Jannet Lewis - Academia.edu (original) (raw)

Papers by Jannet Lewis

Research paper thumbnail of Association of Abnormal Electrocardiography Response on Stress Echocardiogram with Major Adverse Cardiovascular Events in Women: A Report from the Women’s Ischemia Syndrome Evaluation (Wise) Study

Journal of the American College of Cardiology

Research paper thumbnail of Big Ball of Stress: Minoca and Cardiomyopathy in a Young Woman

Journal of the American College of Cardiology

Research paper thumbnail of Relationship of Breast Artery Calcification to Coronary Artery Stenosis: Is Mammography the New Screening Test for Coronary Artery Stenosis in Women?

Journal of the American College of Cardiology

Research paper thumbnail of Breast arterial calcification association with coronary artery calcium scoring and implications for cardiovascular risk assessment in women

Clinical cardiology, Jan 26, 2017

Breast arterial calcification (BAC) is a type of medial artery calcification that can be seen inc... more Breast arterial calcification (BAC) is a type of medial artery calcification that can be seen incidentally on mammography. Studies have suggested association of BAC with cardiovascular risk factors, coronary artery disease (CAD), and cardiovascular morbidity and mortality. Recently published studies have also suggested a modest correlation of BAC with coronary artery calcium (CAC) scoring. Roughly 40 million mammograms are already performed annually in the United States with overlap in patients that undergo CAD screening via CAC scoring. Thus, identification of cardiovascular risk by demonstrating an association between BAC and CAC may enable an instrumental sex-specific methodology to identify asymptomatic women at risk for CAD. The purpose of this article is to review the current state of the literature for BAC and its association with CAC, to review contemporary breast cancer screening guidelines, and to discuss the clinical implications of these findings.

Research paper thumbnail of Hypertrophic cardiomyopathy characterized by marked hypertrophy of the posterior left ventricular free wall: Significance and clinical implications☆

Journal of the American College of Cardiology, Aug 31, 1991

This report describes a subgroup of 17 patients with hypertrophic cardiomyopathy and an unusual a... more This report describes a subgroup of 17 patients with hypertrophic cardiomyopathy and an unusual and distinctive pattern of left ventricular hypertrophy characterized on echocardiography by marked thickening of the posterior left ventricular free wall and virtually normal or only modestly increased ventricular septal thickness. This distribution of hypertrophy often created a distinctive pattern of "inverted" asymmetry of the posterior wall relative to the septum. The thickness of the posterior wall was 20 to 42 mm (mean 25), while that of the basal ventricular septum was only 12 to 24 mm (mean 17). The left ventricular outflow tract was narrowed because of anterior displacement of the mitral valve within the small left ventricular cavity. Systolic anterior motion of the mitral valve was present in 16 of the 17 patients. The patients ranged in age from 13 to 54 years (mean 31) at most recent evaluation; most (11 of 17, 65%) were severely symptomatic and had experienced important symptoms early in life (before age 40). The condition of only 4 of these 11 patients improved with medical therapy over an average follow-up period of 9 years; however, 6 of the 7 patients who had unsuccessful medical treatment and underwent operation with mitral valve replacement (5 patients) or ventricular septal myotomy-myectomy (1 patient) experienced symptomatic benefit from surgery. The subgroup of patients described in this report underscores the morphologic and clinical diversity that exists within the overall disease spectrum of hypertrophic cardiomyopathy. Characteristically, the patients were young, severely symptomatic and demonstrated evidence of outflow obstruction and an "inverted" asymmetric pattern of posterior free wall left ventricular hypertrophy. (ABSTRACT TRUNCATED AT 250 WORDS)

Research paper thumbnail of Relationship between systemic and coronary endothelial function in women with chest pain: pilot phase data from the NHLBI women's ischemia syndrome evaluation (WISE)

J Amer Coll Cardiol, 1998

Research paper thumbnail of Dobutamine Pharmacodynamics During Dobutamine Stress Echocardiography and the Impact of b-Blocker Withdrawal: A Report from the Women's Ischemic Syndrome Evaluation Study

Pharmacotherapy, 2002

To determine the pharmacodynamic parameters of dobutamine during dobutamine stress echocardiograp... more To determine the pharmacodynamic parameters of dobutamine during dobutamine stress echocardiography (DSE) and to determine how beta-blocker withdrawal the evening before DSE affects responses to dobutamine during DSE. Retrospective analysis. University medical center. One hundred thirty-six women who had chest pain or other symptoms suggestive of myocardial ischemia and were considered to have a clinical indication for coronary angiography Patients underwent DSE with dobutamine dosages titrated from 5 to 40 microg/kg/minute. The infusion was terminated if the patient reached target heart rate or symptoms developed. Those taking beta-blockers withheld their doses the evening before DSE. Traditional pharmacodynamic modeling revealed a wide range in responses to dobutamine. Data for 62% of patients not taking beta-blockers were described by the Emax (maximum heart rate response to dobutamine) model, whereas data for only 39% of patients taking beta-blockers were best described by this model (p = 0.01). Patients taking beta-blockers also had a smaller mean increment in left ventricular ejection fraction (10.8% +/- 4.2% vs 14.1% +/- 9.3%, p < 0.01), a trend toward a higher ED50 (dobutamine dosage rate causing half the maximum heart-rate response; median 16.8 microg/kg/min, p = 0.12) and a lower sigmoidicity factor determining the shape of the curve (median 2.1, p = 0.03). The response to dobutamine exhibits wide interpatient variability, even in the absence of beta-blockade. Nonetheless, in the absence of beta-blockers, in most patients the dobutamine response reaches a plateau by the time the maximum infusion rate (40 microg/kg/min) is reached. Withdrawal of beta-blockers the evening before DSE may be inadequate time for elimination of beta-blocker effect, requiring the addition of atropine to achieve the desired response during DSE.

Research paper thumbnail of ACC/AHA clinical competence statement on echocardiography 1 2 3 2 Reprinted from J Am Coll Cardiol 2

Research paper thumbnail of β-Adrenergic receptor gene polymorphisms and hemodynamic response to dobutamine during dobutamine stress echocardiography

Pharmacogenomics J, 2008

Our objective was to determine if β1-adrenergic receptor (β1-AR) and β2-AR gene polymorphisms inf... more Our objective was to determine if β1-adrenergic receptor (β1-AR) and β2-AR gene polymorphisms influence heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) response to dobutamine during dobutamine stress echocardiography (DSE). Patients (n=163) undergoing clinically indicated DSE were enrolled. Dobutamine doses were titrated from 5 to 40 μg kg−1 min−1 at 3 min intervals and HR, SBP

Research paper thumbnail of Mitral Valve Prolapse: Gender Differences in Evaluation and Management

Cardiology in Review, 1999

Mitral valve prolapse is a common clinical disorder that affects approximately 3-4% of the adult ... more Mitral valve prolapse is a common clinical disorder that affects approximately 3-4% of the adult population. Prolapse occurs more commonly in women and has been associated with a variety of cardiac complications including mitral regurgitation, endocarditis, arrhythmias, and sudden death, as well as noncardiac manifestations including stroke. Much of our earlier understanding has been influenced by significant referral biases and lack of controlled studies. Our understanding of mitral prolapse has evolved considerably since the initial descriptions nearly 3 decades ago. This review on the current knowledge regarding diagnosis and management of primary mitral valve prolapse focuses on gender-related issues that influence clinical presentation, prognosis, and therapeutic strategies.

Research paper thumbnail of Abstract 15162: Assessment of Appropriate Use Criteria for Stress Echocardiography in the Emergency Room Evaluation of Chest Pain

Circulation, Nov 20, 2012

Research paper thumbnail of hypertrophic cardiomyopathy Relationship of race to sudden cardiac death in competitive athletes with

The goal of this study was to determine the impact of race on identification of hypertrophic card... more The goal of this study was to determine the impact of race on identification of hypertrophic cardiomyopathy (HCM). BACKGROUND Sudden death in young competitive athletes is due to a variety of cardiovascular diseases (CVDs) and, most commonly, HCM. These catastrophes have become an important issue for African Americans, although HCM has been previously regarded as rare in this segment of the U.S. population.

Research paper thumbnail of Clinical relevance of chest pain during dobutamine stress echocardiography in women

Clinical Cardiology, Nov 11, 1999

Background: Dobutamine stress echocardiography (DSE) is commonly used for diagnosis and managemen... more Background: Dobutamine stress echocardiography (DSE) is commonly used for diagnosis and management of patients with known or suspected coronary artery disease. Chest pain occurring during DSE potentially provides additional diagnostic accuracy. Our experience suggests that chest pain occurs frequently in women undergoing DSE.

Research paper thumbnail of Abstract 1854: Ventricular Dyssynchrony in Left Ventricular Hypertrophy with Normal Systolic Function

Circulation, Oct 31, 2006

Research paper thumbnail of Pulmonary hypertension in sickle cell disease

American Journal of Cardiology, 1994

Research paper thumbnail of Assessment of women with suspected myocardial ischemia: review of findings of the Women's Ischemia Syndrome Evaluation (WISE) Study

Current women's health reports, 2002

Coronary artery disease (CAD) is the most common cause of death in women. In general, noninvasive... more Coronary artery disease (CAD) is the most common cause of death in women. In general, noninvasive testing in women is less reliable compared with testing in men, and most major clinical trials in CAD have included only a minority of female subjects. The Women's Ischemia Syndrome Evaluation (WISE) Study--sponsored by the National Heart, Lung, and Blood Institute--was initiated to improve diagnostic testing in women. The study consisted of four centers that tested existing methodologies as well as innovative techniques to improve diagnostic testing in women. The WISE study also aimed to clarify physiologic determinants of myocardial ischemia and determine whether angiographically normal coronary arteries are associated with myocardial ischemia. The following discussion provides an overview of the WISE study and reviews the reported and published data from the study.

Research paper thumbnail of American College of Cardiology/American Heart Association clinical competence statement on echocardiography: a report of the American College of Cardiology/American Heart Association/American College of Physicians--American Society of Internal Medicine Task Force on Clinical Competence

Circulation, Jan 25, 2003

Research paper thumbnail of Diagnostic, prognostic, and cost assessment of coronary artery disease in women

The American journal of managed care, 2001

Women with obstructive coronary disease appear to be more challenging diagnostically and suffer a... more Women with obstructive coronary disease appear to be more challenging diagnostically and suffer a more adverse prognosis than men. More than one half of women with symptoms of ischemic heart disease have no obstructive coronary artery disease at coronary angiography, yet these women frequently have persistent symptom-related disability and consume large amounts of healthcare resources. Prior evidence has been limited regarding effective diagnostic strategies for the assessment of symptomatic women. The current report synthesizes existing evidence on diagnostic testing in women, including research from the ongoing National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. In addition to recent published evidence (drawn from much larger cohorts of women) that stress echocardiography and nuclear imaging are similar in their ability to risk-stratify women, the WISE study is exploring new pathophysiological mechanisms of microvascular dysfu...

Research paper thumbnail of Estimation of cardiac output and pulmonary vascular resistance by contrast echocardiography transit time measurement: a prospective pilot study

Cardiovascular ultrasound, Jan 31, 2014

Studies with other imaging modalities have demonstrated a relationship between contrast transit a... more Studies with other imaging modalities have demonstrated a relationship between contrast transit and cardiac output (CO) and pulmonary vascular resistance (PVR). We tested the hypothesis that the transit time during contrast echocardiography could accurately estimate both CO and PVR compared to right heart catheterization (RHC). 27 patients scheduled for RHC had 2D-echocardiogram immediately prior to RHC. 3 ml of DEFINITY contrast followed by a 10 ml saline flush was injected, and a multi-cycle echo clip was acquired from the beginning of injection to opacification of the left ventricle. 2D-echo based calculations of CO and PVR along with the DEFINITY-based transit time calculations were subsequently correlated with the RHC-determined CO and PVR. The transit time from full opacification of the right ventricle to full opacification of the left ventricle inversely correlated with CO (r=-0.61, p<0.001). The transit time from peak opacification of the right ventricle to first appearan...

Research paper thumbnail of Transesophageal echocardiography

Journal of The American College of Cardiology, 1992

Research paper thumbnail of Association of Abnormal Electrocardiography Response on Stress Echocardiogram with Major Adverse Cardiovascular Events in Women: A Report from the Women’s Ischemia Syndrome Evaluation (Wise) Study

Journal of the American College of Cardiology

Research paper thumbnail of Big Ball of Stress: Minoca and Cardiomyopathy in a Young Woman

Journal of the American College of Cardiology

Research paper thumbnail of Relationship of Breast Artery Calcification to Coronary Artery Stenosis: Is Mammography the New Screening Test for Coronary Artery Stenosis in Women?

Journal of the American College of Cardiology

Research paper thumbnail of Breast arterial calcification association with coronary artery calcium scoring and implications for cardiovascular risk assessment in women

Clinical cardiology, Jan 26, 2017

Breast arterial calcification (BAC) is a type of medial artery calcification that can be seen inc... more Breast arterial calcification (BAC) is a type of medial artery calcification that can be seen incidentally on mammography. Studies have suggested association of BAC with cardiovascular risk factors, coronary artery disease (CAD), and cardiovascular morbidity and mortality. Recently published studies have also suggested a modest correlation of BAC with coronary artery calcium (CAC) scoring. Roughly 40 million mammograms are already performed annually in the United States with overlap in patients that undergo CAD screening via CAC scoring. Thus, identification of cardiovascular risk by demonstrating an association between BAC and CAC may enable an instrumental sex-specific methodology to identify asymptomatic women at risk for CAD. The purpose of this article is to review the current state of the literature for BAC and its association with CAC, to review contemporary breast cancer screening guidelines, and to discuss the clinical implications of these findings.

Research paper thumbnail of Hypertrophic cardiomyopathy characterized by marked hypertrophy of the posterior left ventricular free wall: Significance and clinical implications☆

Journal of the American College of Cardiology, Aug 31, 1991

This report describes a subgroup of 17 patients with hypertrophic cardiomyopathy and an unusual a... more This report describes a subgroup of 17 patients with hypertrophic cardiomyopathy and an unusual and distinctive pattern of left ventricular hypertrophy characterized on echocardiography by marked thickening of the posterior left ventricular free wall and virtually normal or only modestly increased ventricular septal thickness. This distribution of hypertrophy often created a distinctive pattern of &quot;inverted&quot; asymmetry of the posterior wall relative to the septum. The thickness of the posterior wall was 20 to 42 mm (mean 25), while that of the basal ventricular septum was only 12 to 24 mm (mean 17). The left ventricular outflow tract was narrowed because of anterior displacement of the mitral valve within the small left ventricular cavity. Systolic anterior motion of the mitral valve was present in 16 of the 17 patients. The patients ranged in age from 13 to 54 years (mean 31) at most recent evaluation; most (11 of 17, 65%) were severely symptomatic and had experienced important symptoms early in life (before age 40). The condition of only 4 of these 11 patients improved with medical therapy over an average follow-up period of 9 years; however, 6 of the 7 patients who had unsuccessful medical treatment and underwent operation with mitral valve replacement (5 patients) or ventricular septal myotomy-myectomy (1 patient) experienced symptomatic benefit from surgery. The subgroup of patients described in this report underscores the morphologic and clinical diversity that exists within the overall disease spectrum of hypertrophic cardiomyopathy. Characteristically, the patients were young, severely symptomatic and demonstrated evidence of outflow obstruction and an &quot;inverted&quot; asymmetric pattern of posterior free wall left ventricular hypertrophy. (ABSTRACT TRUNCATED AT 250 WORDS)

Research paper thumbnail of Relationship between systemic and coronary endothelial function in women with chest pain: pilot phase data from the NHLBI women's ischemia syndrome evaluation (WISE)

J Amer Coll Cardiol, 1998

Research paper thumbnail of Dobutamine Pharmacodynamics During Dobutamine Stress Echocardiography and the Impact of b-Blocker Withdrawal: A Report from the Women's Ischemic Syndrome Evaluation Study

Pharmacotherapy, 2002

To determine the pharmacodynamic parameters of dobutamine during dobutamine stress echocardiograp... more To determine the pharmacodynamic parameters of dobutamine during dobutamine stress echocardiography (DSE) and to determine how beta-blocker withdrawal the evening before DSE affects responses to dobutamine during DSE. Retrospective analysis. University medical center. One hundred thirty-six women who had chest pain or other symptoms suggestive of myocardial ischemia and were considered to have a clinical indication for coronary angiography Patients underwent DSE with dobutamine dosages titrated from 5 to 40 microg/kg/minute. The infusion was terminated if the patient reached target heart rate or symptoms developed. Those taking beta-blockers withheld their doses the evening before DSE. Traditional pharmacodynamic modeling revealed a wide range in responses to dobutamine. Data for 62% of patients not taking beta-blockers were described by the Emax (maximum heart rate response to dobutamine) model, whereas data for only 39% of patients taking beta-blockers were best described by this model (p = 0.01). Patients taking beta-blockers also had a smaller mean increment in left ventricular ejection fraction (10.8% +/- 4.2% vs 14.1% +/- 9.3%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), a trend toward a higher ED50 (dobutamine dosage rate causing half the maximum heart-rate response; median 16.8 microg/kg/min, p = 0.12) and a lower sigmoidicity factor determining the shape of the curve (median 2.1, p = 0.03). The response to dobutamine exhibits wide interpatient variability, even in the absence of beta-blockade. Nonetheless, in the absence of beta-blockers, in most patients the dobutamine response reaches a plateau by the time the maximum infusion rate (40 microg/kg/min) is reached. Withdrawal of beta-blockers the evening before DSE may be inadequate time for elimination of beta-blocker effect, requiring the addition of atropine to achieve the desired response during DSE.

Research paper thumbnail of ACC/AHA clinical competence statement on echocardiography 1 2 3 2 Reprinted from J Am Coll Cardiol 2

Research paper thumbnail of β-Adrenergic receptor gene polymorphisms and hemodynamic response to dobutamine during dobutamine stress echocardiography

Pharmacogenomics J, 2008

Our objective was to determine if β1-adrenergic receptor (β1-AR) and β2-AR gene polymorphisms inf... more Our objective was to determine if β1-adrenergic receptor (β1-AR) and β2-AR gene polymorphisms influence heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) response to dobutamine during dobutamine stress echocardiography (DSE). Patients (n=163) undergoing clinically indicated DSE were enrolled. Dobutamine doses were titrated from 5 to 40 μg kg−1 min−1 at 3 min intervals and HR, SBP

Research paper thumbnail of Mitral Valve Prolapse: Gender Differences in Evaluation and Management

Cardiology in Review, 1999

Mitral valve prolapse is a common clinical disorder that affects approximately 3-4% of the adult ... more Mitral valve prolapse is a common clinical disorder that affects approximately 3-4% of the adult population. Prolapse occurs more commonly in women and has been associated with a variety of cardiac complications including mitral regurgitation, endocarditis, arrhythmias, and sudden death, as well as noncardiac manifestations including stroke. Much of our earlier understanding has been influenced by significant referral biases and lack of controlled studies. Our understanding of mitral prolapse has evolved considerably since the initial descriptions nearly 3 decades ago. This review on the current knowledge regarding diagnosis and management of primary mitral valve prolapse focuses on gender-related issues that influence clinical presentation, prognosis, and therapeutic strategies.

Research paper thumbnail of Abstract 15162: Assessment of Appropriate Use Criteria for Stress Echocardiography in the Emergency Room Evaluation of Chest Pain

Circulation, Nov 20, 2012

Research paper thumbnail of hypertrophic cardiomyopathy Relationship of race to sudden cardiac death in competitive athletes with

The goal of this study was to determine the impact of race on identification of hypertrophic card... more The goal of this study was to determine the impact of race on identification of hypertrophic cardiomyopathy (HCM). BACKGROUND Sudden death in young competitive athletes is due to a variety of cardiovascular diseases (CVDs) and, most commonly, HCM. These catastrophes have become an important issue for African Americans, although HCM has been previously regarded as rare in this segment of the U.S. population.

Research paper thumbnail of Clinical relevance of chest pain during dobutamine stress echocardiography in women

Clinical Cardiology, Nov 11, 1999

Background: Dobutamine stress echocardiography (DSE) is commonly used for diagnosis and managemen... more Background: Dobutamine stress echocardiography (DSE) is commonly used for diagnosis and management of patients with known or suspected coronary artery disease. Chest pain occurring during DSE potentially provides additional diagnostic accuracy. Our experience suggests that chest pain occurs frequently in women undergoing DSE.

Research paper thumbnail of Abstract 1854: Ventricular Dyssynchrony in Left Ventricular Hypertrophy with Normal Systolic Function

Circulation, Oct 31, 2006

Research paper thumbnail of Pulmonary hypertension in sickle cell disease

American Journal of Cardiology, 1994

Research paper thumbnail of Assessment of women with suspected myocardial ischemia: review of findings of the Women's Ischemia Syndrome Evaluation (WISE) Study

Current women's health reports, 2002

Coronary artery disease (CAD) is the most common cause of death in women. In general, noninvasive... more Coronary artery disease (CAD) is the most common cause of death in women. In general, noninvasive testing in women is less reliable compared with testing in men, and most major clinical trials in CAD have included only a minority of female subjects. The Women's Ischemia Syndrome Evaluation (WISE) Study--sponsored by the National Heart, Lung, and Blood Institute--was initiated to improve diagnostic testing in women. The study consisted of four centers that tested existing methodologies as well as innovative techniques to improve diagnostic testing in women. The WISE study also aimed to clarify physiologic determinants of myocardial ischemia and determine whether angiographically normal coronary arteries are associated with myocardial ischemia. The following discussion provides an overview of the WISE study and reviews the reported and published data from the study.

Research paper thumbnail of American College of Cardiology/American Heart Association clinical competence statement on echocardiography: a report of the American College of Cardiology/American Heart Association/American College of Physicians--American Society of Internal Medicine Task Force on Clinical Competence

Circulation, Jan 25, 2003

Research paper thumbnail of Diagnostic, prognostic, and cost assessment of coronary artery disease in women

The American journal of managed care, 2001

Women with obstructive coronary disease appear to be more challenging diagnostically and suffer a... more Women with obstructive coronary disease appear to be more challenging diagnostically and suffer a more adverse prognosis than men. More than one half of women with symptoms of ischemic heart disease have no obstructive coronary artery disease at coronary angiography, yet these women frequently have persistent symptom-related disability and consume large amounts of healthcare resources. Prior evidence has been limited regarding effective diagnostic strategies for the assessment of symptomatic women. The current report synthesizes existing evidence on diagnostic testing in women, including research from the ongoing National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. In addition to recent published evidence (drawn from much larger cohorts of women) that stress echocardiography and nuclear imaging are similar in their ability to risk-stratify women, the WISE study is exploring new pathophysiological mechanisms of microvascular dysfu...

Research paper thumbnail of Estimation of cardiac output and pulmonary vascular resistance by contrast echocardiography transit time measurement: a prospective pilot study

Cardiovascular ultrasound, Jan 31, 2014

Studies with other imaging modalities have demonstrated a relationship between contrast transit a... more Studies with other imaging modalities have demonstrated a relationship between contrast transit and cardiac output (CO) and pulmonary vascular resistance (PVR). We tested the hypothesis that the transit time during contrast echocardiography could accurately estimate both CO and PVR compared to right heart catheterization (RHC). 27 patients scheduled for RHC had 2D-echocardiogram immediately prior to RHC. 3 ml of DEFINITY contrast followed by a 10 ml saline flush was injected, and a multi-cycle echo clip was acquired from the beginning of injection to opacification of the left ventricle. 2D-echo based calculations of CO and PVR along with the DEFINITY-based transit time calculations were subsequently correlated with the RHC-determined CO and PVR. The transit time from full opacification of the right ventricle to full opacification of the left ventricle inversely correlated with CO (r=-0.61, p<0.001). The transit time from peak opacification of the right ventricle to first appearan...

Research paper thumbnail of Transesophageal echocardiography

Journal of The American College of Cardiology, 1992