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1.
30 warmblood horses were examined before and after sedation with 20 micrograms/kg BW detomidine, to determine changes of cardiac function parameters, using B-mode, M-mode and Doppler echocardiography. 15 horses showed a heart murmur, but no clinical signs of cardiac heart failure, 15 horses had neither a heart murmur nor other signs of cardiac disease. After sedation with detomidine we could recognise a significant increase of end-diastolic left atrium diameter, an increase of end-systolic left ventricular diameter and aortic root diameter. The end-systolic thickness of papillary muscle and interventricular septum showed a decrease. Fractional shortening and amplitude of left ventricular wall motion was decreased after sedation. The mitral valve echogram revealed a presystolic valve closure and an inflection in the Ac slope (B-notch) in xy horses before sedation. Both increased after sedation with detomidine. Doppler echocardiography showed a decrease of blood flow velocity and velocity time integral (VTI) in the left and right ventricular outflow tract after sedation. Regurgitant flow signals were intensified following sedation in xy horses, especially at the mitral valve.  相似文献   

2.
Clinical, electrocardiographic and echocardiographic examinations were conducted before therapy and 4 days after conversion to normal sinus rhythm in 15 horses with a history of atrial fibrillation of 2-6 months duration. Seven horses showed no other signs of cardiac disease. Four horses suffered additionally from mitral valve insufficiency, while six horses had aortic valve insufficiency, including two of the four horses with mitral valve insufficiency, but none had signs of congestive heart failure. Doppler echocardiographic estimates of various variables were made for assessment of systolic heart function. These included heart rate, stroke volume, cardiac output and cardiac output per kg of body weight (heart index). After conversion to normal sinus rhythm, the horses without heart valve insufficiency showed a statistically significantly decreased heart rate (-24%) and cardiac output (-3%), but an increase in stroke volume (+8.4%) and heart index (+9%). The horses with heart valve insufficiency experienced a statistically significant decrease in heart rate (-21%) after conversion to normal sinus rhythm, but showed an increase in all other variables. Cardiac output increased statistically significantly by 20%, stroke volume by 54% and heart index by 58%.  相似文献   

3.
In 12 healthy warmblood horses and 10 horses with mitral valve insufficiencies (MVI) of various degrees heart rate and pulmonary artery wedge pressure (PWP) was measured at rest and during standardised exercise on a high speed treadmill. There was a significant increase in PWP with each change in speed of the treadmill (p < 0.01). The PWP of horses with mild mitral valve regurgitation under working conditions was not significantly different compared to the healthy horses. The horses with moderate mitral valve regurgitation showed a significant higher pulmonary artery wedge pressure at rest and during exercise compared to the healthy horses (p < 0.01) at rest and during treadmill velocity. The tendencies were seen that mild mitral valve regurgitation results only in mild hemodynamic changes during exercise, while moderate MVI have an important influence on haemodynamics.  相似文献   

4.
Three cases of ruptured mitral valve chordae in the horse   总被引：1，自引：0，他引：1  
The paper describes clinical observations in three horses with ruptured mitral valve chordae. Horses with ruptured mitral valve chordae may have a history of sudden onset of acute distress with predominantly respiratory symptoms. On auscultation there will be a widespread pansystolic murmur with an extension of the area of cardiac auscultation. The third heart sound may be very pronounced and unduly prolonged, associated with high volume flow during early ventricular filling in diastole. However, these sounds are not specific for chordal rupture--they are typical of severe mitral regurgitation. The electrocardiogram may show predominantly backward spatial vectors during ventricular depolarisation. The condition gives rise to left ventricular volume overload and pulmonary hypertension would be expected in horses showing signs of cardiovascular disturbance or those recently affected. Care is necessary during post mortem examination to avoid cutting through the mitral valve before a proper assessment has been made of the chordal insertions.  相似文献   

5.
OBJECTIVE: To determine factors associated with long-term survival in dogs treated surgically for patent ductus arteriosus (PDA). DESIGN: Retrospective case series. Animals-52 dogs treated surgically for left-to-right shunting PDA. PROCEDURE: Data pertaining to age, breed, sex, body weight, clinical examination findings, type and duration of medical treatment, results of thoracic radiography and echocardiography, and surgical and postoperative complications were collected from records. Follow-up information was obtained from medical records or telephone interviews with owners or referring veterinarians. RESULTS: 22 dogs had mitral valve regurgitation. Mean weight and age were not significantly different between dogs with or without mitral valve regurgitation. Twenty-four (46.2%) dogs had clinical signs related to cardiac insufficiency. Left atrial dilatation was observed in 56.3% of dogs that were radiographed. Sonographic imaging was used to diagnose left atrial dilatation in 23 dogs and left ventricular dilatation in 25 dogs. The 1- and 2-year survival rates were 92% and 87%, respectively. Diagnosis of mitral valve regurgitation before surgery was not associated with the probability of survival. Age, weight, lethargy, preoperative treatment with angiotensin-converting enzyme inhibitors, and right atrial dilatation on radiographs at the time of surgery were negatively associated with probability of survival. CONCLUSIONS AND CLINICAL RELEVANCE: Surgical treatment of PDA was curative in young dogs without clinical signs of heart failure. Surgical correction of PDA should be recommended as early as possible after diagnosis, and mitral valve regurgitation is not a contraindication for surgery.  相似文献   

6.
A three-month-old, male intact Norwegian forest cat without any clinical signs was referred to the cardiology service of the author’s teaching hospital for evaluation of a cardiac murmur. The murmur was systolic with an intensity of 4 out of 6 with the point of maximal intensity at the left heart base. Echocardiography revealed a moderate mitral valve regurgitation and a moderate dynamic left ventricular outflow tract obstruction both resulting from systolic anterior motion of the mitral valve (SAM). Moreover, left ventricular concentric hypertrophy was noted. Oral atenolol therapy was initiated. Recheck examination 3.5 months later revealed unchanged murmur characteristics in the still asymptomatic kitten. Echocardiography showed no SAM, but there was a severe fixed aortic stenosis apparent caused by a discrete supravalvular lesion, 4 mm distal to the valve, with an hourglass morphology. Supravalvular aortic stenosis is a rare congenital anomaly in cats, which has not been reported antemortem yet.  相似文献   

7.
Two-dimensional real-time, M-mode and Doppler echocardiographic measurements were made in 11 adult wolves (Canis lupus) anaesthetised with an intramuscular combination of medetomidine, ketamine, butorphanol and acepromazine followed by isoflurane in oxygen. M-mode measurements of the left ventricle, B-mode measurements of the left atrium and aorta, systolic indices, and Doppler measurements of aortic and pulmonary blood outflow, and of mitral and tricuspid blood inflow, were recorded. The values obtained were compared with those reported for dogs of similar bodyweight and body type. The diastolic measurements of the cardiac chambers and walls were similar to those reported for healthy, conscious dogs, but the use of anaesthesia probably resulted in the markedly different systolic cardiac measurements, systolic indices and Doppler blood flow velocities observed in the wolves. Mild mitral regurgitation, probably due to mitral endocardiosis, was observed in one wolf, and trivial functional mitral insufficiency was observed in five others.  相似文献   

8.
Echocardiographic evaluation of 23 horses with aortic insufficiency was performed, using M-mode (n = 23) and 2-dimensional real-time echocardiography (n = 14 of 23). Echocardiograms were evaluated for abnormalities of aortic and mitral valves and alterations in motion of these valves. Changes in left ventricular chamber size and function, as well as aortic root size, were evaluated. The presence of other cardiac disease was also evaluated. Horses with aortic insufficiency had significant increases (P less than 0.01) in mean values of left ventricular chamber size, aortic root diameter, and shortening fraction. Left ventricular free wall thickness also was significantly decreased (P less than 0.01). Valvular abnormalities were seen echocardiographically in all 23 horses. Eighteen horses with aortic insufficiency had thickened valves, whereas two horses had lesions associated with vegetative endocarditis. High-frequency vibrations of the septal leaflet of the mitral valve were noticed in all horses, whereas similar vibrations of the aortic valve were seen in six horses. The presence of a bounding arterial pulse correlated significantly (P less than 0.05) with increased left ventricular chamber size at end diastole and shortening fraction, indicating a marked left ventricular volume overload. A reliable diagnosis of aortic insufficiency can be made with the detection of bounding arterial pulses in concert with a holodiastolic decrescendo grade II to V/V murmur with maximal intensity over the aortic valve area, radiating toward the left cardiac apex.  相似文献   

9.
OBJECTIVE: To report the successful surgical management (open mitral commissurotomy, OMC) of mitral stenosis (MS), incorporating heart-beating cardiopulmonary bypass (CPB), in a 1-year-old dog. STUDY DESIGN: Clinical case. ANIMALS: One-year-old Cairn Terrier with MS. MATERIALS AND METHODS: Diagnosis of MS was confirmed by means of 2-dimensional, continuous-wave and color-flow Doppler echocardiography. Surgery was performed through a left intercostal thoracotomy. CPB was initiated and the heart was kept beating. The fused commissures of the mitral valve were incised to free the cusps of the valve. RESULTS: Left intercostal thoracotomy allowed easy observation of the mitral orifice during heart-beating OMC. Persistent bleeding from the atriotomy site required a second surgical procedure after which the dog had an uneventful recovery. Echocardiography at 2 weeks and 1 year postoperatively indicated substantial improvement in left ventricular filling (pressure half-time=187 ms before surgery, 105 ms [2 weeks] and 110 ms [1 year] after surgery). Enlargement of the left atrium resolved; however, moderate mitral valve regurgitation was still present. CONCLUSIONS: MS can be successfully treated by OMC, facilitated by use of CPB. Substantial improvement in cardiac function was evident by ultrasound and Doppler examination postoperatively. CLINICAL RELEVANCE: OMC under heart-beating CPB should be considered for the treatment of MS in the dog.  相似文献   

10.
Natriuretic peptides are cardiac biomarkers, routinely used for diagnosis, prognosis, and guidance for treatment in human and small animal cardiology. However, their diagnostic and prognostic value in horses has received little study. The aim of this study was to investigate the plasma atrial natriuretic concentration (ANPPl) in a large group of horses with various degrees of valvular regurgitation (VR) and congestive heart failure (CHF). Clinical examination and two-dimensional time-motion mode and Doppler echocardiography were performed on 91 horses admitted to the Equine Teaching Hospital of Liege University, with either no, mild, moderate, or severe VR and presenting various stages of CHF. Plasma atrial natriuretic concentration was measured using a commercially available human radioimmunoassay test. Mean values of body weight, age, ANPPl, and echocardiographic parameters were compared among horses with no, mild, moderate, and severe VR and among horses in different CHF stages. Correlation and linear regression of ANPPl with each echocardiographic parameter and with the percentage of dilation of each of cardiac chambers were assessed. Horses with severe or moderate VR had significantly higher ANPPl than those with mild or no VR. Plasma atrial natriuretic concentration was significantly higher in horses presenting CHF than those without CHF. Plasma atrial natriuretic concentration was significantly correlated with the left atrial diameter and its percentage of dilation. These results suggest a diagnostic value of ANPPl in horses with VR, especially with tricuspid or mitral insufficiency with dilation of the atria.  相似文献   

11.
Two-dimensional and M-mode echocardiography were used to diagnose mitral stenosis in two cats with heart failure. This appeared to be related to mitral valve complex malformation. Ultrasound findings included thickened mitral valve leaflets with inhibited mobility, reduced mitral valve orifice size, abnormal upward (cranial) motion of the caudal mitral leaflet during diastole and severe left atrial enlargement. Colour-flow and spectral Doppler imaging helped characterise this condition. Colour-flow Doppler mapping showed turbulence and increased mitral filling velocity (aliasing) at the site of stenosis and related jets of mitral regurgitation. Spectral Doppler recordings showed increased diastolic mitral filling velocities with spectral broadening and prolonged pressure half-time. Mitral stenosis should be included in the differential diagnosis of cats with severe left atrial enlargement when congenital or acquired mitral valve disease is detected; it may represent an advanced form of mitral valve complex malformation in some cases.  相似文献   

12.
Mitral valvular insufficiency associated with ruptured chordae tendineae was diagnosed in 3 foals with signs of congestive heart failure, which were believed to be secondary to the development of pulmonary hypertension associated with the valvular insufficiency. The septal leaflet of the mitral valve was affected in all 3 foals, and foal 2 also had ruptured chordae tendineae associated with the caudal mitral valve leaflet. Bacterial endocarditis and myocardial necrosis were associated with the ruptured chordae tendineae in foals 3 and 2, respectively. Idiopathic rupture was considered in foal 1. Two-dimensional echocardiography demonstrated a flail mitral valve leaflet in foals 2 and 3 and a ruptured chorda tendineae in foal 3. The ruptured chorda tendineae in foal 1 was not visualized with M-mode echocardiography.  相似文献   

13.
Before the development of echocardiography, cardiac disease in the horse was diagnosed if a loud heart murmur (grade III-IV/VI or louder) and clinical signs of congestive heart failure (coughing, edema, venous distention, jugular pulsations) were detected on physical examination. Arrhythmias that persisted during and after exercise also indicated cardiac disease, which could be characterized electrocardiographically. Electrocardiography, thoracic radiography, angiography, cardiac catheterization, and oximetry could add only small pieces of information about the heart. M-mode echocardiography provided the first "window" with which to evaluate the heart and its intracardiac structures, albeit an ice-pick one-dimensional view. With M-mode echocardiography, the diameter of the aorta at the valves, the left ventricle, right ventricle, and left atrial appendage, as well as the thickness of the interventricular septum and left ventricular free wall, could be measured. Motion and thickness of the tricuspid, mitral, and aortic valves could be assessed, but only in a one-dimensional plane. Two-dimensional echocardiography provided an added dimension, resulting in visualization of all the intracardiac structures, aorta, and pulmonary artery. Two-dimensional echocardiography became the diagnostic technique of choice for the evaluation and characterization of congenital cardiac disease in critically ill neonates, as well as in adult horses. Two-dimensional echocardiography also improved the ability to diagnose valvular regurgitations, characterize valvular lesions (bacterial endocarditis, ruptured chorda tendineae), myocardial function (segmental wall motion abnormalities), atrial size, mass lesions (endocarditis, neoplasia, and thrombi), and pericardial effusion. Information about blood flow was obtained using contrast echocardiography but was limited to certain cardiac abnormalities (congenital cardiac defects and tricuspid regurgitation). This information about blood flow was limited to the detection of positive or negative contrast jets. Comprehensive information about blood flow was lacking until the application of Doppler echocardiography to equine cardiology. Pulsed-wave and color flow Doppler echocardiography resulted in precise localization of the abnormal blood flow and semiquantitation of the shunt flow or regurgitant jet. Color flow Doppler echocardiography sped up the localization and semiquantitation of the jet in many instances and provided some information about blood flow velocity in the enhanced and variance modes. The peak velocity of jets can be determined using continuous-wave Doppler echocardiography. This value then can be used to estimate pressure difference between cardiac chambers or to calculate cardiac output noninvasively if angles parallel to flow can be obtained. Thus, information about cardiac size, function, and blood flow can be combined to diagnose cardiac disease in horses and to formulate a prognosis for life and performance.  相似文献   

14.
M-mode echocardiography, color flow Doppler mapping, and pulsed wave Doppler echocardiography were used to characterize diastolic mitral regurgitation in five dogs and two cats with second- and third-degree atrioventricular block. Incomplete closure and partial reopening of the mitral valve following nonconducted P-waves were demonstrated by m-mode echocardiography. Low velocity reflux of blood into the left atrium after nonconducted P-waves was imaged by color-flow Doppler mapping and spectral Doppler echocardiography. Late diastolic mitral regurgitation was not observed in clinically normal control dogs or cats, but a low velocity, mid-diastolic flow reversal was detected in the dogs. This probably represented normal physiologic intravalvular flow. Diastolic mitral regurgitation is a common echocardiographic finding, in dogs and cats with, second- and third-degree atrioventricular block.  相似文献   

15.
The aim of this study was to investigate the potential haemodynamic effects of valvular insufficiency and recurrent airway obstruction (RAO) in horses with atrial fibrillation (AF). Therefore in ten healthy horses (group 1) and 40 horses with AF a clinical examination, a lung examination, echocardiography and right heart catheterization for measurement of intracardic and pulmonary pressures were performed. According to the clinical findings the horses with AF were subdivided into 4 groups (group 2: AF; group 3: AF/valvular insufficiency; group 4: AF/RAO; group 5: AF/valvular insufficiency/RAO). Most of the horses of group 3 and 5 suffered from two valvular insufficiencies (mitral and tricuspid valve insufficiency: n=11, mitral and aortic valve insufficiency: n=2). The remaining horses showed a single mitral (n=6), tricuspid (n=2) or aortic valve insufficiency (n=1) or more than two valvular insufficiencies (n=4). In group 2 right ventricular mean pressure (RVPm) was higher than in group 1 and 4 (P<0.025); diastolic right ventricular pressure was higher than in group 1; PWP was higher than in group 1 and group 4; PDP was lower compared to group1. Compared to group1 in group 3 left atrial diameter (LA) was greater; the PAPs was higher and the PDP lower (P<0.05). In group 4 RVPm and PWP was lower compared to group 2. In group 5 LA, fractional shortening and diastolic left ventricular diameter were greater, PWP and PAPs were higher and PDP lower compared to group1. Twenty six of the 40 horses with AF (65%) were treated. Successful cardioversion to sinus rhythm occurred in 15 horses (58%). Therapy was successful in 50% of the treated horses of group 2 and 3, in 67% of the treated horses of group 4 and in 63% of the treated horses in group 5. In conclusion the presence of valvular insufficiency or RAO influences the haemodynamics of horses with AF.  相似文献   

16.
Cardiac auscultation was carried out on 111 Thoroughbred horses age 2-5 years to test the hypothesis that athletic training might influence the development of atrioventricular (AV) valve regurgitation in young Thoroughbreds. Murmurs of valvular regurgitation were identified and graded on a 1-6 scale. There were 2 sources of auscultation data: 1) 55 2-year-old horses that were examined by auscultation before training commenced and 9 months later when at race fitness; 2) 56 horses age 2-5 years that were examined on one occasion only (25 2-year-olds, 23 3-year-olds, five 4-year-olds and five 5-year olds). All horses in the second data set were in full training and racing regularly at the time of the examination. To conclude the study, 35 horses were selected randomly from both groups of horses and examined with colour-flow Doppler echocardiography. The aim of the final part of the study was to check specificity and sensitivity of auscultation for detection of AV valve murmurs and therefore validate the auscultation findings. Prior to training, the prevalence in 2-year-old racehorses of murmurs of mitral regurgitation and tricuspid regurgitation was 7.3% (4/55) and 12.7% (7/55), respectively. After training, the prevalence proportions increased to 21.8% (12/55) and 25.5% (14/55). After training, one horse developed a murmur characteristic of aortic regurgitation. The differences in murmur prevalence were statistically significant for mitral and tricuspid regurgitation (paired t test results: mitral regurgitation, P = 0.019; tricuspid regurgitation, P = 0.007), as were the differences in mean murmur grade (P = 0.018 and P = 0.0006, respectively). There were no significant effects of age on the prevalence of valvular regurgitation in 56 horses examined at race fitness. Auscultation was a specific (specificity 100%) and reasonably sensitive method for detection of murmurs of mitral and tricuspid regurgitation (mitral regurgitation: positive predictive value 100%, negative predictive value 84%, tricuspid regurgitation: positive predictive value 100%, negative predictive value 65%). These data suggest that the prevalence and grade of murmurs of mitral and tricuspid valvular regurgitation increase in 2-year-old Thoroughbreds after 9 months of athletic training. Whereas the effects of age and growth on the prevalence of murmurs cannot be ruled out from these data, this study suggests that there is an influence of athletic training on the development of atrioventricular valvular regurgitation in flat-racing Thoroughbreds.  相似文献   

17.
Degenerative mitral valve disease (MVD), the most common acquired heart disease in small-sized dogs, is characterized by valvular degeneration resulting in systolic mitral valve regurgitation (MR). Worsening of MR leads to several combined complications including cardiac remodeling, increased left ventricular filling pressure, pulmonary arterial hypertension, and myocardial dysfunction. Conventional two-dimensional, M-mode, and Doppler examination plays a critical role in the initial and longitudinal assessment of dogs affected by MVD, providing information on mitral valve anatomy, MR severity, left ventricular (LV) size and function, as well as cardiac and vascular pressures. Several standard echocardiographic variables have been shown to be related to clinical outcome. Some of these markers (e.g., left atrium to aorta ratio, regurgitation fraction, pulmonary arterial pressure) may also help in identifying asymptomatic MVD dogs at higher risk of early decompensation, which remains a major issue in practice. However, both afterload and preload are altered during the disease course. This represents a limitation of conventional techniques to accurately assess myocardial function, as most corresponding variables are load-dependent. Recent ultrasound techniques including tissue Doppler imaging, strain and strain rate imaging, and speckle tracking echocardiography, provide new parameters to assess regional and global myocardial performance (e.g., myocardial velocities and gradients, deformation and rate of deformation, and mechanical synchrony). As illustration, the authors present new data obtained from a population of 91 dogs (74 MVD dogs, 17 age-matched controls) using strain imaging, and showing a significant longitudinal systolic alteration at the latest MVD heart failure stage.  相似文献   

18.
Natriuretic peptides are useful in diagnosing heart failure in dogs. However, their usefulness in detecting early stages of myxomatous mitral valve disease (MMVD) has been debated. This study evaluated N-terminal (NT) fragment pro-atrial natriuretic peptide (NT-proANP) and NT-pro-brain natriuretic peptide (NT-proBNP) in 39 Cavalier King Charles Spaniels (CKCS) with pre-clinical mitral valve regurgitation (MR), sixteen dogs with clinical signs of heart failure (HF) and thirteen healthy control dogs. Twenty seven CKCS and ten control dogs were re-examined 4 years after the initial examination and the status of the dogs 5 years after the initial examination was determined by telephone calls to the owner. All dogs were evaluated by clinical examination and echocardiography. CKCS with severe MR had higher NT-proANP and NT-proBNP compared to controls and CKCS with less severe MR. Dogs with clinical signs of HF had markedly elevated NT-proANP and NT-proBNP. Plasma concentrations of the natriuretic peptides measured at re-examination could predict progression in regurgitant jet size.  相似文献   

19.
Two-dimensional and M-mode echocardiograms were recorded from 41 horses before they were successfully treated for atrial fibrillation. In addition, these examinations were performed in a subgroup of 20 horses after treatment, and the results were compared with pretreatment values. Atrial fibrillation in this group of horses was associated with a reduction of mean left ventricular fractional shortening (mean 31 %± 5.24%), and 22 of the 41 horses were below the reference range. The remaining mean M-mode variables were within the normal reference range, although 12 horses had increased left ventricular lumen dimensions in systole, and 8 horses had decreased left ventricular ejection times. Abnormal motion of the mitral valve was present in all horses and was characterized by the absence of A peaks, which were replaced by small diastolic undulations in 55% of the horses. In horses 1 to 20, after conversion to sinus rhythm, the mean fractional shortening increased (35.34%± 5.4%, P = .004), but there were no significant differences in heart rate or left ventricular lumen diameters in systole or diastole. These results suggest that ventricular function may be compromised by the presence of atrial fibrillation. However, this improved after correction of the arrhythmia.  相似文献   

20.
The cardiac effects of high dosages of the ß2-adrenergic agent clenbuterol have been the focus of several histological, biochemical and echocardiographic studies in the past. Possible effects of a therapeutic dosage on myocardial contractility and velocities have not been evaluated using tissue Doppler imaging (TDI) and two-dimensional speckle tracking (2DST) in equine medicine. Twenty-five healthy horses were treated over 14 days with clenbuterol in a normal dosage (0.8 μg/kg every 12 hours). Before and after the treatment, an echocardiographic examination was performed using B-mode, M-mode, color flow Doppler, and tissue Doppler imaging (TDI). In all horses, the radial and circumferential myocardial functions were recorded in the right parasternal short-axis view (SAX). Pulsed-wave (PW) and color TDI were used for evaluation of peak and mean myocardial velocities; myocardial deformation was documented in 2DST. An improvement of diastolic function after clenbuterol treatment was demonstrated by a significant increase of the early diastolic radial wall motion velocity (Em) in all myocardial sections except the right ventricular free wall (RVFW) in TDI, as well as an increase of the E/A quotient in the left ventricular free wall (LVFW) and the interventricular septum (IVS). Shortened time intervals, in particular in the LVFW and a tendency of increase of all deformation parameters showed improved relaxation characteristics of the cardiac muscle after treatment. The results can be interpreted as beginning physiologic cardiac hypertrophy due to clenbuterol treatment. No signs of increased rigidity or reduced compliance of the heart muscle could be found at the applied dosage. This study demonstrates the sensitivity of TDI and 2DST in equine cardiology to detect myocardial remodeling before the appearance of obvious findings in conventional echocardiographic techniques. This technique can be used to detect pharmacologic effects on myocardial function.  相似文献   

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