Skip to main content
Top
Published in: Cardiovascular Ultrasound 1/2018

Open Access 01-12-2018 | Review

Cardiac fluid dynamics meets deformation imaging

Authors: Matteo Dal Ferro, Davide Stolfo, Valerio De Paris, Pierluigi Lesizza, Renata Korcova, Dario Collia, Giovanni Tonti, Gianfranco Sinagra, Gianni Pedrizzetti

Published in: Cardiovascular Ultrasound | Issue 1/2018

Login to get access

Abstract

Cardiac function is about creating and sustaining blood in motion. This is achieved through a proper sequence of myocardial deformation whose final goal is that of creating flow. Deformation imaging provided valuable contributions to understanding cardiac mechanics; more recently, several studies evidenced the existence of an intimate relationship between cardiac function and intra-ventricular fluid dynamics. This paper summarizes the recent advances in cardiac flow evaluations, highlighting its relationship with heart wall mechanics assessed through the newest techniques of deformation imaging and finally providing an opinion of the most promising clinical perspectives of this emerging field. It will be shown how fluid dynamics can integrate volumetric and deformation assessments to provide a further level of knowledge of cardiac mechanics.
Literature
1.
go back to reference Kilner PJ, Yang GZ, Wilkes AJ, Mohiaddin RH, Firmin DN, Yacoub MH. Asymmetric redirection of flow through the heart. Nature. 2000;404:759–61.CrossRefPubMed Kilner PJ, Yang GZ, Wilkes AJ, Mohiaddin RH, Firmin DN, Yacoub MH. Asymmetric redirection of flow through the heart. Nature. 2000;404:759–61.CrossRefPubMed
2.
go back to reference Pedrizzetti G, Domenichini F. Nature optimizes the swirling flow in the human left ventricle. Phys Rev Lett. 2005;95:1–4.CrossRef Pedrizzetti G, Domenichini F. Nature optimizes the swirling flow in the human left ventricle. Phys Rev Lett. 2005;95:1–4.CrossRef
3.
go back to reference Mangual JO, Kraigher-Krainer E, De Luca A, Toncelli L, Shah A, Solomon S, et al. Comparative numerical study on left ventricular fluid dynamics after dilated cardiomyopathy. J Biomech. 2013;46:1611–7.CrossRefPubMed Mangual JO, Kraigher-Krainer E, De Luca A, Toncelli L, Shah A, Solomon S, et al. Comparative numerical study on left ventricular fluid dynamics after dilated cardiomyopathy. J Biomech. 2013;46:1611–7.CrossRefPubMed
4.
go back to reference Carlhäll CJ, Bolger A. Passing strange flow in the failing ventricle. Circ Hear Fail. 2010;3:326–31.CrossRef Carlhäll CJ, Bolger A. Passing strange flow in the failing ventricle. Circ Hear Fail. 2010;3:326–31.CrossRef
5.
go back to reference Son J-W, Park W-J, Choi J-H, Houle H, Vannan MA, Hong G-R, et al. Abnormal left ventricular vortex flow patterns in association with left ventricular apical thrombus formation in patients with anterior myocardial infarction. Circ J. 2012;76:2640–6.CrossRefPubMed Son J-W, Park W-J, Choi J-H, Houle H, Vannan MA, Hong G-R, et al. Abnormal left ventricular vortex flow patterns in association with left ventricular apical thrombus formation in patients with anterior myocardial infarction. Circ J. 2012;76:2640–6.CrossRefPubMed
6.
7.
go back to reference Abe H, Caracciolo G, Kheradvar A, Pedrizzetti G, Khandheria BK, Narula J, et al. Contrast echocardiography for assessing left ventricular vortex strength in heart failure: a prospective cohort study. Eur Heart J Cardiovasc Imaging. 2013;14:1049–60.CrossRefPubMed Abe H, Caracciolo G, Kheradvar A, Pedrizzetti G, Khandheria BK, Narula J, et al. Contrast echocardiography for assessing left ventricular vortex strength in heart failure: a prospective cohort study. Eur Heart J Cardiovasc Imaging. 2013;14:1049–60.CrossRefPubMed
8.
go back to reference Pedrizzetti G, La Canna G, Alfieri O, Tonti G. The vortex—an early predictor of cardiovascular outcome? Nat Rev Cardiol. 2014;11:545–53.CrossRefPubMed Pedrizzetti G, La Canna G, Alfieri O, Tonti G. The vortex—an early predictor of cardiovascular outcome? Nat Rev Cardiol. 2014;11:545–53.CrossRefPubMed
9.
go back to reference Guerra M, Brás-Silva C, Amorim MJ, Moura C, Bastos P, Leite-Moreira AF. Intraventricular pressure gradients in heart failure. Physiol Res. 2013;62:479–87.PubMed Guerra M, Brás-Silva C, Amorim MJ, Moura C, Bastos P, Leite-Moreira AF. Intraventricular pressure gradients in heart failure. Physiol Res. 2013;62:479–87.PubMed
10.
go back to reference Courtois M, Kovács SJ, Ludbrook PA. Transmitral pressure-flow velocity relation. Importance of regional pressure gradients in the left ventricle during diastole. Circulation. 1988;78:661–71.CrossRefPubMed Courtois M, Kovács SJ, Ludbrook PA. Transmitral pressure-flow velocity relation. Importance of regional pressure gradients in the left ventricle during diastole. Circulation. 1988;78:661–71.CrossRefPubMed
11.
go back to reference Hong G-R, Pedrizzetti G, Tonti G, Li P, Wei Z, Kim JK, et al. Characterization and quantification of vortex flow in the human left ventricle by contrast echocardiography using vector particle image Velocimetry. JACC Cardiovasc Imaging. 2008;1:705–17.CrossRefPubMedPubMedCentral Hong G-R, Pedrizzetti G, Tonti G, Li P, Wei Z, Kim JK, et al. Characterization and quantification of vortex flow in the human left ventricle by contrast echocardiography using vector particle image Velocimetry. JACC Cardiovasc Imaging. 2008;1:705–17.CrossRefPubMedPubMedCentral
12.
go back to reference Pedrizzetti G, Martiniello AR, Bianchi V, D’Onofrio A, Caso P, Tonti G. Cardiac fluid dynamics anticipates heart adaptation. J Biomech. 2015;48:388–91.CrossRefPubMed Pedrizzetti G, Martiniello AR, Bianchi V, D’Onofrio A, Caso P, Tonti G. Cardiac fluid dynamics anticipates heart adaptation. J Biomech. 2015;48:388–91.CrossRefPubMed
13.
go back to reference Pedrizzetti G, Martiniello AR, Bianchi V, D’Onofrio A, Caso P, Tonti G. Changes in electrical activation modify the orientation of left ventricular flow momentum: novel observations using echocardiographic particle image velocimetry. Eur Heart J Cardiovasc Imaging. 2016;17:203–9.CrossRefPubMed Pedrizzetti G, Martiniello AR, Bianchi V, D’Onofrio A, Caso P, Tonti G. Changes in electrical activation modify the orientation of left ventricular flow momentum: novel observations using echocardiographic particle image velocimetry. Eur Heart J Cardiovasc Imaging. 2016;17:203–9.CrossRefPubMed
14.
go back to reference Arvidsson PM, Töger J, Carlsson M, Steding-Ehrenborg K, Pedrizzetti G, Heiberg E, et al. Left and right ventricular hemodynamic forces in healthy volunteers and elite athletes assessed with 4D flow magnetic resonance imaging. Am J Physiol Heart Circ Physiol. 2016;312:H314–28.CrossRefPubMed Arvidsson PM, Töger J, Carlsson M, Steding-Ehrenborg K, Pedrizzetti G, Heiberg E, et al. Left and right ventricular hemodynamic forces in healthy volunteers and elite athletes assessed with 4D flow magnetic resonance imaging. Am J Physiol Heart Circ Physiol. 2016;312:H314–28.CrossRefPubMed
15.
go back to reference Eriksson J, Bolger AF, Ebbers T, Carlhäll C-J. Assessment of left ventricular hemodynamic forces in healthy subjects and patients with dilated cardiomyopathy using 4D flow MRI. Physiol Rep. 2016;4:741–7.CrossRef Eriksson J, Bolger AF, Ebbers T, Carlhäll C-J. Assessment of left ventricular hemodynamic forces in healthy subjects and patients with dilated cardiomyopathy using 4D flow MRI. Physiol Rep. 2016;4:741–7.CrossRef
16.
go back to reference Eriksson J, Zajac J, Alehagen U, Bolger AF, Ebbers T, Carlhäll C-J. Left ventricular hemodynamic forces as a marker of mechanical dyssynchrony in heart failure patients with left bundle branch block. Sci Rep. 2017;7:2971.CrossRefPubMedPubMedCentral Eriksson J, Zajac J, Alehagen U, Bolger AF, Ebbers T, Carlhäll C-J. Left ventricular hemodynamic forces as a marker of mechanical dyssynchrony in heart failure patients with left bundle branch block. Sci Rep. 2017;7:2971.CrossRefPubMedPubMedCentral
17.
go back to reference Markl M, Kilner PJ, Ebbers T. Comprehensive 4D velocity mapping of the heart and great vessels by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2011;13:7.CrossRefPubMedPubMedCentral Markl M, Kilner PJ, Ebbers T. Comprehensive 4D velocity mapping of the heart and great vessels by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2011;13:7.CrossRefPubMedPubMedCentral
18.
go back to reference Muñoz DR, Markl M, Mur JLM, Barker A, Fernández-Golfín C, Lancellotti P, et al. Intracardiac flow visualization: current status and future directions. Eur Heart J Cardiovasc Imaging. 2013;14:1029–38.CrossRef Muñoz DR, Markl M, Mur JLM, Barker A, Fernández-Golfín C, Lancellotti P, et al. Intracardiac flow visualization: current status and future directions. Eur Heart J Cardiovasc Imaging. 2013;14:1029–38.CrossRef
19.
go back to reference Sengupta PP, Pedrizzetti G, Kilner PJ, Kheradvar A, Ebbers T, Tonti G, et al. Emerging trends in CV flow visualization. JACC Cardiovasc Imaging. 2012;5:305–16.CrossRefPubMed Sengupta PP, Pedrizzetti G, Kilner PJ, Kheradvar A, Ebbers T, Tonti G, et al. Emerging trends in CV flow visualization. JACC Cardiovasc Imaging. 2012;5:305–16.CrossRefPubMed
20.
go back to reference Claus P, Omar AMS, Pedrizzetti G, Sengupta PP, Nagel E. Tissue tracking Technology for Assessing Cardiac MechanicsPrinciples, normal values, and clinical applications. JACC Cardiovasc Imaging. 2015;8:1444–60.CrossRefPubMed Claus P, Omar AMS, Pedrizzetti G, Sengupta PP, Nagel E. Tissue tracking Technology for Assessing Cardiac MechanicsPrinciples, normal values, and clinical applications. JACC Cardiovasc Imaging. 2015;8:1444–60.CrossRefPubMed
21.
go back to reference Omar AMS, Bansal M, Sengupta PP. Advances in Echocardiographic imaging in heart failure with reduced and preserved ejection fraction. Circ Res. 2016;119:357–74.CrossRefPubMed Omar AMS, Bansal M, Sengupta PP. Advances in Echocardiographic imaging in heart failure with reduced and preserved ejection fraction. Circ Res. 2016;119:357–74.CrossRefPubMed
22.
go back to reference Sengupta PP, Narula J. Reclassifying heart failure: predominantly Subendocardial, Subepicardial, and Transmural. Heart Fail Clin. 2008;4:379–82.CrossRefPubMed Sengupta PP, Narula J. Reclassifying heart failure: predominantly Subendocardial, Subepicardial, and Transmural. Heart Fail Clin. 2008;4:379–82.CrossRefPubMed
23.
go back to reference Pedrizzetti G, Claus P, Kilner PJ, Nagel E. Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use. J Cardiovasc Magn Reson. 2016;18:15.CrossRef Pedrizzetti G, Claus P, Kilner PJ, Nagel E. Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use. J Cardiovasc Magn Reson. 2016;18:15.CrossRef
24.
go back to reference Krishnasamy R, Isbel NM, Hawley CM, Pascoe EM, Burrage M, Leano R, et al. Left ventricular global longitudinal strain (GLS) is a superior predictor of all-cause and cardiovascular mortality when compared to ejection fraction in advanced chronic kidney disease. PLoS One. 2015;10:1–15.CrossRef Krishnasamy R, Isbel NM, Hawley CM, Pascoe EM, Burrage M, Leano R, et al. Left ventricular global longitudinal strain (GLS) is a superior predictor of all-cause and cardiovascular mortality when compared to ejection fraction in advanced chronic kidney disease. PLoS One. 2015;10:1–15.CrossRef
25.
go back to reference Schuster A, Stahnke VC, Unterberg-Buchwald C, Kowallick JT, Lamata P, Steinmetz M, et al. Cardiovascular magnetic resonance feature-tracking assessment of myocardial mechanics: Intervendor agreement and considerations regarding reproducibility. Clin Radiol. 2015;70:989–98.CrossRefPubMedPubMedCentral Schuster A, Stahnke VC, Unterberg-Buchwald C, Kowallick JT, Lamata P, Steinmetz M, et al. Cardiovascular magnetic resonance feature-tracking assessment of myocardial mechanics: Intervendor agreement and considerations regarding reproducibility. Clin Radiol. 2015;70:989–98.CrossRefPubMedPubMedCentral
26.
go back to reference Domenichini F, Pedrizzetti G. Hemodynamic forces in a model left ventricle. Phys Rev Fluids. 2016;1:83201.CrossRef Domenichini F, Pedrizzetti G. Hemodynamic forces in a model left ventricle. Phys Rev Fluids. 2016;1:83201.CrossRef
27.
go back to reference Pedrizzetti G, Arvidsson PM, Töger J, Borgquist R, Domenichini F, Arheden H, et al. On estimating intraventricular hemodynamic forces from endocardial dynamics: a comparative study with 4D flow MRI. J Biomech. 2017;60:203–10.CrossRefPubMed Pedrizzetti G, Arvidsson PM, Töger J, Borgquist R, Domenichini F, Arheden H, et al. On estimating intraventricular hemodynamic forces from endocardial dynamics: a comparative study with 4D flow MRI. J Biomech. 2017;60:203–10.CrossRefPubMed
28.
go back to reference Ekroll IK, Swillens A, Segers P, Dahl T, Torp H, Lovstakken L. Simultaneous quantification of flow and tissue velocities based on multi-angle plane wave imaging. IEEE Trans Ultrason Ferroelectr Freq Control. 2013;60:727–38.CrossRefPubMed Ekroll IK, Swillens A, Segers P, Dahl T, Torp H, Lovstakken L. Simultaneous quantification of flow and tissue velocities based on multi-angle plane wave imaging. IEEE Trans Ultrason Ferroelectr Freq Control. 2013;60:727–38.CrossRefPubMed
29.
go back to reference Merlo M, Pivetta A, Pinamonti B, Stolfo D, Zecchin M, Barbati G, et al. Long-term prognostic impact of therapeutic strategies in patients with idiopathic dilated cardiomyopathy: changing mortality over the last 30 years. Eur J Heart Fail. 2014;16:317–24.CrossRefPubMed Merlo M, Pivetta A, Pinamonti B, Stolfo D, Zecchin M, Barbati G, et al. Long-term prognostic impact of therapeutic strategies in patients with idiopathic dilated cardiomyopathy: changing mortality over the last 30 years. Eur J Heart Fail. 2014;16:317–24.CrossRefPubMed
30.
go back to reference Finocchiaro G, Pinamonti B, Merlo M, Brun F, Barbati G, Sinagra G. Prognostic role of clinical presentation in symptomatic patients with hypertrophic cardiomyopathy. J Cardiovasc Med. 2012;13:810–8.CrossRef Finocchiaro G, Pinamonti B, Merlo M, Brun F, Barbati G, Sinagra G. Prognostic role of clinical presentation in symptomatic patients with hypertrophic cardiomyopathy. J Cardiovasc Med. 2012;13:810–8.CrossRef
31.
go back to reference Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, et al. Classification of the cardiomyopathies: a position statement from the european society of cardiology working group on myocardial and pericardial diseases. Eur Heart J. 2008;29:270–6.CrossRefPubMed Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, et al. Classification of the cardiomyopathies: a position statement from the european society of cardiology working group on myocardial and pericardial diseases. Eur Heart J. 2008;29:270–6.CrossRefPubMed
32.
go back to reference Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy. Eur Heart J. 2014;35:2733–79.CrossRefPubMed Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy. Eur Heart J. 2014;35:2733–79.CrossRefPubMed
33.
go back to reference Stolfo D, Tonet E, Merlo M, Barbati G, Gigli M, Pinamonti B, et al. Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomes. Eur J Heart Fail. 2015;18:205–13.CrossRefPubMed Stolfo D, Tonet E, Merlo M, Barbati G, Gigli M, Pinamonti B, et al. Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomes. Eur J Heart Fail. 2015;18:205–13.CrossRefPubMed
34.
go back to reference Voigt J-U, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/industry task force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2015;16:1–11.CrossRefPubMed Voigt J-U, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/industry task force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2015;16:1–11.CrossRefPubMed
35.
go back to reference Saito K, Okura H, Watanabe N, Hayashida A, Obase K, Imai K, et al. Comprehensive evaluation of left ventricular strain using speckle tracking echocardiography in normal adults: comparison of three-dimensional and two-dimensional approaches. J Am Soc Echocardiogr. 2009;22:1025–30.CrossRefPubMed Saito K, Okura H, Watanabe N, Hayashida A, Obase K, Imai K, et al. Comprehensive evaluation of left ventricular strain using speckle tracking echocardiography in normal adults: comparison of three-dimensional and two-dimensional approaches. J Am Soc Echocardiogr. 2009;22:1025–30.CrossRefPubMed
36.
go back to reference Stokke TM, Hasselberg NE, Smedsrud MK, Sarvari SI, Haugaa KH, Smiseth OA, et al. Geometry as a confounder when assessing ventricular systolic function: comparison between ejection fraction and strain. J Am Coll Cardiol. 2017;70:942–54.CrossRefPubMed Stokke TM, Hasselberg NE, Smedsrud MK, Sarvari SI, Haugaa KH, Smiseth OA, et al. Geometry as a confounder when assessing ventricular systolic function: comparison between ejection fraction and strain. J Am Coll Cardiol. 2017;70:942–54.CrossRefPubMed
37.
go back to reference Rushmer RF. Initial ventricular impulse. A potential key to cardiac evaluation. Circulation. 1964;XXlX:268–83.CrossRef Rushmer RF. Initial ventricular impulse. A potential key to cardiac evaluation. Circulation. 1964;XXlX:268–83.CrossRef
38.
go back to reference Firstenberg MS, Vandervoort PM, Greenberg NL, Smedira NG, McCarthy PM, Garcia MJ, et al. Noninvasive estimation of transmitral pressure drop across the normal mitral valve in humans: importance of convective and inertial forces during left ventricular filling. J Am Coll Cardiol. 2000;36:1942–9.CrossRefPubMed Firstenberg MS, Vandervoort PM, Greenberg NL, Smedira NG, McCarthy PM, Garcia MJ, et al. Noninvasive estimation of transmitral pressure drop across the normal mitral valve in humans: importance of convective and inertial forces during left ventricular filling. J Am Coll Cardiol. 2000;36:1942–9.CrossRefPubMed
39.
go back to reference Greenberg NL, Vandervoort PM, Firstenberg MS, Garcia MJ, Thomas JD. Estimation of diastolic intraventricular pressure gradients by Doppler M-mode echocardiography. Am J Physiol Heart Circ Physiol. 2001;280:H2507–15.CrossRefPubMed Greenberg NL, Vandervoort PM, Firstenberg MS, Garcia MJ, Thomas JD. Estimation of diastolic intraventricular pressure gradients by Doppler M-mode echocardiography. Am J Physiol Heart Circ Physiol. 2001;280:H2507–15.CrossRefPubMed
40.
go back to reference Bermejo J, Antoranz JC, Yotti R, Moreno M, García-Fernández MA. Spatio-temporal mapping of intracardiac pressure gradients. A solution to Euler’s equation from digital postprocessing of color Doppler M-mode echocardiograms. Ultrasound Med Biol. 2001;27:621–30.CrossRefPubMed Bermejo J, Antoranz JC, Yotti R, Moreno M, García-Fernández MA. Spatio-temporal mapping of intracardiac pressure gradients. A solution to Euler’s equation from digital postprocessing of color Doppler M-mode echocardiograms. Ultrasound Med Biol. 2001;27:621–30.CrossRefPubMed
41.
go back to reference Tonti G, Pedrizzetti G, Trambaiolo P, Salustri A. Space and time dependency of inertial and convective contribution to the transmitral pressure drop during ventricular filling. J Am Coll Cardiol. 2001;38:290–1.CrossRefPubMed Tonti G, Pedrizzetti G, Trambaiolo P, Salustri A. Space and time dependency of inertial and convective contribution to the transmitral pressure drop during ventricular filling. J Am Coll Cardiol. 2001;38:290–1.CrossRefPubMed
43.
go back to reference Pasipoularides A. Mechanotransduction mechanisms for Intraventricular diastolic vortex forces and myocardial deformations: part 1. J Cardiovasc Transl Res. 2015;8:76–87.CrossRefPubMedPubMedCentral Pasipoularides A. Mechanotransduction mechanisms for Intraventricular diastolic vortex forces and myocardial deformations: part 1. J Cardiovasc Transl Res. 2015;8:76–87.CrossRefPubMedPubMedCentral
44.
go back to reference Hove JR, Köster RW, Forouhar AS, Acevedo-Bolton G, Fraser SE, Gharib M. Intracardiac fluid forces are an essential epigenetic factor for embryonic cardiogenesis. Nature. 2003;421:172–7.CrossRefPubMed Hove JR, Köster RW, Forouhar AS, Acevedo-Bolton G, Fraser SE, Gharib M. Intracardiac fluid forces are an essential epigenetic factor for embryonic cardiogenesis. Nature. 2003;421:172–7.CrossRefPubMed
46.
go back to reference Friedrich O, Wagner S, Battle AR, Schürmann S, Martinac B. Mechano-regulation of the beating heart at the cellular level - Mechanosensitive channels in normal and diseased heart. Prog Biophys Mol Biol. 2012;110:226–38.CrossRefPubMed Friedrich O, Wagner S, Battle AR, Schürmann S, Martinac B. Mechano-regulation of the beating heart at the cellular level - Mechanosensitive channels in normal and diseased heart. Prog Biophys Mol Biol. 2012;110:226–38.CrossRefPubMed
47.
go back to reference Kerckhoffs RCP, Omens JH, McCulloch AD. A single strain-based growth law predicts concentric and eccentric cardiac growth during pressure and volume overload. Mech Res Commun. 2012;42:40–50.CrossRefPubMed Kerckhoffs RCP, Omens JH, McCulloch AD. A single strain-based growth law predicts concentric and eccentric cardiac growth during pressure and volume overload. Mech Res Commun. 2012;42:40–50.CrossRefPubMed
Metadata
Title
Cardiac fluid dynamics meets deformation imaging
Authors
Matteo Dal Ferro
Davide Stolfo
Valerio De Paris
Pierluigi Lesizza
Renata Korcova
Dario Collia
Giovanni Tonti
Gianfranco Sinagra
Gianni Pedrizzetti
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Cardiovascular Ultrasound / Issue 1/2018
Electronic ISSN: 1476-7120
DOI
https://doi.org/10.1186/s12947-018-0122-2

Other articles of this Issue 1/2018

Cardiovascular Ultrasound 1/2018 Go to the issue