2011) Prognostic implications of pulmonary hypertension in patients with severe aortic stenosis. J Thorac Cardiovasc Surg 142:800–808CrossRefPubMed
31.
Zurück zum Zitat Johnson LW, Hapanowicz MB, Buonanno C, Bowser MA, Marvasti MA, Parker FB (1998) Pulmonary hypertension in isolated aortic stenosis. Hemodynamic correlations and follow-up. J Thorac Cardiovasc Surg 95:603–607 Johnson LW, Hapanowicz MB, Buonanno C, Bowser MA, Marvasti MA, Parker FB (1998) Pulmonary hypertension in isolated aortic stenosis. Hemodynamic correlations and follow-up. J Thorac Cardiovasc Surg 95:603–607
32.
Zurück zum Zitat Ozkan A, Kapadia S, Tuzcu M, Marwick TH (2011) Assessment of left ventricular function in aortic stenosis. Nat Rev Cardiol 8:494–501CrossRefPubMed Ozkan A, Kapadia S, Tuzcu M, Marwick TH (2011) Assessment of left ventricular function in aortic stenosis. Nat Rev Cardiol 8:494–501CrossRefPubMed
33.
Zurück zum Zitat Triposkiadis F, Tentolouris K, Androulakis A, Trikas A, Toutouzas K, Kyriakidis M et al (1995) Left atrial mechanical function in the healthy elderly: new insights from a combined assessment of changes in atrial volume and transmitral flow velocity. J Am Soc Echocardiogr 8:801–809CrossRefPubMed Triposkiadis F, Tentolouris K, Androulakis A, Trikas A, Toutouzas K, Kyriakidis M et al (1995) Left atrial mechanical function in the healthy elderly: new insights from a combined assessment of changes in atrial volume and transmitral flow velocity. J Am Soc Echocardiogr 8:801–809CrossRefPubMed
34.
Zurück zum Zitat Popescu BA, Roşca M (2014) Imaging of myocardial fibrosis in hypertrophic cardiomyopathy: what is the gold standard? Heart 100:605–606CrossRefPubMed Popescu BA, Roşca M (2014) Imaging of myocardial fibrosis in hypertrophic cardiomyopathy: what is the gold standard? Heart 100:605–606CrossRefPubMed
35.
Zurück zum Zitat Tumminello G, Lancellotti P, Lempereur M, D’Orio V, Pierard LA (2007) Determinants of pulmonary artery hypertension at rest and during exercise in patients with heart failure. Eur Heart J 28:569–574CrossRefPubMed Tumminello G, Lancellotti P, Lempereur M, D’Orio V, Pierard LA (2007) Determinants of pulmonary artery hypertension at rest and during exercise in patients with heart failure. Eur Heart J 28:569–574CrossRefPubMed
36.
Zurück zum Zitat Poh KK, Chan MY, Yang H, Yong QW, Chan YH, Ling LH (2008) Prognostication of valvular aortic stenosis using tissue Doppler echocardiography: underappreciated importance of late diastolic mitral annular velocity. J Am Soc Echocardiogr 21:475–481CrossRefPubMed Poh KK, Chan MY, Yang H, Yong QW, Chan YH, Ling LH (2008) Prognostication of valvular aortic stenosis using tissue Doppler echocardiography: underappreciated importance of late diastolic mitral annular velocity. J Am Soc Echocardiogr 21:475–481CrossRefPubMed
37.
Zurück zum Zitat Saraiva RM, Matsumura Y, Yamano T, Greenberg N, Thomas JD, Shiota T (2010) Relation of left atrial dysfunction to pulmonary artery hypertension in patients with aortic stenosis and left ventricular systolic dysfunction. Am J Cardiol 106:409–416CrossRefPubMed Saraiva RM, Matsumura Y, Yamano T, Greenberg N, Thomas JD, Shiota T (2010) Relation of left atrial dysfunction to pulmonary artery hypertension in patients with aortic stenosis and left ventricular systolic dysfunction. Am J Cardiol 106:409–416CrossRefPubMed
38.
Zurück zum Zitat Galli E, Fournet M, Chabanne C, Lelong B, Leguerrier A, Flecher E, Mabo P, Donal E (2016) Prognostic value of left atrial reservoir function in patients with severe aortic stenosis: a 2D speckle-tracking echocardiographic study. Eur Heart J Cardiovasc Imaging 17:533–541CrossRefPubMed Galli E, Fournet M, Chabanne C, Lelong B, Leguerrier A, Flecher E, Mabo P, Donal E (2016) Prognostic value of left atrial reservoir function in patients with severe aortic stenosis: a 2D speckle-tracking echocardiographic study. Eur Heart J Cardiovasc Imaging 17:533–541CrossRefPubMed
39.
Zurück zum Zitat Pagel PS, Kehl F, Gare M, Hettrick DA, Kersten JR, Warltier DC (2003) Mechanical function of the left atrium: new insights based on analysis of pressure volume relations and Doppler echocardiography. Anesthesiology 98:975–994CrossRefPubMed Pagel PS, Kehl F, Gare M, Hettrick DA, Kersten JR, Warltier DC (2003) Mechanical function of the left atrium: new insights based on analysis of pressure volume relations and Doppler echocardiography. Anesthesiology 98:975–994CrossRefPubMed
40.
Zurück zum Zitat Kim SJ, Choisy SC, Barman P, Zhang H, Hancox JC, Jones SA et al (2011) Atrial remodeling and the substrate for atrial fibrillation in rat hearts with elevated afterload. Circ Arrhythm Electrophysiol 4:761–769CrossRefPubMed Kim SJ, Choisy SC, Barman P, Zhang H, Hancox JC, Jones SA et al (2011) Atrial remodeling and the substrate for atrial fibrillation in rat hearts with elevated afterload. Circ Arrhythm Electrophysiol 4:761–769CrossRefPubMed
41.
Zurück zum Zitat Roşca M, Popescu BA, Beladan CC, Călin A, Muraru D, Popa EC, Lancellotti P, Enache R, Coman IM, Jurcuţ R, Ghionea M, Ginghină C (2010) Left atrial dysfunction as a correlate of heart failure symptoms in hypertrophic cardiomyopathy. J Am Soc Echocardiogr 23:1090–1098CrossRefPubMed Roşca M, Popescu BA, Beladan CC, Călin A, Muraru D, Popa EC, Lancellotti P, Enache R, Coman IM, Jurcuţ R, Ghionea M, Ginghină C (2010) Left atrial dysfunction as a correlate of heart failure symptoms in hypertrophic cardiomyopathy. J Am Soc Echocardiogr 23:1090–1098CrossRefPubMed
Metadaten
Titel
Left atrial dysfunction as a determinant of pulmonary hypertension in patients with severe aortic stenosis and preserved left ventricular ejection fraction
verfasst von
Andreea Calin
Anca D. Mateescu
Monica Rosca
Carmen C. Beladan
Roxana Enache
Simona Botezatu
Iulian Cosei
Cosmin Calin
Marian Simion
Carmen Ginghina
Andreea C. Popescu
Bogdan A. Popescu
Publikationsdatum
15.07.2017
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 12/2017
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-017-1211-2

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