1
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Elevated Troponin and Diabetes Mellitus are Independent Predictors of Obstructive Coronary Artery Disease in Patients Presenting With Atrial Fibrillation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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2
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Outcomes and Trends: Recurrent Syncope Presentations to the Emergency Department. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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3
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Investigational Burden in Undifferentiated Syncope Presentations. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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4
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480 Does Sex-Specific High-Sensitivity Troponin T Cut-Off Values Alter Clinical Outcomes in Chest Pain Presentations to the Emergency Department? Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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458 Clinical Utility of Contemporary Guideline-Based High-Risk Features in the Prediction of Cardiac Syncope. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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6
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508 Lack of a Discharge Diagnosis following a Presentation With Syncope is Associated With Inadequate Follow-Up. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Abstract
Abstract
Background
ACE2 activity levels correlate with adverse left atrial remodelling in patients with atrial fibrillation (AF). Several biochemical and structural markers have been associated with embolic stroke of undetermined source (ESUS). The relationship between ACE2 activity and ESUS is unknown.
Purpose
Randomised controlled trials failed to demonstrate a clear benefit of oral anticoagulation in an unselected ESUS population. As selective use of oral anticoagulation guided by biomarker risk-profiling may benefit these patients, we evaluated the association between ACE2 activity and ESUS.
Methods
This prospective case control study compared patients with ESUS against a control group matched for vascular risk factors. ESUS was diagnosed following cerebral vascular imaging and 24 hours of cardiac monitoring to exclude AF. Blood samples were collected for measurement of ACE2 activity, D-Dimer and high sensitivity troponin T (hsTnT).
Results
A total of 51 patients in the ESUS group were compared with 47 patients in the Control group. ACE2 activity and D-Dimer levels were significantly higher in the ESUS group. There was a significant but weak positive correlation between ACE2 activity and hsTnT (r=0.20, p<0.05). Left atrial volume index (LAVI) on echocardiography was significantly higher in the ESUS group. On regression modelling adjusting for LAVI, only ACE2 activity remained significant for ESUS, with a 20% rise in odds for every 4 unit increase in ACE2 activity (OR 1.20; 95% CI: 1.01 - 1.36, p=0.04).
Participant characteristics Control (n=47) ESUS (n=51) P value Age (years) 65.65±6.78 67.20±6.89 0.26 Female gender 22 (45.8) 19 (38.0) 0.43 Hypertension 22 (45.8) 24 (48.0) 0.83 Diabetes mellitus 9 (18.8) 12 (24.0) 0.53 CHA2DS2VASc score 2 (1–3) 2 (1–3) 0.50 LA size & Biomarkers LA volume index (ml/m2) 36.5 (32.6–42.5) 39.1 (36.2–46.0) 0.04 ACE2 (pmol/ml/min) 7.24 (2.66–14.64) 10.16 (4.54–18.80) 0.04 D-Dimer (mg/L) 0.35 (0.3–0.5) 0.40 (0.30–0.60) 0.02 hsTroponin T (ng/L) 7.0 (5–10) 9.00 (6.0–13.5) 0.05 Values are expressed as mean ± standard deviation, median (IQR), or n (%).
Median ACE2 activity
Conclusion(s)
ACE2 activity is associated with ESUS independent of left atrial volume and correlate with elevated Troponin. Further studies are warranted to investigate the utility of ACE2 activity in identifying ESUS patients that may benefit from oral anticoagulation.
Acknowledgement/Funding
This study received project funding from the Eastern Health Foundation
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8
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P574Accuracy of wrist-worn heart rate monitors for chronotropic assessment in atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Wrist-worn fitness and heart rate (HR) monitors are increasingly popular. Previous studies in healthy participants with sinus rhythm (SR) have yielded variable results depending on HR, activity levels and device tested. A paucity of data exists on their accuracy in atrial fibrillation (AF) in ambulatory patients.
Purpose
We sought to assess the HR accuracy of 2 commercially available smart watches (Fitbit Charge HR [FB] and Apple Watch Series 3 [AW]) compared with Holter monitoring in an ambulant patient cohort.
Methods
Patients aged >18 years referred for 24-hour Holter monitoring were prospectively recruited. The Holter monitor was the criterion measure. Each patient was randomly allocated to either a FB or AW along with their Holter monitor. The study protocol was approved by the institutional review board.
Statistical analysis: Pearson (r) correlation coefficients and Bland-Altman comparison with 95% limits of agreement (LoA) were evaluated to assess criterion validity and agreement between the smart watch and Holter ECG-HR. Bias was the calculated mean difference between the smart watch and ECG-HR. A ± 10-beat different between Holter-HR and SW-HR was used as a clinically relevant range to establish the accuracy of HR estimation by SW.
Results
Across all devices, 53,288 hear rate values were recorded from 32 patients. Twenty six patients were in persistent AF and six were in SR. Twelve patients wore the FB while 20 wore the AW. In the FB arm, nice patient were in persistent AF and three in SR. In the AW arm, persistent AF was the rhythm in seventeen and SR in three. Patients in SR demonstrated overall strong agreement compared to Holter monitoring (Mean Bias <1 beat, LoA −11 to 11 beats) and a correlation coefficient of 0.87 (p<0.001). In AF, both devices underestimated HR measurements (Overall Bias −9 beats, LoA −41 to 23, r=0.60, p<0.001). The AW had lower bias and narrower LoA compared to FB (−5 beats vs −13 beats, LoA −31 to 21 beats vs −50 to 22 beats). Using a ± 10-beat range against ECG-HR for clinical accuracy, both the AW and FB performed satisfactorily in SR with 95.2% of AW and 92.2% of FB HR readings considered valid. In AF, however, the AW-HR readings were within the ± 10-beat threshold in 76.5% of the time compared with only 56.1% of FB readings.
Conclusion
In ambulatory patients, smart watches were accurate in HR estimation when compared to Holter monitor in SR; however tended to underestimate HR in AF. Further improvements in device technology are needed before the widespread consumer adoption of this nascent technology for chronotropic assessment in arrhythmias.
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9
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Impaired Cardiac Reserve on Dobutamine Stress Echocardiography Predicts Development of Hepatorenal Syndrome. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Inducible Left Ventricular Outflow Tract Obstruction is Associated with a Higher Incidence of Perioperative Cardiac Arrest in Liver Transplantation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Hepatorenal Syndrome in Patients Undergoing Liver Transplantation is an Independent Risk Factor for Perioperative Cardiac Complications. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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An Elevated P Wave Terminal Force V1 is not Associated with Worsening Atrial Electroanatomic Substrate. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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The Accuracy of Smartwatches Compared to Holter Monitors for Heart Rate Monitoring in Atrial Fibrillation: A Pilot Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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High Risk Syncope: Guideline-Based Monitoring and Follow Up. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Smartwatch Based Arrhythmia Detection: Accuracy of Clinician Interpretation of Unclassified Tracings. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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16
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Impact of Cardiovascular Risk Factors on Survival following Liver Transplantation: Results from the Australian & New Zealand Liver Transplant Registry. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Cardiac Output in End-Stage Liver Disease Increases Proportional to the Degree of Liver Dysfunction. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Rise in Proportional Early Cardiovascular Mortality Following Liver Transplantation: Temporal Trends from the Australian & New Zealand Liver Transplant Registry. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Elevated Plasma Angiotensin Converting Enzyme 2 (ACE2) Activity is Associated with Embolic Stroke of Undetermined Source. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Accuracy of a Novel Smart Watch-Based Wireless Electrocardiogram for Arrhythmia Detection. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Successful Use of Dothiepin in the Management of Prolonged Vasovagal Syncope. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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The Utility of P-Wave Terminal Force V1 is Limited by its Reliability. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Electrolyte Replacement for Atrial Fibrillation in the Emergency Department does not Promote Cardioversion. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Ivabradine for Refractory Sinus Tachycardia Associated with Vagus Nerve Compression. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Atrial Fibrillation Leads to Increased Hospitalisation in Patients Undergoing Dialysis. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Atrial Fibrillation: Predictors of Re-Presentation to the Emergency Department. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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27
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28
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Atrial Fibrillation: Predictors of Inpatient Hospital Admission. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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29
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Point-of-Care Utilisation of Single Lead Smartphone Electrocardiogram in Screening for Arrhythmias: PULSE Trial. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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High-Sensitivity Troponin Elevation in Ischaemic Stroke and Associated Cardiac Abnormalities. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Heart Rate Assessment by Smart Watch: Utility or Futility? Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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32
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Admission High-Sensitivity Troponin Elevation in Thrombolysed Stroke Patients: An Early Predictor of Disability and Mortality? Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Vital Signs Measured by Photoplethysmography Underestimates Heart Rate in Atrial Fibrillation and Tachycardia. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Outcomes of Pre-Loading vs In-Lab Loading with Prasugrel and Ticagrelor in Patients With Acute Coronary Syndromes (ACS) Undergoing Percutaneous Coronary Intervention (PCI). Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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35
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Bilateral Pheochromocytoma and Paraganglioma Causing Cardiomyopathy: A Multi-Modality Imaging Diagnosis. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Adverse outcomes in patients with peripheral vascular disease (PVD) following percutaneous coronary intervention (PCI). Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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