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Mamazhakypov A, Sartmyrzaeva M, Kushubakova N, Duishobaev M, Maripov A, Sydykov A, Sarybaev A. Right Ventricular Response to Acute Hypoxia Exposure: A Systematic Review. Front Physiol 2022; 12:786954. [PMID: 35095556 PMCID: PMC8791628 DOI: 10.3389/fphys.2021.786954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Acute hypoxia exposure is associated with an elevation of pulmonary artery pressure (PAP), resulting in an increased hemodynamic load on the right ventricle (RV). In addition, hypoxia may exert direct effects on the RV. However, the RV responses to such challenges are not fully characterized. The aim of this systematic review was to describe the effects of acute hypoxia on the RV in healthy lowland adults. Methods: We systematically reviewed PubMed and Web of Science and article references from 2005 until May 2021 for prospective studies evaluating echocardiographic RV function and morphology in healthy lowland adults at sea level and upon exposure to simulated altitude or high-altitude. Results: We included 37 studies in this systematic review, 12 of which used simulated altitude and 25 were conducted in high-altitude field conditions. Eligible studies reported at least one of the RV variables, which were all based on transthoracic echocardiography assessing RV systolic and diastolic function and RV morphology. The design of these studies significantly differed in terms of mode of ascent to high-altitude, altitude level, duration of high-altitude stay, and timing of measurements. In the majority of the studies, echocardiographic examinations were performed within the first 10 days of high-altitude induction. Studies also differed widely by selectively reporting only a part of multiple RV parameters. Despite consistent increase in PAP documented in all studies, reports on the changes of RV function and morphology greatly differed between studies. Conclusion: This systematic review revealed that the study reports on the effects of acute hypoxia on the RV are controversial and inconclusive. This may be the result of significantly different study designs, non-compliance with international guidelines on RV function assessment and limited statistical power due to small sample sizes. Moreover, the potential impact of other factors such as gender, age, ethnicity, physical activity, mode of ascent and environmental factors such as temperature and humidity on RV responses to hypoxia remained unexplored. Thus, this comprehensive overview will promote reproducible research with improved study designs and methods for the future large-scale prospective studies, which eventually may provide important insights into the RV response to acute hypoxia exposure.
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Affiliation(s)
- Argen Mamazhakypov
- Department of Internal Medicine, Excellence Cluster Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Justus Liebig University of Giessen, Giessen, Germany
| | - Meerim Sartmyrzaeva
- Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
- Kyrgyz Indian Mountain Biomedical Research Center, Bishkek, Kyrgyzstan
| | - Nadira Kushubakova
- Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
- Kyrgyz Indian Mountain Biomedical Research Center, Bishkek, Kyrgyzstan
| | - Melis Duishobaev
- Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
- Kyrgyz Indian Mountain Biomedical Research Center, Bishkek, Kyrgyzstan
| | - Abdirashit Maripov
- Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
- Kyrgyz Indian Mountain Biomedical Research Center, Bishkek, Kyrgyzstan
| | - Akylbek Sydykov
- Department of Internal Medicine, Excellence Cluster Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Justus Liebig University of Giessen, Giessen, Germany
- Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Akpay Sarybaev
- Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
- Kyrgyz Indian Mountain Biomedical Research Center, Bishkek, Kyrgyzstan
- *Correspondence: Akpay Sarybaev
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Gaur P, Sartmyrzaeva M, Maripov A, Muratali Uulu K, Saini S, Ray K, Kishore K, Akunov A, Sarybaev A, Kumar B, Singh SB, Vats P. Cardiac Acclimatization at High Altitude in Two Different Ethnicity Groups. High Alt Med Biol 2021; 22:58-69. [PMID: 33400909 DOI: 10.1089/ham.2020.0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Gaur, Priya, Meerim Sartmyrzaeva, Abdirashit Maripov, Kubatbek Muratali Uulu, Supriya Saini, Koushik Ray, Krishna Kishore, Almaz Akunov, Akpay Sarybaev, Bhuvnesh Kumar, Shashi Bala Singh, and Praveen Vats. Cardiac acclimatization at high altitude in two different ethnicity groups. High Alt Med Biol. 22:58-69, 2021. Introduction: High altitude (HA) exposure causes substantial increase in pulmonary artery pressure (PAP) and resistance. However, the effects of HA hypoxia exposure on cardiac function remain incompletely understood. Studies evaluating interethnic differences in cardiac functions in response to HA exposure are lacking. We aimed to compare the cardiac performance in Indian versus Kyrgyz healthy lowland subjects over the course of a 3-week HA exposure at 4,111 m. Methodology: Ten Indians and 20 Kyrgyz subjects were studied to assess cardiac acclimatization noninvasively by echocardiography in two different ethnic groups for 3 weeks of stay at HA. Pulmonary hemodynamics, right and left ventricular functions were evaluated at basal and on days 3, 7, 14, and 21 of HA exposure and on day 3 of deinduction. Results: HA exposure significantly increased PAP, pulmonary vascular resistance, cardiac output (CO), and heart rates (HRs) in both groups. Tricuspid regurgitant gradient increased significantly in both the group at day 3 versus basal; 38.9 mmHg (31.8, 42.9) versus 21.9 mmHg (19.5, 22.6) in Kyrgyz; and 34.1 mmHg (30.2, 38.5) versus 20.4 mmHg (19.7, 21.3) in Indians. HR increased significantly in Indians at day 3 and 7, whereas in Kyrgyz throughout exposure. CO increased significantly in both groups at day 3 versus basal with 5.9 L/min (5.5, 6.4) versus 5.1 L/min (4.4, 5.9) in Kyrgyz, and 5.7 L/min (5.56, 5.98) versus 4.9 L/min (4.1, 5.3) in Indians. Both groups exhibited preserved right ventricular diastolic and systolic functions at HAs. HA exposure changed the left ventricular diastolic parameters only in Kyrgyz subjects with impaired mitral inflow E/A, but not in Indian subjects. All cardiac changes induced at HAs have been recovered fully upon deinduction in both, except lateral-septal A', which remained low in Indians. Conclusion: Although pulmonary hemodynamics responses were similar in both groups, there were differences in cardiac functional parameters between the two in response to HA exposure that may be accounted to ethnic variation.
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Affiliation(s)
- Priya Gaur
- Endocrinology and Metabolism Division, Defense Institute of Physiology and Allied Sciences, Delhi, India
| | | | - Abdirashit Maripov
- Kyrgyz Indian Mountain Biomedical Research Center, Bishkek, Kyrgyz Republic
| | | | - Supriya Saini
- Endocrinology and Metabolism Division, Defense Institute of Physiology and Allied Sciences, Delhi, India
| | - Koushik Ray
- Endocrinology and Metabolism Division, Defense Institute of Physiology and Allied Sciences, Delhi, India
| | - Krishna Kishore
- Endocrinology and Metabolism Division, Defense Institute of Physiology and Allied Sciences, Delhi, India
| | - Almaz Akunov
- Kyrgyz Indian Mountain Biomedical Research Center, Bishkek, Kyrgyz Republic
| | - Akpay Sarybaev
- Kyrgyz Indian Mountain Biomedical Research Center, Bishkek, Kyrgyz Republic
| | - Bhuvnesh Kumar
- Endocrinology and Metabolism Division, Defense Institute of Physiology and Allied Sciences, Delhi, India
| | - Shashi Bala Singh
- Endocrinology and Metabolism Division, Defense Institute of Physiology and Allied Sciences, Delhi, India
| | - Praveen Vats
- Endocrinology and Metabolism Division, Defense Institute of Physiology and Allied Sciences, Delhi, India
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Barton GP, Vildberg L, Goss K, Aggarwal N, Eldridge M, McMillan AB. Simultaneous determination of dynamic cardiac metabolism and function using PET/MRI. J Nucl Cardiol 2019; 26:1946-1957. [PMID: 29717407 PMCID: PMC7851880 DOI: 10.1007/s12350-018-1287-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 04/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac metabolic changes in heart disease precede overt contractile dysfunction. However, metabolism and function are not typically assessed together in clinical practice. The purpose of this study was to develop a cardiac positron emission tomography/magnetic resonance (PET/MR) stress test to assess the dynamic relationship between contractile function and metabolism in a preclinical model. METHODS Following an overnight fast, healthy pigs (45-50 kg) were anesthetized and mechanically ventilated. 18F-fluorodeoxyglucose (18F-FDG) solution was administered intravenously at a constant rate of 0.01 mL/s for 60 minutes. A cardiac PET/MR stress test was performed using normoxic gas (FIO2 = .209) and hypoxic gas (FIO2 = .12). Simultaneous cardiac imaging was performed on an integrated 3T PET/MR scanner. RESULTS Hypoxic stress induced a significant increase in heart rate, cardiac output, left ventricular (LV) ejection fraction (EF), and peak torsion. There was a significant decline in arterial SpO2, LV end-diastolic and end-systolic volumes in hypoxia. Increased LV systolic function was coupled with an increase in myocardial FDG uptake (Ki) during hypoxic stress. CONCLUSION PET/MR with continuous FDG infusion captures dynamic changes in both cardiac metabolism and contractile function. This technique warrants evaluation in human cardiac disease for assessment of subtle functional and metabolic abnormalities.
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Affiliation(s)
- Gregory P Barton
- Department of Pediatrics, UW School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave. H6/551 CSC, Madison, WI, 53792, USA.
- Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, USA.
| | - Lauren Vildberg
- Department of Pediatrics, UW School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave. H6/551 CSC, Madison, WI, 53792, USA
- Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, USA
| | - Kara Goss
- Department of Pediatrics, UW School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave. H6/551 CSC, Madison, WI, 53792, USA
- Department of Medicine, University of Wisconsin-Madison, Madison, USA
- Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, USA
| | - Niti Aggarwal
- Division of Cardiovascular Disease Department of Medicine, University of Wisconsin-Madison, Madison, USA
- Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - Marlowe Eldridge
- Department of Pediatrics, UW School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave. H6/551 CSC, Madison, WI, 53792, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, USA
- Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, USA
| | - Alan B McMillan
- Department of Radiology, University of Wisconsin-Madison, Madison, USA
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Bosco G, Paoli A, Rizzato A, Marcolin G, Guagnano MT, Doria C, Bhandari S, Pietrangelo T, Verratti V. Body Composition and Endocrine Adaptations to High-Altitude Trekking in the Himalayas. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1211:61-68. [PMID: 31309516 DOI: 10.1007/5584_2019_414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Long-term exposure to high altitude causes adaptive changes in several blood biochemical markers along with a marked body mass reduction involving both the lean and fat components. The aim of this study was to evaluate the impact of extended physical strain, due to extensive trekking at high altitude, on body composition, selected biomarkers in the blood, and the protective role of a high-protein diet in muscle dysfunction. We found that physical strain at high altitude caused a significant reduction in body mass and body fat, with a concomitant increase in the cross-sectional area of thigh muscles and an unchanged total lean body mass. Further, we found reductions in plasma leptin and homocysteine, while myoglobin, insulin, and C-reactive protein significantly increased. Creatine kinase, lactate dehydrogenase, and leptin normalized per body fat were unchanged. These findings demonstrate that high-altitude hypoxia, involving extended physical effort, has an impact on muscle function and body composition, facilitating sarcopenia and affecting body mass and fat distribution. It also activates pro-inflammatory metabolic pathways in response to muscular distress. These changes can be mitigated by a provision of a high-protein diet.
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Affiliation(s)
- Gerardo Bosco
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Antonio Paoli
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Alex Rizzato
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Giuseppe Marcolin
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Maria Teresa Guagnano
- Department of Medicine and Aging, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Christian Doria
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Suwas Bhandari
- Department of Critical Care and Internal Medicine, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Tiziana Pietrangelo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Vittore Verratti
- Department of Psychological Sciences, Health and Territory "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.
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Woods DR, O'Hara JP, Boos CJ, Hodkinson PD, Tsakirides C, Hill NE, Jose D, Hawkins A, Phillipson K, Hazlerigg A, Arjomandkhah N, Gallagher L, Holdsworth D, Cooke M, Green NDC, Mellor A. Markers of physiological stress during exercise under conditions of normoxia, normobaric hypoxia, hypobaric hypoxia, and genuine high altitude. Eur J Appl Physiol 2017; 117:893-900. [PMID: 28299447 PMCID: PMC5388721 DOI: 10.1007/s00421-017-3573-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/13/2017] [Indexed: 11/29/2022]
Abstract
Purpose To investigate whether there is a differential response at rest and following exercise to conditions of genuine high altitude (GHA), normobaric hypoxia (NH), hypobaric hypoxia (HH), and normobaric normoxia (NN). Method Markers of sympathoadrenal and adrenocortical function [plasma normetanephrine (PNORMET), metanephrine (PMET), cortisol], myocardial injury [highly sensitive cardiac troponin T (hscTnT)], and function [N-terminal brain natriuretic peptide (NT-proBNP)] were evaluated at rest and with exercise under NN, at 3375 m in the Alps (GHA) and at equivalent simulated altitude under NH and HH. Participants cycled for 2 h [15-min warm-up, 105 min at 55% Wmax (maximal workload)] with venous blood samples taken prior (T0), immediately following (T120) and 2-h post-exercise (T240). Results Exercise in the three hypoxic environments produced a similar pattern of response with the only difference between environments being in relation to PNORMET. Exercise in NN only induced a rise in PNORMET and PMET. Conclusion Biochemical markers that reflect sympathoadrenal, adrenocortical, and myocardial responses to physiological stress demonstrate significant differences in the response to exercise under conditions of normoxia versus hypoxia, while NH and HH appear to induce broadly similar responses to GHA and may, therefore, be reasonable surrogates.
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Affiliation(s)
- David Richard Woods
- Royal Centre for Defence Medicine, Birmingham, UK. .,Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK. .,University of Newcastle, Newcastle upon Tyne, UK. .,Northumbria and Newcastle NHS Trusts, Wansbeck General and Royal Victoria Infirmary, Newcastle, UK.
| | - John Paul O'Hara
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - Christopher John Boos
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK.,Department of Cardiology, Poole Hospital NHS Foundation Trust, Poole, UK.,Department of Postgraduate Medical Education, Bournemouth University, Poole, UK
| | | | - Costas Tsakirides
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - Neil Edward Hill
- Royal Centre for Defence Medicine, Birmingham, UK.,Imperial College London, London, UK.,Charing Cross Hospital, London, UK
| | - Darren Jose
- Pathology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Amanda Hawkins
- Pathology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Kelly Phillipson
- Department of Biochemistry, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK
| | | | | | - Liam Gallagher
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | | | - Mark Cooke
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | | | - Adrian Mellor
- Royal Centre for Defence Medicine, Birmingham, UK.,Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK.,James Cook University Hospital, Middlesbrough, TS4 3BW, UK
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The Effects of Sex on Cardiopulmonary Responses to Acute Normobaric Hypoxia. High Alt Med Biol 2016; 17:108-15. [DOI: 10.1089/ham.2015.0114] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sørensen AH, Wemmelund KB, Møller-Helgestad OK, Sloth E, Juhl-Olsen P. Asphyxia causes ultrasonographic D-shaping of the left ventricle--an experimental porcine study. Acta Anaesthesiol Scand 2016; 60:203-12. [PMID: 26346667 DOI: 10.1111/aas.12606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 08/02/2015] [Accepted: 08/08/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In critical care, early diagnosis and correct treatment are of the utmost importance. Focused ultrasonography has gained acceptance as a pivotal tool for this by elucidating the underlying pathology. For example, massive pulmonary embolism is characterised by right ventricular dilatation. However, theoretically these characteristics might also be generated by asphyxia and the consequent hypoxia. We aimed to evaluate the ultrasonographic characteristics of asphyxia in a porcine model. METHODS Nineteen (13 intervention, 6 control) piglets were subjected to asphyxia until cardiac arrest, by disconnecting the ventilator tube. Ultrasonographic short-axis cine loops of the left ventricle were obtained every 30 seconds. The left ventricular (LV) eccentricity index (index of LV D-shaping) was quantified along with LV end-diastolic/end-systolic areas. Invasive pressures were measured throughout. RESULTS The LV eccentricity index increased from 1.14 (1.10-1.31) to 1.86 (1.48-2.38), (P = 0.002), after 1.5 min, receded thereafter to baseline levels followed by a second increase after 5.5 min. LV end-diastolic area decreased from 11.6 cm(2) (11.1-13.2) to 6.3 cm(2) (3.3 -11.0) after 2.0 min (P = 0.009). Subsequently, values returned to the baseline level. DISCUSSION The early and transient acute dilatation of the RV, coinciding with D-shaping of the LV and decrease in LV end-diastolic area seen in our study represent a combination of ultrasonographic characteristics normally attributed to pulmonary embolism. Early changes in ventricular chamber sizes and shape with septal flattening related to asphyxia can occur, but appear to be transient and disappear as circulatory collapse progresses, in an animal model. Despite this, asphyxia may represent a cause of ultrasonographic misinterpretation.
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Affiliation(s)
- A. H. Sørensen
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - K. B. Wemmelund
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - O. K. Møller-Helgestad
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - E. Sloth
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - P. Juhl-Olsen
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
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The effects of exercise at high altitude on high-sensitivity cardiac troponin release and associated biventricular cardiac function. Clin Res Cardiol 2013; 103:291-9. [DOI: 10.1007/s00392-013-0654-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
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