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2.
Tidsskr Nor Laegeforen ; 141(5)2021 03 23.
Artigo em Norueguês | MEDLINE | ID: mdl-33754666

RESUMO

BACKGROUND: Sarcoidosis is a multi-system inflammatory disorder resulting in the formation of non-caseating granulomas in various parts of the body. Cardiac involvement is associated with worse prognosis, probably due to the destructive effects the granulomas can have on the electrical conduction system. The diagnosis of cardiac sarcoidosis can be challenging due to the limited accuracy of various clinical criteria. CASE PRESENTATION: A woman in her fifties developed symptoms in the form of dry cough and uncharacteristic chest pain. Thorough assessment was initiated, but the true cause remained undiagnosed for several years. The patient suffered from recurrent arrythmias and eventually a weakened ventricular function and cardiac failure. A multidisciplinary approach revealed that the patient was suffering from cardiac sarcoidosis. INTERPRETATION: Cardiac sarcoidosis may initially present with mild symptoms, but left bundle branch block, total AV-block and supraventricular tachycardias, as well as weakened ventricular function, should raise suspicion of the condition. Magnetic resonance imaging and echocardiography may be of help during clinical assessment, and positron emission tomography/computed tomography and biopsy can confirm the condition.


Assuntos
Cardiomiopatias , Sarcoidose , Arritmias Cardíacas , Bloqueio de Ramo/diagnóstico , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Sarcoidose/complicações , Sarcoidose/diagnóstico
3.
Am J Cardiol ; 146: 89-94, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33529617

RESUMO

Diagnosing cardiac amyloidosis is challenging and requires a high index of suspicion in patients with an increased left ventricular wall thickness (LVWT). Low QRS voltage on electrocardiogram (ECG) has been regarded as the hallmark ECG finding in cardiac amyloidosis; however, the presence of low voltage can range from 20-74% and the voltage/mass ratio carries a greater diagnostic accuracy than QRS voltage alone. Patients with cardiac amyloidosis can have conduction system infiltration and this may result in a BBB. Therefore, the ECG or mass/voltage criteria established for patients with a narrow QRS in the diagnosis of cardiac amyloidosis may not be applicable in patients with a BBB. We sought to identify criteria to aid in the diagnosis of cardiac amyloidosis in patients with increased LVWT on echocardiogram and with a BBB on ECG. We calculated the total QRS score/LVWT, limb lead QRS score/LVWT, R in lead aVL/LVWT, R in lead I/LVWT, and Sokolow index/LVWT. In patients with an increase in LVWT and BBB, total QRS voltage that is indexed to wall thickness can help distinguish between patients with increased wall thickness who have cardiac amyloidosis from those who have LVH related to a pressure overload state. A unique index of Total QRS Score/LVWT is the best predictor of cardiac amyloidosis with a cutoff value of 92.5 mV/cm which is 100% sensitive and 83% specific for the diagnosis of cardiac amyloidosis. This may be a useful screening tool in patients with an increased wall thickness to raise diagnostic suspicion for cardiac amyloidosis.


Assuntos
Amiloidose/diagnóstico , Bloqueio de Ramo/complicações , Eletrocardiografia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Cardiopatias/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Amiloidose/etiologia , Amiloidose/fisiopatologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Seguimentos , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Humanos , Masculino , Estudos Retrospectivos
4.
Am J Case Rep ; 22: e928852, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33446625

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the lungs but can involve any organ. The medical community is struggling to cope with the critical illness associated with the disease. On top of that, patients who have recovered from COVID-19 have presented with complications such as thrombotic episodes in various organs both during and after being infected with SARS-CoV-2. A COVID-19-associated prothrombotic state has been mentioned in multiple recent research articles. The role of anticoagulants is debatable, because even after receiving them prophylactically, many patients have experienced thrombotic episodes. The situation, therefore, represents a challenge to the medical community. CASE REPORT We report on a COVID-19-associated prothrombotic state in a 65-year-old man with no history of comorbid illness. Initially, he presented with right-sided weakness and was found to have had an acute ischemic stroke. Urgent imaging after the stroke revealed changes on electrocardiography that were remarkable for left bundle branch block. The patient's elevated cardiac enzyme levels correlated with a silent acute myocardial infarction (MI). His echocardiogram revealed a left ventricular (LV) thrombus. He was managed with a multidisciplinary approach involving Neurology, Cardiology, and Medicine. CONCLUSIONS COVID-19-associated prothrombotic episodes involving arterial and venous systems have been reported in the literature. But concomitant stroke, acute MI, and LV thrombus rarely have been documented. The role of prophylactic or therapeutic anticoagulation is still unclear because even when patients are on these drugs, they continue to develop thrombotic episodes. Indeed, further studies are required to develop a standard management plan for what can be a fatal situation.


Assuntos
COVID-19/complicações , AVC Isquêmico/virologia , Infarto do Miocárdio/virologia , Trombose/virologia , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/virologia , COVID-19/diagnóstico , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Humanos , AVC Isquêmico/diagnóstico por imagem , Masculino , Infarto do Miocárdio/diagnóstico , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios X
5.
Int J Cardiol ; 327: 201-208, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33309760

RESUMO

BACKGROUND: Intraventricular conduction disturbances are associated with an increased risk of adverse cardiovascular outcomes. However, data about factors associated with intraventricular conduction disturbances are sparse. We aimed to identify the clinical factors associated with intraventricular conduction disturbances in the general population. METHODS: Cross-sectional study in a sample of 3704 participants (age range 45-86 years, 55.2% women). Intraventricular conduction disturbances were defined as QRS > 110 ms on electrocardiograms, and classified into right bundle branch block (RBBB), left bundle branch block (LBBB), left anterior fascicular block (LAFB) and non-specific intraventricular conduction disturbances (NIVCD). RESULTS: The number of participants, the resulting prevalence (square brackets) and 95% CI (round brackets) of intraventricular conduction disturbances and subtypes (RBBB, LBBB, LAFB and NIVCD) were 187 [5.1% (4.4-5.8%)], 103 [2.9%, (2.3-3.4%)], 29 [0.8% (0.6-1.1%)], 31 (0.9% [0.6-1.2%]), and 47 [1.3% (0.9-1.7)], respectively. Multivariable logistic regression identified male sex [odds ratio and (95% CI): 2.55 (1.34-4.86)] and increasing age (p-value for trend <0.001) as being associated with RBBB; hypertension [3.08 (1.20-7.91)] and elevated NT-proBNP [3.26 (1.43-7.41)] as being associated with LBBB; elevated NT-proBNP [3.14 (1.32-7.46)] as being associated with LFAB; and male sex [5.97 (1.91-18.7)] and increased height [1.31 (1.06-1.63)] as being associated with NIVCD. CONCLUSION: In a sample of the Swiss middle-aged population, the clinical factors associated with intraventricular conduction disturbances differed according to the intraventricular conduction disturbances subtype: male sex and ageing for RBBB; hypertension and elevated NT-proBNP for LBBB; elevated NT-proBNP for LAFB; and male sex and increased height for NIVCD.


Assuntos
Bloqueio de Ramo , Hipertensão , Adulto , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/epidemiologia , Estudos Transversais , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Suíça
7.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370998

RESUMO

Coronary artery fistulas are abnormal vascular conduits, rarely related to atrioventricular conduction abnormalities. We report the case of a 52-year-old woman who presented with dyspnoea on exertion. Her ECG revealed advanced atrioventricular block and left bundle branch block. CT scans confirmed two fistulas, from the conus branch of right coronary artery and from the left anterior descending coronary artery, into the pulmonary artery. The patient underwent pacemaker implantation. To date, only nine patients with different degrees of heart blocks associated with coronary artery fistulas have been reported. Herein, we review and summarise previously reported cases of different degrees of heart blocks associated with coronary artery fistulas.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Bloqueio de Ramo/diagnóstico , Anomalias dos Vasos Coronários/complicações , Fístula/complicações , Marca-Passo Artificial , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/terapia , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Ecocardiografia , Eletrocardiografia , Teste de Esforço/métodos , Feminino , Fístula/diagnóstico , Humanos , Pessoa de Meia-Idade , Tecnécio Tc 99m Sestamibi/administração & dosagem , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
8.
Pan Afr Med J ; 37(Suppl 1): 13, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33343792

RESUMO

Klinefelter syndrome is the most common congenital abnormality causing primary hypogonadism and predisposing to a state of hypercoagulability. We report the case of a 37-year-old man, of Algerian nationality, diagnosed with Klinefelter syndrome admitted to the hospital via the emergency room for acute chest pain and dyspnea. The patient arrived in Tunisia 36 hours ago. On admission, body temperature was 38.2°C, blood pressure, pulse and respiratory rate were 130/70 mmHg, 120/minute and 26/minute, respectively. He had an oxygen saturation of 87% in room air. His electrocardiography revealed a complete right bundle-branch block, chest X-Ray was normal. In front of the clinical presentation and the origin of the patient coming from an endemic country, COVID-19 infection was suspected but ruled out by pharyngeal swabs testing negative by real-time reverse-transcription polymerase chain reaction test and massive pulmonary embolism was diagnosed from his chest computed tomography images. The symptoms improved with anticoagulation treatment.


Assuntos
COVID-19/diagnóstico , Síndrome de Klinefelter/fisiopatologia , Embolia Pulmonar/diagnóstico , Síndrome do Desconforto Respiratório/diagnóstico , Adulto , Bloqueio de Ramo/diagnóstico , Dor no Peito/etiologia , Dispneia/etiologia , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Masculino , Síndrome do Desconforto Respiratório/etiologia , Tomografia Computadorizada por Raios X
10.
Kardiologiia ; 60(7): 78-85, 2020 Aug 11.
Artigo em Russo | MEDLINE | ID: mdl-33155944

RESUMO

Aim To compare diagnostic significance of different criteria for complete left bundle branch block (cLBBB) in prediction of reverse left ventricular (LV) remodeling associated with cardiac resynchronization therapy (CRT).Materials and methods This study included 93 patients (men, 81.7 %; mean age at the time of implantation, 56.6±9.3 years). Achievement of a maximum decrease in LV end-systolic volume (ESV) was recorded during the entire follow-up period for evaluation of LV reversibility by CRT. Based on the dynamics of LV ESV, patients were divided into two groups, non-responders (n=27) and responders (n=66). cLBBB was determined by 9 criteria (ESC 2006 and 2013, AHA 2009, Strauss, and MIRACLE, CARE-HF, MADIT-CRT, REVERSE, and RAFT used in large multicenter studies).Results Incidence of cLBBB was significantly higher in the group of responders as demonstrated by the AHA (p=0.001), ESC 2013 (p=0.014), Strauss (p=0.002), MADIT-CRT (p=0.014), REVERSE (p=0.013), and RAFT (p<0.001) criteria. The highest specificity was shown for the AHA and RAFT (92.6 %) criteria, and the highest sensitivity and overall accuracy were shown for the Strauss (80.3 % and 72.04 %, respectively) criterium. The criteria proposed in actual clinical guidelines (AHA and ESC 2013) demonstrated a strong consistency in detecting cLBBB (κ=0.818, 95 % CI, 0.7-0.936; p<0.001). However, the Strauss and ESC 2006 / AHA / ESC 2013 showed the least consistency in identifying cLBBB. For the criteria described in large multicenter studies, consistency in detecting cLBBB was minimal in most cases. However, criteria with moderate or strong consistency were used in the studies, which results have substantiated the use of cLBBB as a selection criterium (MADIT-CRT, REVERSE, and RAFT).Conclusion The reversibility of LV remodeling associated with CRT was different in patients with cLBBB determined by different criteria. All actual cLBBB criteria (AHA, ESC 2013, and Strauss) were significantly more frequently observed in the responder group. Nevertheless, these criteria differed in their sensitivity and specificity. A number of large multicenter studies have used criteria with minimal consistency in detecting cLBBB, which should be taken into account in interpreting results of these studies.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/terapia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Remodelação Ventricular
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 353-356, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018001

RESUMO

Bundle branch block (BBB) is one of the most common cardiac disorder, and can be detected by electro-cardiogram (ECG) signal in clinical practice. Conventional methods adopted some kinds of hand-craft features, whose discriminative power is relatively low. On the other hand, these methods were based on the supervised learning, which required the high cost heartbeat annotation in the training. In this paper, a novel end-to-end deep network was proposed to classify three types of heartbeat: right BBB (RBBB), left BBB (LBBB) and others with a multiple instance learning based training strategy. We trained the proposed method on the China Physiological Signal Challenge 2018 database (CPSC) and tested on the MIT-BIH Arrhythmia database (AR). The proposed method achieved an accuracy of 78.58%, and sensitivity of 84.78% (LBBB), 51.23% (others) and 99.72% (RBBB), better than the baseline methods. Experimental results show that our method would be a good choice for the BBB classification on the ECG dataset with record-level labels instead of heartbeat annotations.


Assuntos
Bloqueio de Ramo , Eletrocardiografia , Arritmias Cardíacas/diagnóstico , Bloqueio de Ramo/diagnóstico , China , Frequência Cardíaca , Humanos
12.
Praxis (Bern 1994) ; 109(14): 1117-1118, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33108996

RESUMO

CME/Answers: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome Abstract. Left bundle branch block (LBBB) is the electrocardiographic correlate of a pathologic transmission of the electrical signals in the myocardium which can lead to a dyssynchronous left ventricular activation and thus to an inefficient contraction of the ventricles. It is usually the expression of an underlying cardiopathy and represents an independent risk factor of cardiovascular mortality, therefore further examination is indicated in each case. Besides the treatment of an underlying disease, a specific therapy has been available since the introduction of cardiac resynchronization therapy (CRT). A rarer phenomenon is the painful left bundle branch block in structurally healthy hearts.


Assuntos
Bloqueio de Ramo , Terapia de Ressincronização Cardíaca , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/terapia , Eletrocardiografia , Ventrículos do Coração , Humanos , Síndrome , Resultado do Tratamento
15.
Circ Heart Fail ; 13(7): e006925, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32605387

RESUMO

BACKGROUND: Mild heart failure (HF) patients without left bundle branch block (LBBB) did not derive a significant reduction in risk of a HF event/death in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). However, the efficacy of CRT with a defibrillator (CRT-D) may be modified after the development of the first hospitalization for HF (HHF). We aimed to study the effect of CRT-D on long-term risk of recurrent HHF in patients without LBBB in MADIT-CRT. METHODS: Data on recurring HHF were collected for 1818 subjects. The CRT-D versus implantable cardioverter-defibrillator-only risk for first and subsequent HHF was assessed by QRS morphology in on-treatment analysis using Cox proportional hazards regression modeling. RESULTS: During long-term follow-up, 412 patients had ≥1 HHF and 333 had ≥2 HHF. Multivariate analysis revealed that in LBBB patients, CRT-D, compared with implantable cardioverter-defibrillator, was associated with a significant reduction in risk of first and subsequent HHF (first: hazard ratio, 0.41 [95% CI, 0.31-0.54], P<0.001; subsequent: hazard ratio, 0.45 [95% CI, 0.29-0.70], P<0.001). Among patients without LBBB, the benefit of CRT-D was nonsignificant for the first HHF (hazard ratio, 0.96; P=0.808). However, after occurrence of a first HHF, CRT-D therapy was associated with a pronounced 44% reduction in risk of subsequent HHF (hazard ratio, 0.56 [95% CI, 0.32-0.97], P=0.039). Patients without LBBB with ≥1 HHF during the first year of follow-up demonstrated increasing dyssynchrony at 1 year compared with those who had no HHF (P=0.016). CONCLUSIONS: In MADIT-CRT, we show a beneficial effect of CRT-D in patients without LBBB subsequent to development of a first HHF, possibly due to increased dyssynchrony associated with HF progression. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00180271, NCT01294449, and NCT02060110.


Assuntos
Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca , Desfibriladores Implantáveis , Cardioversão Elétrica/métodos , Insuficiência Cardíaca/terapia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Bloqueio de Ramo/diagnóstico , Ecocardiografia , Eletrocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Recidiva , Fatores de Risco , Resultado do Tratamento
16.
J Card Fail ; 26(7): 626-632, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32544622

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a respiratory syndrome with high rates of mortality, and there is a need for easily obtainable markers to provide prognostic information. We sought to determine whether the electrocardiogram (ECG) on hospital presentation provides prognostic information, specifically related to death. METHODS AND RESULTS: We performed a retrospective cohort study in patients with COVID-19 who had an ECG at or near hospital admission. Clinical characteristics and ECG variables were manually abstracted from the electronic health record and first ECG. Our primary outcome was death. THERE WERE: 756 patients who presented to a large New York City teaching hospital with COVID-19 who underwent an ECG. The mean age was 63.3 ± 16 years, 37% were women, 61% of patients were nonwhite, and 57% had hypertension; 90 (11.9%) died. In a multivariable logistic regression that included age, ECG, and clinical characteristics, the presence of one or more atrial premature contractions (odds ratio [OR] 2.57, 95% confidence interval [CI] 1.23-5.36, P = .01), a right bundle branch block or intraventricular block (OR 2.61, 95% CI 1.32-5.18, P = .002), ischemic T-wave inversion (OR 3.49, 95% CI 1.56-7.80, P = .002), and nonspecific repolarization (OR 2.31, 95% CI 1.27-4.21, P = .006) increased the odds of death. ST elevation was rare (n = 5 [0.7%]). CONCLUSIONS: We found that patients with ECG findings of both left-sided heart disease (atrial premature contractions, intraventricular block, repolarization abnormalities) and right-sided disease (right bundle branch block) have higher odds of death. ST elevation at presentation was rare.


Assuntos
Betacoronavirus , Bloqueio de Ramo/mortalidade , Infecções por Coronavirus/mortalidade , Eletrocardiografia/mortalidade , Insuficiência Cardíaca/mortalidade , Pneumonia Viral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Eletrocardiografia/métodos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Estudos Retrospectivos
17.
Circ Arrhythm Electrophysiol ; 13(7): e008210, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32538136

RESUMO

BACKGROUND: Cardiac resynchronization therapy (CRT) improves heart failure outcomes but has significant nonresponse rates, highlighting limitations in ECG selection criteria: QRS duration (QRSd) ≥150 ms and subjective labeling of left bundle branch block (LBBB). We explored unsupervised machine learning of ECG waveforms to identify CRT subgroups that may differentiate outcomes beyond QRSd and LBBB. METHODS: We retrospectively analyzed 946 CRT patients with conduction delay. Principal component analysis (PCA) dimensionality reduction obtained a 2-dimensional representation of preCRT 12-lead QRS waveforms. k-means clustering of the 2-dimensional PCA representation of 12-lead QRS waveforms identified 2 patient subgroups (QRS PCA groups). Vectorcardiographic QRS area was also calculated. We examined following 2 primary outcomes: (1) composite end point of death, left ventricular assist device, or heart transplant, and (2) degree of echocardiographic left ventricular ejection fraction (LVEF) change after CRT. RESULTS: Compared with QRS PCA Group 2 (n=425), Group 1 (n=521) had lower risk for reaching the composite end point (HR, 0.44 [95% CI, 0.38-0.53]; P<0.001) and experienced greater mean LVEF improvement (11.1±11.7% versus 4.8±9.7%; P<0.001), even among patients with LBBB with QRSd ≥150 ms (HR, 0.42 [95% CI, 0.30-0.57]; P<0.001; mean LVEF change 12.5±11.8% versus 7.3±8.1%; P=0.001). QRS area also stratified outcomes but had significant differences from QRS PCA groups. A stratification scheme combining QRS area and QRS PCA group identified patients with LBBB with similar outcomes to non-LBBB patients (HR, 1.32 [95% CI, 0.93-1.62]; difference in mean LVEF change: 0.8% [95% CI, -2.1% to 3.7%]). The stratification scheme also identified patients with LBBB with QRSd <150 ms with comparable outcomes to patients with LBBB with QRSd ≥150 ms (HR, 0.93 [95% CI, 0.67-1.29]; difference in mean LVEF change: -0.2% [95% CI, -2.7% to 3.0%]). CONCLUSIONS: Unsupervised machine learning of ECG waveforms identified CRT subgroups with relevance beyond LBBB and QRSd. This method may assist in objective classification of bundle branch block morphology in CRT.


Assuntos
Terapia de Ressincronização Cardíaca , Diagnóstico por Computador , Eletrocardiografia , Insuficiência Cardíaca/terapia , Processamento de Sinais Assistido por Computador , Aprendizado de Máquina não Supervisionado , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/fisiopatologia , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Progressão da Doença , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração , Coração Auxiliar , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
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