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Jashari, Haki
Publications (10 of 10) Show all publications
Bajraktari, G., Jashari, H., Ibrahimi, P., Alfonso, F., Jashari, F., Ndrepepa, G., . . . Henein, M. Y. (2018). Complete revascularization for patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: a meta-analysis of randomized trials. Coronary Artery Disease, 29(3), 204-215
Open this publication in new window or tab >>Complete revascularization for patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: a meta-analysis of randomized trials
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2018 (English)In: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 29, no 3, p. 204-215Article in journal (Refereed) Published
Abstract [en]

Introduction: Despite the recent findings in randomized clinical trials (RCTs) with limited sample sizes and the updates in clinical guidelines, the current available data for the complete revascularization (CR) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) at the time of primary percutaneous coronary intervention (PCI) are still contradictory.

Aim: The aim of this meta-analysis of the existing RCTs was to assess the efficacy of the CR versus revascularization of infarct-related artery (IRA) only during primary PCI in patients with STEMI and multivessel disease (MVD).

Patients and methods: We searched PubMed, MEDLINE, Embase, Scopus, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases aiming to find RCTs for patients with STEMI and MVD which compared CR with IRA-only. Random effect risk ratios (RRs) were calculated for efficacy and safety outcomes.

Results: Ten RCTs with 3291 patients were included. The median follow-up duration was 17.5 months. Major adverse cardiac events (RR=0.57; 0.43-0.76; P<0.0001), cardiac mortality (RR=0.52; 0.31-0.87; P=0.014), and repeat revascularization (RR=0.50; 0.30-0.84; P=0.009) were lower in CR compared with IRA-only strategies. However, there was no significant difference in the risk of all-cause mortality, recurrent nonfatal myocardial infarction, stroke, major bleeding events, and contrast-induced nephropathy.

Conclusion: For patients with STEMI and MVD undergoing primary PCI, the current evidence suggests that the risk of major adverse cardiac events, repeat revascularization, and cardiac death is reduced by CR. However, the risk for all-cause mortality and PCI-related complications is not different from the isolated culprit lesion-only treatment. Although these findings support the cardiac mortality and safety benefit of CR in stable STEMI, further large trials are required to provide better guidance for optimum management of such patients.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
Keywords
complete revascularization, coronary artery disease, infarct-related artery-only revascularization, multivessel disease, ST-segment elevation myocardial infarction
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-150707 (URN)10.1097/MCA.0000000000000602 (DOI)000430474900006 ()29346126 (PubMedID)2-s2.0-85045855798 (Scopus ID)
Available from: 2018-08-21 Created: 2018-08-21 Last updated: 2019-09-16Bibliographically approved
diva2:1049451
Open this publication in new window or tab >>Coarctation repair normalizes left ventricular function and aorto-septal angle in neonates
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2017 (English)In: Congenital Heart Disease, ISSN 1747-079X, E-ISSN 1747-0803, Vol. 12, no 2, p. 218-225Article in journal (Refereed) Published
Abstract [en]

Background and aims: Patients with coarctation of the aorta (CoA) have increased left ventricular (LV) afterload that has been shown to impact the LV and ascending aortic function. We aimed to examine the effect of coarctation on LV function and aorto-septal angle (AoSA) before and after surgical repair.

Methods: We retrospectively studied 21 patients with surgically repaired CoA at a median age of 9 (2-53) days at three time points: (1) just before intervention, (2) at short-term follow-up, and (3) at medium-term follow-up after intervention. AoSA was measured from the parasternal long axisview, at three time points during the cardiac cycle: (1) end diastole, (2) beginning of systole, and (3) at peak ejection in the descending aorta. In addition to conventional LV structure and function, global longitudinal strain, and strain rate were measured using STE technique and Tomtec soft-ware. Three groups of age matched healthy children served as controls at each time point.

Results: AoSA was significantly wider before intervention, in particular at peak ejection in the descending aorta (1448 6 6.48 vs. 1368 6 4.18; P < .0001), and correlated with CoA pressure gradi-ent. After intervention, AoSA normalized and significantly correlated with the increase of LV cavity function and overall LV deformation parameters.

Conclusions: AoSA is abnormally wide in neonates with CoA and is associated with severity ofobstruction, LV dysfunction and compromised LV global deformation.

Keywords
aorto-septal angle, coarctation of the aorta, left ventricular function, neonate
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-128146 (URN)10.1111/chd.12430 (DOI)000398705700014 ()27874244 (PubMedID)
Available from: 2016-11-24 Created: 2016-11-24 Last updated: 2018-06-09Bibliographically approved
Bajraktari, G., Jashari, H., Ibrahimi, P., Jashari, F., Elezi, S., Ndrepepa, G. & Henein, M. Y. (2016). Comparison of drug-eluting balloon versus drug-eluting stent treatment of DES in-stent restenosis: a meta-analysis of randomized and observational studies. Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 27-31, 2016, Rome, ITALY. European Heart Journal, 37, 670-670
Open this publication in new window or tab >>Comparison of drug-eluting balloon versus drug-eluting stent treatment of DES in-stent restenosis: a meta-analysis of randomized and observational studies
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2016 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, p. 670-670Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2016
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-129757 (URN)000383869503228 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 27-31, 2016, Rome, ITALY
Note

Supplement: 1

Meeting Abstract: P3430

Available from: 2017-01-10 Created: 2017-01-09 Last updated: 2018-06-09Bibliographically approved
Bajraktari, G., Jashari, H., Ibrahimi, P., Alfonso, F., Jashari, F., Ndrepepa, G., . . . Henein, M. Y. (2016). Comparison of drug-eluting balloon versus drug-eluting stent treatment of drug-eluting stent in-stent restenosis: A meta-analysis of available evidence. International Journal of Cardiology, 218, 126-135
Open this publication in new window or tab >>Comparison of drug-eluting balloon versus drug-eluting stent treatment of drug-eluting stent in-stent restenosis: A meta-analysis of available evidence
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2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 218, p. 126-135Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In-stent restenosis (ISR) remains an important concern despite the recent advances in the drug-eluting stent (DES) technology. The introduction of drug-eluting balloons (DEB) offers a good solution to such problem.

OBJECTIVES: We performed a meta-analysis to assess the clinical efficiency and safety of DEB compared with DES in patients with DES-ISR.

METHODS: A systematic search was conducted and all randomized and observational studies which compared DEB with DES in patients with DES-ISR were included. The primary outcome measure-major adverse cardiovascular events (MACE)-as well as individual events as target lesion revascularization (TLR), stent thrombosis (ST), myocardial infarction (MI), cardiac death (CD) and all-cause mortality, were analyzed.

RESULTS: Three randomized and 4 observational studies were included with a total of 2052 patients. MACE (relative risk [RR]=1.00, 95% confidence interval (CI) 0.68 to 1.46, P=0.99), TLR (RR=1.15 [CI 0.79 to 1.68], P=0.44), ST (RR=0.37[0.10 to 1.34], P=0.13), MI (RR=0.97 [0.49 to 1.91], P=0.93) and CD (RR=0.73 [0.22 to 2.45], P=0.61) were not different between patients treated with DEB and with DES. However, all-cause mortality was lower in patients treated with DEB (RR=0.45 [0.23 to 0.87, P=0.019) and in particular when compared to only first generation DES (RR 0.33 [0.15-0.74], P=0.007). There was no statistical evidence for publication bias.

CONCLUSIONS: The results of this meta-analysis showed that DEB and DES have similar efficacy and safety for the treatment of DES-ISR.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-126955 (URN)10.1016/j.ijcard.2016.05.040 (DOI)000377856300022 ()27232924 (PubMedID)
Available from: 2016-10-24 Created: 2016-10-24 Last updated: 2018-06-09Bibliographically approved
Jashari, H., Lannering, K., Ibrahimi, P., Djekic, D., Mellander, M., Rydberg, A. & Henein, M. Y. (2016). Persistent reduced myocardial deformation in neonates after CoA repair. International Journal of Cardiology, 221(15), 886-891
Open this publication in new window or tab >>Persistent reduced myocardial deformation in neonates after CoA repair
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2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 221, no 15, p. 886-891Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Surgical repair of coarctation of the aorta (CoA) is a safe procedure in children, however the condition is known for its potential recurrence and other related complications. The available evidence shows abnormal intrinsic properties of the aorta in CoA, thus suggesting additional effect, even after CoA repair, on left ventricular (LV) function. Accordingly, we sought to obtain a better understanding of LV myocardial mechanics in very early-corrected CoA using two-dimensional STE.

METHODS AND RESULTS: We retrospectively studied 21 patients with corrected CoA at a median age of 9 (2-53) days at three time points: 1) just before intervention, 2) at short-term follow-up and 3) at medium-term follow-up after intervention and compared them with normal values. Speckle tracking analysis was conducted via vendor independent software, Tomtec. After intervention, LV function significantly improved (from -12.8±3.9 to -16.7±1.7; p<0.001), however normal values were not reached even at medium term follow-up (-18.3±1.7 vs. -20±1.6; p=0.002). Medium term longitudinal strain correlated with pre intervention EF (r=0.58, p=0.006). Moreover, medium term subnormal values were more frequently associated with bicuspid aortic valve (33.3% vs. 66.6%; p<0.05).

CONCLUSION: LV myocardial function in neonates with CoA can be feasibly evaluated and followed up by speckle tracking echocardiography. LV subendocardial dysfunction however, remains in early infancy coarctation long after repair. Long-term follow-up through adulthood using myocardial deformation measurements should shed light on the natural history and consequences of this anomaly.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Coarctation of the aorta, Speckle tracking echocardiography, Longitudinal strain, Neonates, Children
National Category
Pediatrics Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-126952 (URN)10.1016/j.ijcard.2016.07.114 (DOI)000384692600169 ()27434366 (PubMedID)
Available from: 2016-10-24 Created: 2016-10-24 Last updated: 2018-06-09Bibliographically approved
Jashari, H. (2016). The effect of pressure afterload due to aortic coarctation on left ventricular function in children. (Doctoral dissertation). Umeå: Umeå Universitet
Open this publication in new window or tab >>The effect of pressure afterload due to aortic coarctation on left ventricular function in children
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background:

Coarctation of the aorta (CoA) is a congenital heart disease which represents a narrowing of the proximal descending aorta, hence increasing pressure afterload to the left ventricle (LV). Conventional treatment of native CoA is surgical repair, however potential recurrence or other related complications e.g. aortic rupture, heart failure and cerebrovascular events are common. Thus, lifelong follow-up of these patients is required. Echocardiography is the most patient’s friendly method to evaluate CoA and in particular its effect on LV function. Moreover, the novel speckle tracking echocardiography (STE) is an important method to assess subclinical LV dysfunction, a technique that promises better evaluation of LV function in these patients.

The aims of this thesis were to review the literature on LV function in children with CoA using myocardial deformation imaging technologies, hence, to better understand the current knowledge and vagueness of the scientific evidence. We also aimed to study the effect of early CoA repair on the structure and function of LV and ascending aorta. In addition, we wished to establish in a meta-analysis format normal values of speckle tracking derived strain and strain rate values.

Methods:

Study 1. We have systematically searched the PubMed, and studies that fulfilled the inclusion criteria were critically analyzed and presented on a narrative form.

Study 2 and 3. In addition to conventional echocardiographic measures of LV and ascending aorta, we measured longitudinal strain and strain rate of the LV using a vendor independent software, TomTec. We have also measured the aorto-septal angle (AoSA). Data was compared with normal healthy controls.

Study 4. Electronic databases were systematically searched and suitable studies were meta analyzed using Comprehensive meta-analysis version 3 software.

Results:

Study 1. In 7/4945 included articles, 123 and 76 patients with congenital aortic stenosis (CAS) and CoA were reported, respectively. Normal conventional LV function, with subclinical myocardial dysfunction were reported in all studies before intervention. After intervention, a consistent improvement of myocardial deformation parameters was documented, even though not reaching normal values.

Study 2. In 21 patients with CoA, LV function significantly improved after intervention (p <0.001), however normal values were not reached even at medium-term follow-up (p = 0.002). Medium-term longitudinal strain correlated with pre intervention LV ejection faction (EF) (r = 0.58, p = 0.006). Medium-term subnormal values were more frequently associated with Bicuspid aortic valve (BAV) (33.3% vs. 66.6%; p <0.05).

Study 3. AoSA was abnormally wide before intervention, in particular at peak ejection in the descending aorta (p <0.0001), and correlated with CoA pressure gradient. After intervention, AoSA normalized and significantly correlated with the increase of LV cavity function and overall LV deformation parameters.

Study 4. In a meta-analysis of 28/282 studies including 1192 subjects, strain and strain rate values were established. Longitudinal strain normal mean values varied from -12.9 to -26.5 (mean, -20.5; 95 % CI, -20.0 to -21.0). Normal mean values of circumferential strain varied from -10.5 to -27.0 (mean, -22.06; 95 % CI, -21.5 to -22.5). Radial strain normal mean values varied from 24.9 to 62.1 (mean, 45.4; 95 % CI, 43.0 to 47.8). Meta-regression showed LV end-diastolic diameter as a significant determinant of variation of longitudinal strain. Longitudinal systolic strain rate was significantly determined by age and radial strain was influenced by the type of vendor used.

Conclusion:

The systematic review showed subclinical LV dysfunction in children with CoA before and after correction. However, since most of the patients were operated at an older age and had preserved LV EF, the effect of early intervention on LV function was only speculated. Our children with CoA who were operated at an earlier age showed LV subclinical dysfunction even at medium- term after intervention while the AoSA returned to normal shortly after intervention. Lower longitudinal strain values were found in patients with LV dysfunction (LV EF <50%) before intervention and BAV. Finally, normal range values for strain and strain rate have been established and seem to be influenced by patients’ age, LV end-diastolic diameter and vendor used.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2016. p. 97
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1864
Keywords
Coarctation of the aorta, congenital aortic stenosis, left ventricle, myocardial deformation imaging, speckle tracking echocardiography, longitudinal strain, aorto-septal angle, children
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-128126 (URN)978-91-7601-615-2 (ISBN)
Public defence
2016-12-21, Hörsal D Unod T 9, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2016-11-30 Created: 2016-11-24 Last updated: 2018-06-09Bibliographically approved
Jashari, H., Rydberg, A., Ibrahimi, P., Bajraktari, G. & Henein, M. Y. (2015). Left ventricular response to pressure afterload in children: aortic stenosis and coarctation A systematic review of the current evidence. International Journal of Cardiology, 178, 203-209
Open this publication in new window or tab >>Left ventricular response to pressure afterload in children: aortic stenosis and coarctation A systematic review of the current evidence
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2015 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 178, p. 203-209Article, review/survey (Refereed) Published
Abstract [en]

Congenital aortic stenosis (CAS) and Coarctation of Aorta (CoA) represent two forms of pressure afterload that affect the left ventricle (LV), hence require regular echocardiographic monitoring. Subclinical dysfunction of the LV exists even in asymptomatic patients with preserved left ventricular ejection fraction (EF), implying low sensitivity of EF in predicting optimum time for intervention. In this article we review patterns of LV myocardial deformation before and after correction of CAS and CoA in infants, children and adolescents, showing their important role in monitoring the course of LV dysfunction. A systematic search using PubMed was performed and suitable studies are presented on a narrative form. Normal EF and/or fractional shortening (FS), with subclinical myocardial dysfunction are reported in all studies before intervention. The short-term results, after intervention, were related to the type of procedure, with no improvement or further deterioration related to surgery but immediate improvement after balloon intervention. Long term follow-up showed further improvement but still subnormal function. Thus correction of CAS and CoA before irreversible LV dysfunction is vital, and requires longitudinal studies in order to identify the most accurate parameter for function prognostication. Until then, conventional echocardiographic parameters together with myocardial velocities and deformation parameters should continue to provide follow-up reproducible measures of ventricular function.

Keywords
Congenital aortic stenosis, Coarctation of aorta, Left ventricle, Myocardial deformation imaging
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-98834 (URN)10.1016/j.ijcard.2014.10.089 (DOI)000345697300053 ()25464254 (PubMedID)
Available from: 2015-03-16 Created: 2015-01-27 Last updated: 2018-06-07Bibliographically approved
Jashari, H., Rydberg, A., Ibrahimi, P., Bajraktari, G., Kryeziu, L., Jashari, F. & Henein, M. Y. (2015). Normal ranges of left ventricular strain in children: a meta-analysis. Cardiovascular Ultrasound, 13, Article ID 37.
Open this publication in new window or tab >>Normal ranges of left ventricular strain in children: a meta-analysis
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2015 (English)In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 13, article id 37Article, review/survey (Refereed) Published
Abstract [en]

Aims: The definition of normal values of two-dimensional speckle-tracking echocardiography derived left ventricular (LV) deformation parameters, is of critical importance for the routine application of this modality in children. The objectives of this study were to perform a meta-analysis of normal ranges for longitudinal, circumferential and radial strain/strain rate values and to identify confounders that may contribute to differences in reported measures. Methods and Results: A systematic search was conducted. Studies describing normal healthy subjects and observational studies that used control groups as a comparison were included. Data were combined using a random-effect model. Effects of demographic, clinical and equipment variables were assessed through meta-regression. The search identified 1,192 subjects form 28 articles. Longitudinal strain (LS) normal mean values varied from -12.9 to -26.5 (mean, -20.5; 95 % CI, -20.0 to -21.0). Normal mean values of circumferential strain (CS) varied from -10.5 to -27.0 (mean, -22.06; 95 % CI, -21.5 to -22.5). Radial strain (RS) normal mean values varied from 24.9 to 62.1 (mean, 45.4; 95 % CI, 43.0 to 47.8). Meta-regression showed LV end diastolic diameter as a significant determinant of variation for LS. Longitudinal systolic strain rate (LSRs) was significantly determined by the age and RS by the type of vendor used. Conclusion: Variations among different normal ranges were dependent on the vendor used, LV end-diastolic diameter and age. Vendor-independent software for analyzing myocardial deformation in children, using images from different vendors would be the ideal solution for strain measurements or else using the same system for patient's follow up.

Keywords
Strain, Echocardiography, Children, Left ventricle
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-107851 (URN)10.1186/s12947-015-0029-0 (DOI)000359041400001 ()26250696 (PubMedID)
Available from: 2015-10-13 Created: 2015-08-28 Last updated: 2018-06-07Bibliographically approved
Watt, A., Lindqvist, P., Jashari, H., Holmgren, A. & Henein, M. (2015). Pre-operative right ventricular function predicts clinical outcome after prophylactic tricuspid ring implantation. European Heart Journal, 36, 1107-1108
Open this publication in new window or tab >>Pre-operative right ventricular function predicts clinical outcome after prophylactic tricuspid ring implantation
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2015 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, p. 1107-1108Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-110587 (URN)000361205107318 ()
Note

Supplement: 1 Meeting Abstract: P6302

Available from: 2015-11-03 Created: 2015-10-23 Last updated: 2018-06-07Bibliographically approved
diva2:848269
Open this publication in new window or tab >>Global dyssynchrony correlates with compromised left ventricular filling and stroke volume but not with ejection fraction or QRS duration in HFpEF
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2014 (English)In: International Cardiovascular Forum Journal, ISSN 2410-2636, Vol. 1, no 3, p. 147-151Article in journal (Refereed) Published
Abstract [en]

Background and Aim: Mechanical global left ventricular (LV) dyssynchrony reflected as prolonged total isovolumic time(t-IVT) has been introduced as a potential mechanism behind compromised stroke volume in heart failure (HF). It has alsobeen shown to be superior to other markers of dyssynchrony in predicting response to cardiac resynchronization therapy(CRT), but its application in HF with preserved ejection fraction (HFpEF) remains unknown. The aim of this study was toassess the role of t-IVT in explaining symptoms in HFpEF.Methods: In 55 symptomatic HFpEF patients (age 60±9 years, NYHA class II-IV; LV EF ≥45%) and 24 age and gendermatched controls, a complete Doppler echocardiographic study was performed including mitral annulus peak systolicexcursion (MAPSE) and myocardial velocities as well as LV filling, outflow tract velocity time integral (VTI) and stroke volumemeasurements. Global LV dyssynchrony was assessed by t-IVT [in s/min; calculated as: 60 - (total ejection time + total fillingtime)], Tei index (t-IVT/ejection time) and pre-ejection time difference between LV and RV.Results: Patients had reduced lateral and septal MAPSE (p=0.009 and p=0.01, respectively) lower lateral and septal s’(p=0.002 and p=0.04, respectively) and e’ (p<0.001, for both) velocities and higher E/e’ ratio (p=0.01) compared to controls.They also had longer t-IVT (p<0.001), higher Tei index (p=0.04), but similar pre-ejection time difference and LVEF to controls.T-IVT correlated with LV filling time (r=0.44, p<0.001), stroke volume (r=-0.41; p=0.002), MAPSE (lateral: r=-0.36, p=0.007 andseptal: r=-0.31; p=0.02), but not with LV mass index, LVEF, E/e’ ratio or QRS duration.Conclusion: Patients with HFpEF have exaggerated global mechanical dyssynchrony shown by prolonged t-IVT, comparedwith healthy age and gender matched controls. The relationship between t-IVT, LV filling and stroke volume suggests anassociation, more important than with ejection fraction or electrical dyssynchrony. These results support the importance ofthe individualistic approach for optimum HFpEF patient management.

Place, publisher, year, edition, pages
Barcaray International Publishing, 2014
Keywords
Heart failure, left ventricular dyssynchrony, total isovolumic time, longitudinal function, stroke volume
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-107580 (URN)10.17987/icfj.v1i3.40 (DOI)
Available from: 2015-08-24 Created: 2015-08-24 Last updated: 2018-06-07Bibliographically approved
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