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(Circulation. 1998;98:1644-1650.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Doppler Estimation of Left Ventricular Filling Pressure in Sinus Tachycardia

A New Application of Tissue Doppler Imaging

Sherif F. Nagueh, MD; Issam Mikati, MD; Helen A. Kopelen, RDMS; Katherine J. Middleton, RCT; Miguel A. Quiñones, MD; ; William A. Zoghbi, MD

From the Section of Cardiology, Baylor College of Medicine and The Methodist Hospital, Echocardiography, Houston, Tex.

Correspondence to William A. Zoghbi, MD, Director, Echocardiography Research, Baylor College of Medicine and Methodist Hospital, 6550 Fannin SM-677, Houston, TX 77030. E-mail wzoghbi{at}bcm.tmc.edu

	Abstract

Top Abstract Introduction Methods Results Discussion References

 
Background—Doppler echocardiography is frequently used to predict filling pressures in normal sinus rhythm, but it is unknown whether it can be applied in sinus tachycardia, with merging of E and A velocities. Tissue Doppler imaging (TDI) can record the mitral annular velocity. The early diastolic velocity (E_a) behaves as a relative load-independent index of left ventricular relaxation, which corrects the influence of relaxation on the transmitral E velocity.

Methods and Results—We evaluated 100 patients 64±12 years old with simultaneous Doppler and invasive hemodynamics. Mitral inflow was classified into 3 patterns: complete merging of E and A velocities (pattern A), discernible velocities with A dominance (B), or E dominance (C). The Doppler data were analyzed at the mitral valve tips for E, acceleration and deceleration times of E, and isovolumic relaxation time. In patterns B and C, the A velocity, E/A ratio, and atrial filling fraction were derived. Pulmonary venous flow velocities were also measured, and TDI was used to acquire E_a and A_a. Weak significant relations were observed between pulmonary capillary wedge pressure (PCWP) and sole parameters of mitral flow, pulmonary venous flow, and annular measurements. These were better for patterns A and C. E/E_a ratio had the strongest relation to PCWP [r=0.86, PCWP=1.55+1.47(E/E_a)], irrespective of the pattern and ejection fraction. This equation was tested prospectively in 20 patients with sinus tachycardia. A strong relation was observed between catheter and Doppler PCWP (r=0.91), with a mean difference of 0.4±2.8 mm Hg.

Conclusions—The ratio of transmitral E velocity to E_a can be used to estimate PCWP with reasonable accuracy in sinus tachycardia, even with complete merging of E and A velocities.

Key Words: tachycardia • diastole • pressure • echocardiography

	Introduction

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The determination of ventricular function and filling pressures is important in patients with sinus tachycardia (ST) of various causes. Although invasive assessment is possible, it carries a certain risk and takes longer than noninvasive assessment by echocardiography. Doppler was successfully applied to estimate filling pressures in normal sinus rhythm^{1 2 3 4 5 6 7 8} and recently in atrial fibrillation.^{9 10} It is unknown whether it can be of value in ST because of the merging of mitral E and A velocities to various degrees. Furthermore, the utility of pulmonary venous flow is unknown, given the difficulty of its acquisition in the intensive care unit with transthoracic imaging.⁵

Tissue Doppler imaging (TDI) allows the recording of myocardial contraction and relaxation velocities.^{11 12 13 14 15 16 17} Compared with mitral inflow velocity, the early diastolic velocity at the mitral annulus (E_a) is less influenced by left atrial pressure.¹⁷ The ratio E/E_a can correct for the influence of relaxation on transmitral E and relates strongly to filling pressures.¹⁷ Whether the use of TDI will be helpful in ST is unknown. This investigation was undertaken to evaluate the role of conventional Doppler and TDI in the estimation of filling pressures in ST.

	Methods

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Patient Population
Patients with ST undergoing right heart catheterization at the Methodist Hospital (Houston, Tex) were screened. Patients with a heart rate 100 bpm and partial or complete merging of mitral E and A velocities were eligible. Those with mitral stenosis, prosthetic mitral valves (n=5), inadequate pressure tracings (n=3), poor echocardiographic windows (n=3), or atrial fibrillation (n=7) were excluded. Accordingly, 100 patients with ST (age, 64±12 years [range, 27 to 86 years]; 60 men; 31 on mechanical ventilation; Table 1) undergoing right heart catheterization in the intensive care unit (n=70) or catheterization laboratory (n=30) were consecutively enrolled. All patients (or next of kin) gave informed consent before participation.

View this table: [in this window] [in a new window]   Table 1. Diagnosis of the Initial and Prospective Populations

Echocardiographic Studies
All patients, while in a supine position, had simultaneous right heart catheterization with echo-Doppler studies using an Acuson XP-128 equipped with a multifrequency transducer and the TDI program. Two-dimensional imaging was performed, followed by Doppler. For mitral inflow, the sample volume was placed at the mitral valve tips in the apical 4-chamber view with recording of 5 to 10 cardiac cycles. Isovolumic relaxation time (IVRT) was acquired.^{1 3} Pulmonary venous flow was recorded from the right pulmonary vein, guided by color Doppler. With the TDI program, a 5-mm sample volume was placed at the lateral corner of the mitral annulus in the 4-chamber view. Gains were adjusted to eliminate background noise and allow for clear tissue signal; 5 to 10 cycles were then recorded. We previously noted that the lateral annular velocities are higher and easier to record than the septal velocities,¹⁷ and consequently, they were used.

Echocardiographic Analysis
A single investigator blinded to all data performed the analysis using an off-line station (Digisonics EC 500). Left ventricular ejection fraction (LVEF) was calculated with the multiple-diameter method.¹⁸ Doppler measurements were averaged over 5 consecutive cycles. Three inflow patterns were noted (Figure 1). Patients with pattern A exhibited a single waveform, with complete merging of E and A velocities. The A pattern was further divided into 2 categories: 1 with the velocity peaking in the first half of the diastolic filling period (A₁) and the other peaking in the second half (A₂). In patterns B and C, the E and A velocities could be identified. In B, the E velocity was lower than the A velocity, and the reverse was present in pattern C.

View larger version (88K): [in this window] [in a new window]   Figure 1. Representative cases of each mitral inflow pattern (A1, A2, B, and C) and corresponding TDI velocities.

The following Doppler parameters were measured in all patterns: peak E velocity, acceleration (AT) and deceleration (DT) times of E velocity, and IVRT. In the B and C patterns, peak A velocity, E/A, atrial filling fraction, and DT of the A velocity were also obtained. The AT was measured from the onset of the early diastolic mitral inflow to its peak. When possible, the DT of E was derived by linear extrapolation of the peak E velocity to the baseline. In patterns B and C, this measurement was made if the E velocity decreased by 30% of its peak value before onset of the A wave. DT of the A wave was measured by linear extrapolation of peak A velocity to baseline.⁶ The atrial filling fraction and IVRT were obtained as previously described.¹ To account for the influence of heart rate on A velocity in patterns B and C, a corrected A velocity was derived as peak A minus mitral velocity at onset of A.¹⁹ The square root of the RR interval was used to correct for the influence of heart rate on IVRT, AT of E, and DT of E and A velocities.

Pulmonary venous flow was analyzed for the peak velocity and time velocity integral of systolic (TVI_s), diastolic (TVI_d), and atrial reversal waves. The end of the T wave marked the end-systolic velocity. The ratio of the peak systolic to peak diastolic velocity and respective time velocity integrals were calculated. Systolic filling fraction²⁰ was derived as SFF=TVI_s/(TVI_s+TVI_d). The following measurements were made from the mitral annular velocity by TDI: early diastolic (E_a) and late diastolic (A_a) velocities and E_a/A_a and E/E_a ratios. With complete merging of E_a and A_a, the resulting velocity was taken as E_a.

Hemodynamic Measurements
Mean right atrial pressure, pulmonary artery pressure, and pulmonary capillary wedge pressure (PCWP) were measured with a pulmonary artery catheter. The wedge position was verified by changes in the waveform and when needed, with O₂ saturation (O₂ saturation >95%). In the catheterization laboratory, fluoroscopy was also used. An investigator unaware of the echocardiographic data acquired the pressure measurements. All were an average of 5 cycles at end-expiratory apnea. Fluid-filled transducers were balanced before the study with the zero level at the midaxillary line. Cardiac output (average of 3 cycles with <10% variation) was derived by thermodilution.

Statistical Analysis
Continuous variables are presented as mean±SD. The ² and the Fisher exact tests were used to compare the frequency of mean PCWP >12 mm Hg among the inflow patterns. ANOVA was used to compare LVEF, PR interval, and heart rate among the 3 patterns. Bonferroni correction was then applied for multiple comparisons. Linear regression analysis was used to correlate Doppler parameters, patterns, LVEF, heart rate, TDI velocities, and ratios to mean PCWP. Stepwise regression analysis was subsequently performed. On further analysis of the relation between PCWP and E/E_a, the 120 patients with ST in this study were combined with the 60 patients in normal sinus rhythm previously reported from our laboratory.¹⁷ Significance was set at P0.05.

	Results

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Doppler Patterns, Parameters, and Feasibility in ST
Hemodynamic data are presented in Table 2. Thirty-five patients had the A, 37 the B, and 28 the C pattern. Heart rate was similar among the 3 patterns (111±4 bpm in A, 112±7 bpm in B, and 110±6 bpm in C, P=0.37), as was IVRT. The PR interval, however, was longer with the A pattern (178±22 ms in A, 125±18 ms in B, and 131±25 ms in C, P<0.001). Recording of pulmonary venous flow was feasible in 38 patients (38%), with a higher success rate in the catheterization laboratory than in the intensive care units (60% versus 29%). By comparison, TDI acquisition of E_a and A_a was successful in all 100 patients. Distinct E_a and A_a velocities were recorded in all patients with patterns B and C and in 10 patients (29%) with pattern A.

View this table: [in this window] [in a new window]   Table 2. Hemodynamics of the Initial and Prospective Populations

Relation of Doppler Patterns and Parameters to PCWP
Pattern B was more frequently associated with a normal PCWP, whereas the A and C patterns were more frequent with elevated PCWP (P=0.04 for A versus B and C versus B, Table 3). No significant difference in the prevalence of mean PCWP >12 mm Hg was seen between the A and C patterns. Within the A group, elevated PCWP was more prevalent in A₁ than in A₂ (P=0.001). A significant overlap existed, however, among the patterns in the distinction of normal versus elevated PCWP.

View this table: [in this window] [in a new window]   Table 3. Distribution of Mitral Inflow Patterns in Relation to PCWP in the Initial Population

Weak relations were present between the transmitral flow parameters and PCWP (Table 4). The DT of E velocity could be measured in 90 patients (90%) and atrial filling fraction in 52 (80% of B and C). No significant relations with PCWP were observed for A velocity, E at onset of A, corrected A velocity, or the ratio of E to corrected A velocity (r=0.23, P=0.14). Similarly, correction for the effect of heart rate did not improve the correlation of the time intervals with PCWP (DT of E, r=-0.37; DT of A, r=0.4; AT, r=-0.4; and IVRT, r=-0.5). The PR interval had no significant relation with the DT of A velocity (r=0.1, P>0.2). In patients with satisfactory pulmonary venous flow recordings, SFF had the best correlation with PCWP (r=-0.53, P=0.009). PCWP related weakly to E_a and A_a. However, the strongest relation with PCWP was seen with E/E_a (r=0.86, PCWP= 1.55+1.47[E/E_a]; SEE=3.9 mm Hg; Figure 2).

View this table: [in this window] [in a new window]   Table 4. Correlation Between PCWP and Doppler Parameters in the Initial Group

View larger version (19K): [in this window] [in a new window]   Figure 2. Plot of PCWP vs E/Ea in 100 initial patients.

Effect of Inflow Pattern and Ejection Fraction on the Relationship of Doppler Parameters to Mean PCWP
Significant weak relations were noted between the transmitral flow variables and PCWP in all 3 patterns (Table 5). Overall, relations were worse for pattern B. LVEF was higher in pattern B (51±15% versus 36±16% and 39±15% for A and C, respectively; P<0.001), which may explain in part the weaker relations in this group, as recently noted.²¹

View this table: [in this window] [in a new window]   Table 5. Correlation of PCWP to Doppler Parameters in the 3 Inflow Patterns

The E/E_a ratio had a good relation to PCWP, irrespective of the inflow pattern (Figure 3), even in the 25 patients with complete merging of E_a and A_a (r=0.87, P<0.001; PCWP, 7 to 28 mm Hg). Although transmitral variables had stronger relations with PCWP in patients with LVEF <45% (n=51, Table 6), E/E_a performed reasonably well in both groups (Figure 4). The correlation remained strong in patients with LVEF 30% (n=28, r=0.88, P<0.001). Stepwise regression analysis revealed no increment in predicting filling pressures with inflow pattern or LVEF once E/E_a was introduced in the regression model.

View larger version (22K): [in this window] [in a new window]   Figure 3. Relation of PCWP to E/Ea in patterns A, B, and C.

View this table: [in this window] [in a new window]   Table 6. Correlation of PCWP vs Doppler Parameters According to LVEF

View larger version (19K): [in this window] [in a new window]   Figure 4. Plot of PCWP vs E/Ea in 100 initial patients, grouped by LVEF.

Prediction of Mean PCWP Prospectively
The equation derived initially [PCWP=1.55+1.47(E/E_a)] was tested prospectively in a separate population for the prediction of PCWP. Of 25 patients screened, 2 with atrial fibrillation and 3 with prosthetic mitral valves were excluded. Thus, 20 patients were included (age, 69±8 years; 14 men; EF, 55±15%). Tables 1 and 2 provide their clinical diagnoses and hemodynamics. Seven had the A pattern, 9 the B, and 4 the C. Mean PCWP related well with E/E_a (R²=0.83; mean difference, -0.4±2.8 mm Hg [range, –5 to 6] between Doppler and catheter PCWP). Figure 5 shows this relation in the prospective and total populations. The mean difference between Doppler and catheter PCWPs in the 120 patients was 0±3.7 mm Hg (Figure 6).

View larger version (22K): [in this window] [in a new window]   Figure 5. Left, Relation of catheter PCWP to Doppler-estimated pressure in prospective group. Right, Plot of catheter PCWP vs Doppler PCWP in total population with ST.

View larger version (23K): [in this window] [in a new window]   Figure 6. Bland-Altman plot of Doppler and catheter PCWP in total population with ST.

The sensitivity and specificity of Doppler parameters for PCWP >12 mm Hg are shown in Table 7 (n=120). With a receiver operator curve, E/E_a ratio >10 had the best performance, with a sensitivity of 78% and specificity of 95%. A ratio >8 had a higher sensitivity of 87% (specificity, 70%), whereas a ratio of 12 had a higher specificity, 96% (sensitivity, 68%). An E/E_a ratio >10 had the highest sensitivity (85%) and specificity (93%) for detecting PCWP >15 mm Hg.

View this table: [in this window] [in a new window]   Table 7. Sensitivity and Specificity of Selected Doppler Parameters for PCWP >12 mm Hg in ST

Reproducibility
Ten studies were chosen at random and analyzed by another investigator and by the same investigator at a later time. The mean intraobserver and interobserver differences (mean±SD) for E/E_a were -0.46±1.3 (-2 to 0.75) and 0±1.9 (-2 to 1.5), respectively. The corresponding differences for the Doppler PCWP were –0.7±1.9 (-4 to 1) mm Hg and 0±2 (-2 to 2) mm Hg, respectively.

	Discussion

Top Abstract Introduction Methods Results Discussion References

 
This is the first investigation to examine the utility of conventional Doppler and TDI velocities in the estimation of PCWP in ST, a clinical condition that challenges this methodology. Of the 3 inflow patterns, the A₁ and C were most predictive of high filling pressures. Weak significant relations were noted for individual mitral and pulmonary venous flow and TDI variables. The strongest relation with PCWP was observed with E/E_a, which corrects for the influence of myocardial relaxation on the mitral E velocity. This relation remained strong irrespective of the inflow pattern and LVEF and performed equally well in a prospective population.

Transmitral Flow and Estimation of PCWP
Various degrees of merging of mitral E and A velocities occur during ST secondary to shortening of the diastolic filling period, adding complexity to the evaluation of filling dynamics and pressure. In this study, we have shown that for comparable heart rates, the degree of merging is determined in part by the PR interval, such that patients with a longer PR interval are more likely to have complete merging. We observed 3 inflow patterns. Patients with accelerated early filling (A₁ and C) in ST, similar to normal sinus rhythm, were more likely to have elevated PCWP (83%). However, 44% of the patients with slow early filling (A₂ and B) had elevated PCWP. The relations of all mitral inflow parameters to mean PCWP were also weaker in pattern B. This may be due in part to the stronger influence of impaired relaxation on the E velocity despite an elevated PCWP. With shortening of diastole due to tachycardia, the slow relaxation leaves these patients with a prolonged IVRT and thus an abbreviated filling time. Accordingly, although an impaired relaxation pattern in normal sinus rhythm usually denotes normal PCWP,²² this is not the case in ST, analogous to the recent report in hypertrophic cardiomyopathy.²¹

Because heart rate influences the A velocity,¹⁹ we attempted to correct for the influence of atrial preload by using the mitral velocity at onset of A. The results were worse than with the conventional A velocity and E/A ratio. Peak E velocity and IVRT related best, but nevertheless weakly, with filling pressure. When these relations were further examined according to LVEF, much better correlations were identified in patients with depressed EF, similar to normal sinus rhythm²¹ and atrial fibrillation,⁹ further emphasizing the limitations of simple mitral inflow in the evaluation of filling pressures in patients with normal systolic function.

Pulmonary Venous Flow
The low yield of adequate pulmonary venous flow (38%) in this study is similar to our earlier observations with transthoracic echocardiography in the intensive care unit⁵ and is much lower than in ambulatory patients. This resulted from the inclusion of heavily instrumented patients and the high-frequency interference commonly present in the intensive care unit. Despite the small number analyzed, significant relations were present with PCWP, were best for SFF, and were directionally similar to patients in sinus rhythm.^{2 3 7 20} In our experience, the majority of ambulatory patients evaluated with echocardiography have normal heart rates, whereas critically ill patients in the intensive care units are usually tachycardic. Thus, the difficulty of acquisition of pulmonary venous flow in this study is a limitation for its use in several patients with ST.

Tissue Doppler Imaging
We observed weak but significant inverse relations between E_a, A_a, and PCWP. For E_a, this is probably related to the compensatory increase in left atrial pressure with impaired relaxation. For A_a, which reflects annular motion secondary to atrial contraction, a negative relation to filling pressures is expected, similar to the inverse relation of the transmitral A velocity to PCWP in sinus rhythm.^{1 3 5} E_a behaves as an index of LV relaxation that is reduced with impaired relaxation and is less influenced by left atrial pressure.^{15 16 17} Sohn et al¹⁶ demonstrated changes in the transmitral E velocity and DT with saline infusion and nitroglycerin, without a significant change in the E_a velocity at the septal corner of the mitral annulus. As such, E_a can partially correct for the influence of relaxation on the transmitral E velocity, as recently shown in our laboratory.¹⁷ The concept of correcting for the relaxation influence on transmitral E using E_a is similar to the approach with the color M-mode flow propagation velocity, reported in sinus rhythm²³ and atrial fibrillation.⁹

In this investigation, the E/E_a ratio provided the best index for the prediction of PCWP, irrespective of the filling pattern. Importantly, E/E_a performed well in patients with normal LVEF, the most problematic group for conventional Doppler. Furthermore, in patients with complete merging of E and A, E/E_a also performed well, highlighting the important role of TDI-derived velocities in ST. The equations we derived previously in patients with sinus rhythm (PCWP=1.9+1.24 E/E_a)¹⁷ and with heart transplants²⁴ (PCWP=2.6+1.46 E/E_a) are very similar to the one derived in this study, further demonstrating the validity of this new approach in the estimation of filling pressures. In fact, the relation of E/E_a to PCWP was maintained if our initial 60 patients in normal sinus rhythm¹⁷ were combined with the 120 patients in ST (r=0.87, Figure 7). There were minor differences between the equations derived for these 2 separate populations, and the addition of heart rate did not add to the predictive power of E/E_a in the stepwise regression analysis. Although the use of the specific equations may yield slightly more accurate prediction of PCWP, particularly for very high filling pressures, the unifying equation PCWP=2+1.3 E/E_a (180 patients combined) can be used for practical purposes in sinus rhythm, irrespective of heart rate. The sensitivity and specificity of different E/E_a values in predicting PCWP >15 mm Hg (n=180) are shown in Table 8. The best cutoff remains E/E_a >10 (sensitivity, 92%; specificity, 80%).

View larger version (26K): [in this window] [in a new window]   Figure 7. Plot of PCWP by catheter vs E/Ea in 180 patients combined: 60 with normal sinus rhythm17 and 120 with ST.

View this table: [in this window] [in a new window]   Table 8. Sensitivity and Specificity of Various E/Ea Cutoffs for PCWP >15 mm Hg in the 180 Patients Combined: Normal Sinus Rhythm17 (n=60) and ST (n=120)

Limitations
We have few patients with the A₂ subpattern. Our observations in this subgroup need further evaluation. We used the single annular velocity in lieu of the E_a, with merging of E_a and A_a. Although this may not always have been the true E_a, when the data were analyzed for this group of patients, the correlation was as strong as that in patients with separate E_a and A_a. We could not completely evaluate the utility of pulmonary venous flow in ST because of the low feasibility given the supine position of all our patients. It is important to note that, although E/E_a provided a reasonable estimate of PCWP, the 95% confidence limits are wide and should be considered in application of the regression equation. It is thus possible that, depending on the clinical setting and the estimated PCWP, one may need invasive measurements. However, for a Doppler estimate of PCWP 22 mm Hg, there is 95% certainty that the actual pressure is >15 mm Hg; conversely, an estimated pressure 8 mm Hg is indicative of PCWP 15 mm Hg. None of our patients had regional dysfunction at the lateral base. Accordingly, we cannot address the utility of TDI velocities at the lateral annular corner in patients with lateral wall abnormalities. Fortunately, this is an uncommon clinical occurrence.

	Acknowledgments

 
We thank Anna Zamora and Eula Landry for their secretarial assistance.

	Footnotes

 
Guest editor for this article was A. Jamil Tajik, MD, Mayo Clinic, Rochester, Minn.

Received December 10, 1997; revision received May 28, 1998; accepted June 16, 1998.

	References

Top Abstract Introduction Methods Results Discussion References

 
1. Mulvagh S, Quiñones MA, Kleiman NS, Cheirif BJ, Zoghbi WA. Estimation of left ventricular end diastolic pressure from Doppler transmitral flow velocity in cardiac patients independent of systolic performance. J Am Coll Cardiol. 1992;20:112–119.[Abstract]

2. Rossvoll O, Hatle LK. Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left ventricular diastolic pressures. J Am Coll Cardiol. 1993;21:1687–1696.[Abstract]

3. Appleton CP, Galloway JM, Gonzalez MS, Graballa M, Basnight MA. Estimation of left ventricular filling pressures using two dimensional and Doppler echocardiography in adult patients with cardiac disease. J Am Coll Cardiol. 1993;22:1972–1982.[Abstract]

4. Vanoverschelde JLJ, Robert AR, Gerbaux A, Michel X, Hanet C, Wijns W. Noninvasive estimation of pulmonary arterial wedge pressure with Doppler transmitral flow velocity pattern in patients with known heart disease. Am J Cardiol. 1995;75:383–389.[Medline] [Order article via Infotrieve]

5. Nagueh SF, Kopelen HA, Zoghbi WA. Feasibility and accuracy of Doppler echocardiographic estimation of pulmonary artery occlusive pressure in the intensive care unit. Am J Cardiol. 1995;75:1256–1262.[Medline] [Order article via Infotrieve]

6. Tenenbaum A, Motro M, Hod H, Kaplinsky E, Vered Z. Shortened Doppler-derived mitral A wave deceleration time: an important predictor of elevated left ventricular filling pressure. J Am Coll Cardiol. 1996;27:700–705.[Abstract]

7. Pozzoli M, Capomolla S, Pinna G, Cobelli F, Tavazzi L. Doppler echocardiography reliably predicts pulmonary artery wedge pressure in patients with chronic heart failure with and without mitral regurgitation. J Am Coll Cardiol. 1996;27:883–893.[Abstract]

8. Giannuzzi P, Imparato A, Temporelli PL, de Vito F, Silva PL, Scapellato F, Giordano A. Doppler-derived mitral deceleration time of early filling as a strong predictor of pulmonary capillary wedge pressure in postinfarction patients with left ventricular systolic dysfunction. J Am Coll Cardiol. 1994;23:1630–1637.[Abstract]

9. Nagueh SF, Kopelen HA, Quiñones MA. Assessment of left ventricular filling pressures by Doppler in the presence of atrial fibrillation. Circulation. 1996;94:2138–2145.[Abstract/Free Full Text]

10. Chirillo F, Brunazzi MC, Barbiero M, Giavarina D, Pasqualini M, Franceschini-Grisolia E, Cotogni A, Cavarzerani A, Rigatelli G, Stritoni P, Longhini C. Estimating mean pulmonary wedge pressure in patients with chronic atrial fibrillation from transthoracic Doppler indexes of mitral and pulmonary venous flow velocity. J Am Coll Cardiol. 1997;30:19–26.[Abstract]

11. Uematsu M, Miyatake K, Tanaka N, Matsuda H, Sano A, Yamazaki N, Hirama M, Yamagishi M. Myocardial velocity gradient as a new indicator of regional left ventricular contraction: detection by a two-dimensional tissue Doppler imaging technique. J Am Coll Cardiol. 1995;26:217–223.[Abstract]

12. Miyatake K, Yamagishi M, Tanaka N, Uematsu M, Yamazaki N, Mine Y, Sano A, Hirama M. New method for evaluating left ventricular wall motion by color-coded tissue Doppler imaging: in vitro and in vivo studies. J Am Coll Cardiol. 1995;25:717–724.[Abstract]

13. Garcia MG, Rodriguez L, Ares M, Griffin BP, Thomas JD, Klein AL. Differentiation of constrictive pericarditis from restrictive cardiomyopathy: assessment of left ventricular diastolic velocities in longitudinal axis by Doppler tissue imaging. J Am Coll Cardiol. 1996;27:108–114.[Abstract]

14. Rodriguez L, Garcia M, Ares M, Griffin BP, Nakatani S, Thomas JD. Assessment of mitral annular dynamics during diastole by Doppler tissue imaging: comparison with mitral Doppler inflow in subjects without heart disease and in patients with left ventricular hypertrophy. Am Heart J. 1996;131:982–987.[Medline] [Order article via Infotrieve]

15. Oki T, Tabata T, Yamada H, Wakatsuki T, Shinohara H, Nishikado A, Luchi A, Fukuda N, Susumo I. Clinical application of pulsed Doppler tissue imaging for assessing abnormal left ventricular relaxation. Am J Cardiol. 1997;79:921–928.[Medline] [Order article via Infotrieve]

16. Sohn D-W, Chai I-H, Lee D-J, Kim H-C, Kim H-S, Oh B-H, Lee M-M, Park Y-B, Choi Y-S, Seo J-D, Lee Y-W. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol. 1997;30:474–480.[Abstract]

17. Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quiñones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30:1527–1533.[Abstract]

18. Quiñones MA, Waggoner AD, Reduto LA, Nelson JG, Young JB, Winters WLJ, Riberio LGT, Miller RR. A new simplified and accurate method for determining ejection fraction with two-dimensional echocardiography. Circulation. 1981;64:744–753.[Abstract/Free Full Text]

19. Appleton CP. Influence of incremental changes in heart rate on mitral flow velocity: assessment in lightly sedated conscious dogs. J Am Coll Cardiol. 1991;17:227–236.[Abstract]

20. Kuecherer HF, Muhiudeen IA, Kusumoto FM, Lee E, Mouliniur LE, Cahalan MK, Schiller NB. Estimation of mean left atrial pressure from transesophageal pulsed Doppler echocardiography of pulmonary venous flow. Circulation. 1990;82:1127–1139.[Abstract/Free Full Text]

21. Nishimura R, Appleton C, Redfield M, Ilstrup D, Holmes D, Tajik A. Noninvasive Doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol. 1996;28:1226–1233.[Abstract]

22. Choong CY, Herrmann HC, Weyman AE, Fifer MA. Preload dependence of Doppler-derived indices of left ventricular diastolic function in humans. J Am Coll Cardiol. 1987;10:800–818.[Abstract]

23. Garcia MJ, Ares MA, Asher C, Rodriguez L, Vandervoort P, Thomas JD. An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure. J Am Coll Cardiol. 1997;29:448–454.[Abstract]

24. Sundereswaran L, Nagueh SF, Vardan S, Middleton KJ, Zoghbi WA, Quiñones MA, Amione-Torre G. Estimation of left and right ventricular filling pressures after heart transplantation by tissue Doppler imaging. Am J Cardiol. 1998;82:352–357.[Medline] [Order article via Infotrieve]

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				L. A. Rustad, B. H. Amundsen, S. A. Slordahl, and A. Stoylen Upright bicycle exercise echocardiography in patients with myocardial infarction shows lack of diastolic, but not systolic, reserve: a tissue Doppler study Eur J Echocardiogr, June 1, 2009; 10(4): 503 - 508. [Abstract] [Full Text] [PDF]

				R Mizuno, S Fujimoto, Y Saito, and S Nakamura Depressed recovery of subendocardial perfusion in persistent heart failure after complete revascularisation in diabetic patients with hibernating myocardium Heart, May 1, 2009; 95(10): 830 - 834. [Abstract] [Full Text] [PDF]

				S. F. Nagueh, C. P. Appleton, T. C. Gillebert, P. N. Marino, J. K. Oh, O. A. Smiseth, A. D. Waggoner, F. A. Flachskampf, P. A. Pellikka, and A. Evangelisa Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography Eur J Echocardiogr, March 1, 2009; 10(2): 165 - 193. [Full Text] [PDF]

				W. Mullens, A. G. Borowski, R. J. Curtin, J. D. Thomas, and W.H. Tang Tissue Doppler Imaging in the Estimation of Intracardiac Filling Pressure in Decompensated Patients With Advanced Systolic Heart Failure Circulation, January 6, 2009; 119(1): 62 - 70. [Abstract] [Full Text] [PDF]

				S. D. Solomon and L. W. Stevenson Recalibrating the Barometer: Is It Time to Take a Critical Look at Noninvasive Approaches to Measuring Filling Pressures? Circulation, January 6, 2009; 119(1): 13 - 15. [Full Text] [PDF]

				N. Skubas Intraoperative Doppler Tissue Imaging Is a Valuable Addition to Cardiac Anesthesiologists' Armamentarium: A Core Review Anesth. Analg., January 1, 2009; 108(1): 48 - 66. [Abstract] [Full Text] [PDF]

				M. Richardson-Lobbedez, S. Marechaux, C. Bauters, J. Darchis, J. L. Auffray, J. J. Bauchart, J. M. Aubert, T. H. LeJemtel, M. Lesenne, E. Van Belle, et al. Prognostic importance of tissue Doppler-derived diastolic function in patients presenting with acute coronary syndrome: a bedside echocardiographic study Eur J Echocardiogr, September 1, 2008; 9(5): 594 - 598. [Abstract] [Full Text] [PDF]

				N R Van de Veire, J De Sutter, J J Bax, and J R T C Roelandt Technological advances in tissue Doppler imaging echocardiography Heart, August 1, 2008; 94(8): 1065 - 1074. [Abstract] [Full Text] [PDF]

				A. Y-M. Wang, M. Wang, C. W-K. Lam, I. H-S. Chan, Y. Zhang, and J. E. Sanderson Left Ventricular Filling Pressure by Doppler Echocardiography in Patients With End-Stage Renal Disease Hypertension, July 1, 2008; 52(1): 107 - 114. [Abstract] [Full Text] [PDF]

				J.-M. Tartiere, D. Logeart, L. Tartiere-Kesri, and A. Cohen-Solal Colour tissue Doppler underestimates myocardial velocity as compared to spectral tissue Doppler: Poor reliability between both methods Eur J Echocardiogr, March 1, 2008; 9(2): 268 - 272. [Abstract] [Full Text] [PDF]

				M. M. Riordan, E. P. Weiss, T. E. Meyer, A. A. Ehsani, S. B. Racette, D. T. Villareal, L. Fontana, J. O. Holloszy, and S. J. Kovacs The effects of caloric restriction- and exercise-induced weight loss on left ventricular diastolic function Am J Physiol Heart Circ Physiol, March 1, 2008; 294(3): H1174 - H1182. [Abstract] [Full Text] [PDF]

				G. A. Whalley, S. P. Wright, A. Pearl, G. D. Gamble, H. J. Walsh, M. Richards, and R. N. Doughty Prognostic role of echocardiography and brain natriuretic peptide in symptomatic breathless patients in the community Eur. Heart J., February 2, 2008; 29(4): 509 - 516. [Abstract] [Full Text] [PDF]

				L. Groban, L. M. Yamaleyeva, B. M. Westwood, T. T. Houle, M. Lin, D. W. Kitzman, and M. C. Chappell Progressive Diastolic Dysfunction in the Female mRen(2).Lewis Rat: Influence of Salt and Ovarian Hormones J. Gerontol. A Biol. Sci. Med. Sci., January 1, 2008; 63(1): 3 - 11. [Abstract] [Full Text] [PDF]

				M. E. Davis, C. J. Pemberton, T. G. Yandle, S. F. Fisher, J. G. Lainchbury, C. M. Frampton, M. T. Rademaker, and M. Richards Urocortin 2 infusion in human heart failure Eur. Heart J., November 1, 2007; 28(21): 2589 - 2597. [Abstract] [Full Text] [PDF]

				Y.-Y. Lam, M. G Kaya, W. Li, V. S Mahadevan, A. A Khan, M. Y Henein, and M. Mullen Effect of endovascular stenting of aortic coarctation on biventricular function in adults Heart, November 1, 2007; 93(11): 1441 - 1447. [Abstract] [Full Text] [PDF]

				B. A. Borlaug, V. Melenovsky, M. M. Redfield, K. Kessler, H.-J. Chang, T. P. Abraham, and D. A. Kass Impact of Arterial Load and Loading Sequence on Left Ventricular Tissue Velocities in Humans J. Am. Coll. Cardiol., October 16, 2007; 50(16): 1570 - 1577. [Abstract] [Full Text] [PDF]

				D. Th. Kremastinos, D. P. Tsiapras, A. G. Kostopoulou, E. S. Hamodraka, A. S. Chaidaroglou, and E. D. Kapsali NT-proBNP levels and diastolic dysfunction in {beta}-Thalassaemia major patients Eur J Heart Fail, May 1, 2007; 9(5): 531 - 536. [Abstract] [Full Text] [PDF]

				J. D. Thomas and Z. B. Popovic Assessment of Left Ventricular Function by Cardiac Ultrasound J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2012 - 2025. [Abstract] [Full Text] [PDF]

				H Okura, Y Takada, T Kubo, K Iwata, S Mizoguchi, H Taguchi, I Toda, J Yoshikawa, and K Yoshida Tissue Doppler-derived index of left ventricular filling pressure, E/E', predicts survival of patients with non-valvular atrial fibrillation Heart, September 1, 2006; 92(9): 1248 - 1252. [Abstract] [Full Text] [PDF]

				J. E. Moller, P. A. Pellikka, G. S. Hillis, and J. K. Oh Prognostic Importance of Diastolic Function and Filling Pressure in Patients With Acute Myocardial Infarction Circulation, August 1, 2006; 114(5): 438 - 444. [Full Text] [PDF]

				M. I. Burgess, C. Jenkins, J. E. Sharman, and T. H. Marwick Diastolic Stress Echocardiography: Hemodynamic Validation and Clinical Significance of Estimation of Ventricular Filling Pressure With Exercise J. Am. Coll. Cardiol., May 2, 2006; 47(9): 1891 - 1900. [Abstract] [Full Text] [PDF]

				S. H. Ahmed, L. L. Clark, W. R. Pennington, C. S. Webb, D. D. Bonnema, A. H. Leonardi, C. D. McClure, F. G. Spinale, and M. R. Zile Matrix Metalloproteinases/Tissue Inhibitors of Metalloproteinases: Relationship Between Changes in Proteolytic Determinants of Matrix Composition and Structural, Functional, and Clinical Manifestations of Hypertensive Heart Disease Circulation, May 2, 2006; 113(17): 2089 - 2096. [Abstract] [Full Text] [PDF]

				N. Middleton, R. Shave, K. George, G. Whyte, J. Forster, D. Oxborough, D. Gaze, and P. Collinson Novel application of flow propagation velocity and ischaemia-modified albumin in analysis of postexercise cardiac function in man Exp Physiol, May 1, 2006; 91(3): 511 - 519. [Abstract] [Full Text] [PDF]

				M. Cannesson, D. Jacques, M. R. Pinsky, and J. Gorcsan III Effects of modulation of left ventricular contractile state and loading conditions on tissue Doppler myocardial performance index Am J Physiol Heart Circ Physiol, May 1, 2006; 290(5): H1952 - H1959. [Abstract] [Full Text] [PDF]

				J. K. Oh, L. Hatle, A. J. Tajik, and W. C. Little Diastolic Heart Failure Can Be Diagnosed by Comprehensive Two-Dimensional and Doppler Echocardiography J. Am. Coll. Cardiol., February 7, 2006; 47(3): 500 - 506. [Abstract] [Full Text] [PDF]

				J. O. Hunderi, C. R. Thompson, and O. A. Smiseth Deceleration time of systolic pulmonary venous flow: a new clinical marker of left atrial pressure and compliance J Appl Physiol, February 1, 2006; 100(2): 685 - 689. [Abstract] [Full Text] [PDF]

				T. E. Meyer, S. J. Kovacs, A. A. Ehsani, S. Klein, J. O. Holloszy, and L. Fontana Long-Term Caloric Restriction Ameliorates the Decline in Diastolic Function in Humans J. Am. Coll. Cardiol., January 17, 2006; 47(2): 398 - 402. [Abstract] [Full Text] [PDF]

				T. K. Lim, H. Ashrafian, G. Dwivedi, P. O. Collinson, and R. Senior Increased left atrial volume index is an independent predictor of raised serum natriuretic peptide in patients with suspected heart failure but normal left ventricular ejection fraction: Implication for diagnosis of diastolic heart failure Eur J Heart Fail, January 1, 2006; 8(1): 38 - 45. [Abstract] [Full Text] [PDF]

				C. Wallentin Guron, O. Bech-Hanssen, R. Wikh, A. Rosengren, M. Hartford, and K. Caidahl The E/e filling index and right ventricular pressure in relation to applied international Doppler recommendations of left ventricular filling assessment Eur J Echocardiogr, December 1, 2005; 6(6): 419 - 428. [Abstract] [Full Text] [PDF]

				K. George, D. Oxborough, J. Forster, G. Whyte, R. Shave, E. Dawson, C. Stephenson, L. Dugdill, B. Edwards, and D. Gaze Mitral annular myocardial velocity assessment of segmental left ventricular diastolic function after prolonged exercise in humans J. Physiol., November 15, 2005; 569(1): 305 - 313. [Abstract] [Full Text] [PDF]

				L. Groban and S. Y. Dolinski Transesophageal Echocardiographic Evaluation of Diastolic Function Chest, November 1, 2005; 128(5): 3652 - 3663. [Abstract] [Full Text] [PDF]

				M. Kidawa, L. Coignard, G. Drobinski, M. Krzeminska-Pakula, D. Thomas, M. Komajda, and R. Isnard Comparative Value of Tissue Doppler Imaging and M-Mode Color Doppler Mitral Flow Propagation Velocity for the Evaluation of Left Ventricular Filling Pressure Chest, October 1, 2005; 128(4): 2544 - 2550. [Abstract] [Full Text] [PDF]

				J. K. Oh Echocardiography as a Noninvasive Swan-Ganz Catheter Circulation, June 21, 2005; 111(24): 3192 - 3194. [Full Text] [PDF]

				A. Diwan, M. McCulloch, G. M. Lawrie, M. J. Reardon, and S. F. Nagueh Doppler Estimation of Left Ventricular Filling Pressures in Patients With Mitral Valve Disease Circulation, June 21, 2005; 111(24): 3281 - 3289. [Abstract] [Full Text] [PDF]

				C. F. Baicu, M. R. Zile, G. P. Aurigemma, and W. H. Gaasch Left Ventricular Systolic Performance, Function, and Contractility in Patients With Diastolic Heart Failure Circulation, May 10, 2005; 111(18): 2306 - 2312. [Abstract] [Full Text] [PDF]

				B. P. Paelinck, A. de Roos, J. J. Bax, J. M. Bosmans, R. J. van Der Geest, D. Dhondt, P. M. Parizel, C. J. Vrints, and H. J. Lamb Feasibility of tissue magnetic resonance imaging: A pilot study in comparison with tissue Doppler imaging and invasive measurement J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1109 - 1116. [Abstract] [Full Text] [PDF]

				A. D. Michaels, B. McKeown, M. Kostal, K. T. Vakharia, M. V. Jordan, I. L. Gerber, E. Foster, and K. Chatterjee Effects of Intravenous Levosimendan on Human Coronary Vasomotor Regulation, Left Ventricular Wall Stress, and Myocardial Oxygen Uptake Circulation, March 29, 2005; 111(12): 1504 - 1509. [Abstract] [Full Text] [PDF]

				R. Senior and H. Ashrafian Screening for isolated diastolic dysfunction - a bridge too far? Eur J Echocardiogr, March 1, 2005; 6(2): 79 - 82. [Full Text] [PDF]

				P. M. Srivastava, L. M. Burrell, and P. Calafiore Lateral vs medial mitral annular tissue Doppler in the echocardiographic assessment of diastolic function and filling pressures: which should we use? Eur J Echocardiogr, March 1, 2005; 6(2): 97 - 106. [Abstract] [Full Text] [PDF]

				J. I. Poelaert and G. Schupfer Hemodynamic Monitoring Utilizing Transesophageal Echocardiography: The Relationships Among Pressure, Flow, and Function Chest, January 1, 2005; 127(1): 379 - 390. [Full Text] [PDF]

				D. C. Jacques, M. R. Pinsky, D. Severyn, and J. Gorcsan III Influence of Alterations in Loading on Mitral Annular Velocity by Tissue Doppler Echocardiography and Its Associated Ability To Predict Filling Pressures Chest, December 1, 2004; 126(6): 1910 - 1918. [Abstract] [Full Text] [PDF]

				T. E. Meyer, M. Karamanoglu, A. A. Ehsani, and S. J. Kovacs Left ventricular chamber stiffness at rest as a determinant of exercise capacity in heart failure subjects with decreased ejection fraction J Appl Physiol, November 1, 2004; 97(5): 1667 - 1672. [Abstract] [Full Text] [PDF]

				I. Hashimoto, A. H. Bhat, X. Li, M. Jones, C. H. Davies, J. C. Swanson, S. T. Schindera, and D. J. Sahn Tissue Doppler-derived myocardial acceleration for evaluation of left ventricular diastolic function J. Am. Coll. Cardiol., October 6, 2004; 44(7): 1459 - 1466. [Abstract] [Full Text] [PDF]

				C J McMahon, S F Nagueh, R S Eapen, W J Dreyer, I Finkelshtyn, X Cao, B W Eidem, L I Bezold, S W Denfield, J A Towbin, et al. Echocardiographic predictors of adverse clinical events in children with dilated cardiomyopathy: a prospective clinical study Heart, August 1, 2004; 90(8): 908 - 915. [Abstract] [Full Text] [PDF]

				G. Pela, G. Regolisti, P. Coghi, A. Cabassi, A. Basile, A. Cavatorta, C. Manca, and A. Borghetti Effects of the reduction of preload on left and right ventricular myocardial velocities analyzed by Doppler tissue echocardiography in healthy subjects Eur J Echocardiogr, August 1, 2004; 5(4): 262 - 271. [Abstract] [Full Text] [PDF]

				S. J. Skaluba and S. E. Litwin Mechanisms of Exercise Intolerance: Insights From Tissue Doppler Imaging Circulation, March 2, 2004; 109(8): 972 - 977. [Abstract] [Full Text] [PDF]

				T H Marwick Clinical applications of tissue Doppler imaging: a promise fulfilled Heart, December 1, 2003; 89(12): 1377 - 1378. [Abstract] [Full Text] [PDF]

				S R Ommen and R A Nishimura A clinical approach to the assessment of left ventricular diastolic function by Doppler echocardiography: update 2003 Heart, November 1, 2003; 89(90003): iii18 - 23. [Full Text] [PDF]

				C. Rivas-Gotz, D. S. Khoury, M. Manolios, L. Rao, H. A. Kopelen, and S. F. Nagueh Time interval between onset of mitral inflow and onset of early diastolic velocity by tissue Doppler: a novel index of left ventricular relaxation: Experimental studies and clinical application J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1463 - 1470. [Abstract] [Full Text] [PDF]

				B.P Paelinck, J.W.M van Eck, S.G De Hert, and T.C Gillebert Effects of postural changes on cardiac function in healthy subjects Eur J Echocardiogr, September 1, 2003; 4(3): 196 - 201. [Abstract] [Full Text] [PDF]

				H. Hasegawa, W. C. Little, M. Ohno, S. Brucks, A. Morimoto, H.-J. Cheng, and C.-P. Cheng Diastolic mitral annular velocityduring the development of heart failure J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1590 - 1597. [Abstract] [Full Text] [PDF]

				M. Wang, G. W. K. Yip, A. Y. M. Wang, Y. Zhang, P. Y. Ho, M. K. Tse, P. K. W. Lam, and J. E. Sanderson Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value J. Am. Coll. Cardiol., March 5, 2003; 41(5): 820 - 826. [Abstract] [Full Text] [PDF]

				A. D. Waggoner Alternative Echocardiographic Methods to Assess Left Ventricular Diastolic Function Journal of Diagnostic Medical Sonography, July 1, 2002; 18(4): 218 - 230. [Abstract] [PDF]

				C Seiler, T Pohl, E Lipp, D Hutter, and B Meier Regional left ventricular function during transient coronary occlusion: relation with coronary collateral flow Heart, July 1, 2002; 88(1): 35 - 42. [Abstract] [Full Text] [PDF]

				F. Prunier, R. Gaertner, L. Louedec, J.-B. Michel, J.-J. Mercadier, and B. Escoubet Doppler echocardiographic estimation of left ventricular end-diastolic pressure after MI in rats Am J Physiol Heart Circ Physiol, July 1, 2002; 283(1): H346 - H352. [Abstract] [Full Text] [PDF]

				J. Poelaert, A. Denault, F. Bernard, and P. Couture Diagnosis of Diastolic Dysfunction: Importance of Spectral Doppler Imaging * Response Anesth. Analg., April 1, 2002; 94(4): 1043 - 1045. [Full Text] [PDF]

				J.-W. Ha, J. K. Oh, L. H. Ling, R. A. Nishimura, J. B. Seward, and A. J. Tajik Annulus Paradoxus: Transmitral Flow Velocity to Mitral Annular Velocity Ratio Is Inversely Proportional to Pulmonary Capillary Wedge Pressure in Patients With Constrictive Pericarditis Circulation, August 28, 2001; 104(9): 976 - 978. [Abstract] [Full Text] [PDF]

				M. S. Firstenberg, B. D. Levine, M. J. Garcia, N. L. Greenberg, L. Cardon, A. J. Morehead, J. Zuckerman, and J. D. Thomas Relationship of echocardiographic indices to pulmonary capillary wedge pressures in healthy volunteers J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1664 - 1669. [Abstract] [Full Text] [PDF]

				S. R. Ommen, R. A. Nishimura, C. P. Appleton, F. A. Miller, J. K. Oh, M. M. Redfield, and A. J. Tajik Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling Pressures : A Comparative Simultaneous Doppler-Catheterization Study Circulation, October 10, 2000; 102(15): 1788 - 1794. [Abstract] [Full Text] [PDF]

				L. Hatle and G. R. Sutherland Regional myocardial function--a new approach. Eur. Heart J., August 1, 2000; 21(16): 1337 - 1357. [PDF]

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