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Han YC, Kim SM, Jang JH, Choi KN, Park BS, Noh EJ, Kim KH, Seol SH, Yang TH, Kim DK, Kim DI, Kim DS. Association of P-Wave Dispersion With Paroxysmal Atrial Fibrillation in Patients With Acute Anterior Wall ST Segment Elevation Myocardial Infarction. Korean Circ J 2009. [DOI: 10.4070/kcj.2009.39.2.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Yang-Chun Han
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Seong-Man Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Je-Hyuck Jang
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Kyu-Nam Choi
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Bong-Soo Park
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Eun-Ji Noh
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Ki-Hun Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Sang-Hoon Seol
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Tae-Hyun Yang
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Dae-Kyeong Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
| | - Dong-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Pusan Paik Hospital, Busan, Korea
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Filtered signal-averaged P-wave duration during pneumoperitoneum in patients undergoing laparoscopic cholecystectomy: A reflection of pathophysiological cardiac changes. Surg Endosc 2007; 22:221-7. [DOI: 10.1007/s00464-007-9676-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2006] [Revised: 01/29/2007] [Accepted: 02/24/2007] [Indexed: 10/22/2022]
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Yilmaz R, Kasap H, Baykan M, Durmus I, Kaplan S, Celik S, Erdol C. Assessment of left ventricular function by Doppler tissue imaging in patients with atrial fibrillation following acute myocardial infarction. Int J Cardiol 2005; 102:79-85. [PMID: 15939102 DOI: 10.1016/j.ijcard.2004.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Revised: 01/16/2004] [Accepted: 04/25/2004] [Indexed: 10/26/2022]
Abstract
AIMS We studied tissue Doppler parameters in patients with atrial fibrillation following acute myocardial infarction, and their relation to P wave durations and P dispersion. METHODS Echocardiographic examination was performed in 84 consecutive patients with first anterior acute myocardial infarction. In addition to other conventional echocardiographic parameters, the peak systolic (Sm), early diastolic (Em) and late diastolic (Am) velocities were obtained at the lateral corner of the mitral annulus by pulsed wave tissue Doppler. The Em/Am ratio and the ratio of early diastolic mitral inflow velocity to Em (E/Em), which is a marker of diastolic filling pressure, were calculated. Electrocardiogram was recorded from all patients on admission; P wave measurements were also performed. RESULTS Atrial fibrillation occurred in 20 (23.8%) of 84 patients. The patients with atrial fibrillation had significant reduction of Em (5.6+/-1.5 vs. 8.7+/-2.7 cm/s, p < 0.001), Em/Am (0.61+/-0.27 vs. 0.84+/-0.23, p = 0.001) and Sm (7.1+/-1.0 vs. 8.3+/-1.9 cm/s, p < 0.001) values compared with those without. The E/Em ratio (14.45+/-4.62 vs. 7.47+/-2.79, p < 0.001), P maximum (102+/-11 vs. 95+/-11 ms, p = 0.02) and P dispersion (35+/-7 vs. 26+/-7 ms, p < 0.001) were significantly higher in patients with atrial fibrillation than in those without. In all patients, P dispersion showed significant correlation with Em (r = -0.33, p = 0.002), Sm (r = -0.40, p < 0.001) and E/Em (r = 0.32, p = 0.003). When E/Em > or = 10 was used as cutpoint, atrial fibrillation could be predicted with a sensitivity of 90%, and a specificity of 84%. CONCLUSIONS The patients with atrial fibrillation following acute myocardial infarction have reduced systolic and diastolic mitral annular velocities and increased E/Em ratio, P maximum and P dispersion values compared to those without. P dispersion is correlated with systolic and diastolic left ventricular function after acute myocardial infarction. The E/Em ratio appears to be a useful parameter for assessing the risk of atrial fibrillation occurrence after anterior acute myocardial infarction.
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Affiliation(s)
- Remzi Yilmaz
- The Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
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Yilmaz R, Demirbag R, Durmus I, Kasap H, Baykan M, Kucukosmanoglu M, Celik S, Erdol C. Association of stage of left ventricular diastolic dysfunction with P wave dispersion and occurrence of atrial fibrillation after first acute anterior myocardial infarction. Ann Noninvasive Electrocardiol 2005; 9:330-8. [PMID: 15485510 PMCID: PMC6932443 DOI: 10.1111/j.1542-474x.2004.94568.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the association of stage of left ventricular diastolic dysfunction after acute myocardial infarction (AMI) with P maximum, P dispersion, and atrial fibrillation (AF) occurrence rate. BACKGROUND The occurrence of AF following AMI is frequently associated with a left ventricle restrictive filling pattern. Increased P dispersion is also associated with the occurrence of AF after AMI. But, the relation between the stage of left ventricular diastolic dysfunction and the P wave measurements after AMI has not yet been investigated. METHODS Electrocardiograms of 90 patients with first anterior AMI were recorded on admission, and P wave measurements were performed. The left ventricular diastolic functions were evaluated by transthoracic echocardiography. On the basis of mitral inflow, subjects were stratified into three left ventricular diastolic filling patterns. All patients were monitored continuously for the detection of AF in the Coronary Care Unit. RESULTS Thirty patients had a normal filling pattern (33.3%) (NF group), 37 had impaired relaxation (41.1%) (IR group), and 23 had pseudonormal/restrictive filling pattern (25.6%) (PN/R group). P maximum was longer in the PN/R group (103 +/- 12 ms) compared with the NF group (94 +/- 9 ms, P = 0.019), but no significant difference was found between PN/R and IR (96 +/- 13 ms, P > 0.05) groups, and between NF and IR groups (P > 0.05). There was no significant difference for P minimum among the groups (P > 0.05). P dispersion was longer in the PN/R group (35 +/- 6 ms) than in the NF (26 +/- 7 ms, P < 0.001) and IR groups (26 +/- 6 ms, P < 0.001), but not different between the NF and IR groups (P > 0.05). Occurrence of AF was significantly more frequent in the PN/R group (52.2%) than in the NF (16.7%, P = 0.007) and IR groups (10.8%, P = 0.001). Frequency of AF was not different between the NF and IR groups (P > 0.05). In multivariate analyses, the stage of diastolic dysfunction was independently associated with P maximum, P minimum, P dispersion, and the occurrence of AF (P < 0.001, P = 0.035, P < 0.001, and P = 0.002, respectively). CONCLUSIONS P maximum and P dispersion are increased, and AF occurrence risk is higher in patients with pseudonormal/restrictive filling pattern after first anterior AMI. The stage of diastolic dysfunction is an independent predictor of P wave measurements and AF occurrence.
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Affiliation(s)
- Remzi Yilmaz
- The Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
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Baykan M, Celik S, Erdöl C, Durmuş I, Orem C, Küçükosmanoğlu M, Yilmaz R. Effects of P-wave dispersion on atrial fibrillation in patients with acute anterior wall myocardial infarction. Ann Noninvasive Electrocardiol 2003; 8:101-6. [PMID: 12848789 PMCID: PMC6932667 DOI: 10.1046/j.1542-474x.2003.08202.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND P-wave dispersion (P dispersion), defined as the difference between the maximum and the minimum P-wave duration (P minimum), and maximum P-wave duration (P maximum) have been used to evaluate the discontinuous propagation of sinus impulse and the prolongation of atrial conduction time respectively. The aim of this study was to investigate whether early assessment of P dispersion predicts paroxysmal atrial fibrillation (AF) in patients with acute anterior wall myocardial infarction (MI). METHODS We prospectively evaluated 147 consecutive patients (45 women, 102 men; aged 55 +/- 9 years) with a first acute anterior wall MI. All patients were evaluated by echocardiography to measure the left atrial diameter and left ventricular ejection fraction (LVEF). Electrocardiography was recorded from all patients on admission and every day during hospitalization. RESULTS AF occurred in 25 patients. In 122 patients, AF did not occur. P maximum was found to be significantly higher in patients with AF than in patients without AF (115 +/- 17.3 ms vs 101 +/- 14.7 ms, P = 0.001). P dispersion also was significantly higher in patients with AF than in patients without AF (50 +/- 12.5 ms vs 43 +/- 10.1 ms, P = 0.01). There was no significant difference between the two groups in P minimum (64 +/- 12.5 ms vs 59 +/- 11.7 ms, P = 0.057). The echocardiographically left atrial diameters were not significantly higher in the patients with AF than those without (25 +/- 3.38 mm and 23 +/- 3.36 mm, respectively, P = 0.76). LVEF was found to be significantly different in the patients who developed AF and in those who did not (37.96 +/- 6.18% vs 47.70 +/- 6.01%, P = 0.0001). CONCLUSIONS Although P maximum and P dispersion are significant predictive factors of AF in patients with acute anterior wall MI in the univariate analysis, on the basis of multivariate analysis, only age and LVEF were independent predictive parameters for AF.
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Affiliation(s)
- Merih Baykan
- Department of Cardiology, KTU Faculty of Medicine, Trabzon, Turkey.
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Mehta A, Jain AC, Mehta MC, Billie M. Usefulness of left atrial abnormality for predicting left ventricular hypertrophy in the presence of left bundle branch block. Am J Cardiol 2000; 85:354-9. [PMID: 11078306 DOI: 10.1016/s0002-9149(99)00746-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The objective of this study was to identify left atrial (LA) abnormality on the electrocardiogram and other related variables as predictors of left ventricular (LV) hypertrophy in the presence of left bundle branch block (LBBB). In the presence of complete LBBB, the diagnosis of electrocardiographic abnormalities is problematic and that of LV hypertrophy remains difficult. The usual electrocardiographic criteria applied for the diagnosis of LV hypertrophy may not be reliable in the presence of LBBB. Therefore, noninvasive criteria will help physicians diagnose LV hypertrophy with electrocardiography. LA abnormality on the electrocardiogram was assessed by 2 independent observers as predictor of LV hypertrophy in the presence of LBBB in 120 patients, and data were compared with those of 100 patients without LA abnormality. LV mass was calculated from echocardiographic data. Besides LA abnormality, the other variables studied for prediction of LV hypertrophy were gender, age, body surface area, body mass index, frontal axis, and QrS duration. Of the 6 criteria analyzed, the P terminal force was found to be the most common and consistent criterion to detect LA abnormality. LV hypertrophy was confirmed by echocardiographic determination of LV mass in both groups. Observers reliably differentiated between the hypertrophied and normal-sized left ventricle in the presence of LBBB by correlating LA abnormality with LV mass determined by echocardiography. Observer 1 detected LA abnormality in 89% and observer 2 in 84% of patients. False-positive results were present in 11% and 16%. The observer's recognition of LA abnormality in the present study was 91%. The 2 observers showed a sensitivity of 81% and 79% and a specificity of 91% and 88%, respectively, when diagnosis of LV hypertrophy was determined. LV mass increased significantly and was diagnostic of LV hypertrophy in 92% of patients with LA abnormality. In the remaining 11 patients (8%), the LA abnormality was of marginal abnormal magnitude. Each 0.01-mV/s increase in LA abnormality gave an increase of 30 g of LV mass. LV mass was increased in 86% of patients when corrected by body surface area. LV hypertrophy in the presence of LBBB on electrocardiography was found in only 13 patients (10%) when the 6 frequently used conventional criteria for diagnosis of LV hypertrophy by electrocardiography were used. Regression analysis revealed LA abnormality to be a strong independent predictor of increased LV mass. Multivariate analysis also revealed age, body mass index, body surface area, frontal axis, and QrS duration to be significant predictors of LV mass. This noninvasive study correlates LA abnormality by electrocardiogram and LV hypertrophy with echocardiography to conclude that LA abnormality was significantly diagnostic of LV hypertrophy in the presence of LBBB. Age, body mass index, body surface area, frontal axis, and QrS duration were also significant predictors of LV mass.
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Affiliation(s)
- A Mehta
- Department of Medicine, West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown 26506-9157, USA
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Dilaveris PE, Andrikopoulos GK, Metaxas G, Richter DJ, Avgeropoulou CK, Androulakis AM, Gialafos EJ, Michaelides AP, Toutouzas PK, Gialafos JE. Effects of ischemia on P wave dispersion and maximum P wave duration during spontaneous anginal episodes. Pacing Clin Electrophysiol 1999; 22:1640-7. [PMID: 10598968 DOI: 10.1111/j.1540-8159.1999.tb00384.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
P wave dispersion (P dispersion), defined as the difference between the maximum and the minimum P wave duration, and maximum P wave duration (P maximum) are electrocardiographic (ECG) markers that have been used to evaluate the discontinuous propagation of sinus impulses and the prolongation of atrial conduction time, respectively. To study the effects of myocardial ischemia on P dispersion and P maximum, 95 patients with coronary artery disease (CAD) and typical angina pectoris and 15 controls with angina like symptoms underwent 12-lead surface ECG during and after the relief of pain. During pain and during the asymptomatic period, P maximum and P dispersion were calculated from the averaged complexes of all 12 leads. P dispersion increased significantly during spontaneous angina (45+/-17 ms) compared to the asymptomatic period (40+/-15 ms), P < 0.001 only in the patient group. Both P maximum and P dispersion showed higher values during angina in those patients who developed diffuse ischemia, as estimated with ST segment changes in multiple ECG leads. P dispersion showed higher values during the anginal episode in patients with left ventricular dysfunction, independently of the presence of a previous myocardial infarction. Atrial conduction abnormalities, as estimated with P maximum and particularly P dispersion, are significantly influenced by myocardial ischemia in patients with CAD and spontaneous angina.
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Affiliation(s)
- P E Dilaveris
- State Department of Cardiology, Hippokration Hospital, Athens, Greece.
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Hopkins CB, Barrett O. Electrocardiographic diagnosis of left atrial enlargement. Role of the P terminal force in lead V1. J Electrocardiol 1989; 22:359-63. [PMID: 2529337 DOI: 10.1016/0022-0736(89)90012-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The ability of the electrocardiographic criterion, P terminal force in lead V1 (PTF-V1), to diagnosis left atrial enlargement (LAE) is evaluated in a group of 317 men. A left atrial index greater than 2.2 cm/m2, determined by echocardiography, is used as the standard for LAE. The value for this criterion of 0.04 mm-sec performs best, although there is no significant difference in percent correct diagnosis for values of PTF-V1 ranging from 0.03 to 0.09 mm-sec.
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Affiliation(s)
- C B Hopkins
- University of South Carolina School of Medicine, Columbia
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Hutchins SW, Murphy ML, Dinh H. Recent Progress in the Electrocardiographic Diagnosis of Ventricular Hypertrophy. Cardiol Clin 1987. [DOI: 10.1016/s0733-8651(18)30534-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Murphy ML, Thenabadu PN, de Soyza N, Meade J, Doherty JE, Baker BJ. Sensitivity of electrocardiographic criteria for left ventricular hypertrophy according to type of cardiac disease. Am J Cardiol 1985; 55:545-9. [PMID: 3155902 DOI: 10.1016/0002-9149(85)90244-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The sensitivity of 30 electrocardiographic criteria for left ventricular (LV) hypertrophy, isolated or combined, was examined to determine the relation to the underlying disease. Patients with coronary artery disease (CAD), systemic hypertension, valvular heart disease and cardiomyopathy were evaluated. A cardiac partition technique was used to define ventricular hypertrophy. Single electrocardiographic criteria often showed high sensitivity for 1 disease state, but not for others. Precordial voltage criteria were most sensitive for those with hypertensive and valvular disease. A QRS axis of more than -30 degrees occurred most often in patients with CAD. Both left atrial abnormality and abnormal T-wave inversion of more than 1 mm in V6 occurred with a high sensitivity in general; however, T-wave inversion of more than 1 mm in V6 had a low sensitivity in cardiomyopathy. Methods using combinations of various electrocardiographic criteria improved sensitivity. Using these methods, sensitivity of the electrocardiogram for LV hypertrophy was excellent for patients with systemic hypertension and valvular heart disease and acceptable by usual standards for patients with CAD and cardiomyopathy. Because the use of a single criterion is often ineffective, methods using multiple electrocardiographic criteria to detect LV hypertrophy are recommended when the patients under study have diverse cardiac diseases.
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Murphy ML, Thenabadu PN, de Soyza N, Doherty JE, Baker BJ. Left atrial abnormality as an electrocardiographic criterion for the diagnosis of left ventricular hypertrophy in the presence of right bundle branch block. Am J Cardiol 1983; 52:381-3. [PMID: 6223523 DOI: 10.1016/0002-9149(83)90143-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Left atrial (LA) abnormality determined from precordial lead V1 was assessed by 2 observers as a criterion of left ventricular (LV) hypertrophy in the presence of right bundle branch block (BBB) in 23 patients. The presence of LV hypertrophy was confirmed from a postmortem cardiac partition technique and defined at 2 levels of confidence: probable and definite hypertrophy. Observers reliably differentiated between the hypertrophied and normal-sized ventricle in the presence of right BBB by using LA abnormality as an electrocardiographic criterion. When defined as definite hypertrophy, observer 1 correctly identified LV hypertrophy in 78% of the cases and observer 2 in 67% of the cases. False-positive results were present in 21% of cases by observer 1 and 14% by observer 2. Comparable results were achieved when a definition of probable hypertrophy was used. Observer performance of recognition of LA abnormality in this study was satisfactory with 91% agreement between observers. Our results are comparable and in some instances superior to conventional criteria commonly recommended to diagnose LV hypertrophy on the electrocardiogram without right BBB.
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Hamby RI. Clinical correlates of the coronary arteriogram. Cardiovasc Intervent Radiol 1982; 5:124-36. [PMID: 6758936 DOI: 10.1007/bf02552299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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13
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Hamby RI, Prakash MN, Wyne UA, Hoffman I. Electrocardiographic left ventricular hypertrophy and coronary artery disease: clinical, hemodynamic, and angiographic correlates. Am Heart J 1980; 100:794-801. [PMID: 6449860 DOI: 10.1016/0002-8703(80)90058-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Shettigar UR, Barry WH, Hultgren HN. P wave analysis in ischaemic heart disease. An echocardiographic, haemodynamic, and angiographic assessment. Heart 1977; 39:894-9. [PMID: 901685 PMCID: PMC483338 DOI: 10.1136/hrt.39.8.894] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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