Ritu Thamman MD
@iamritu
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Associate Professor #cardiologist #SoMe editor @CircOutcomes @JournalASEcho #BOD @ase360 @PittHealthSci @ColumbiaMed @NUFeinbergMed #echofirst #NewJersey girl
University of Pittsburgh SOM
Joined January 2010
💔women wait 10 min longer to be seen for chest pain in ER.💔women less likely to be triaged as emergent case.💔women less likely to get ekg,or🫀monitor, or to.be seen by a cardiologist in the ER for CP.💔less likely to be admitted 🏥 for CP #ACCWIC #ACC21 .#DisparitiesOfCare
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I am sad to inform that my family friend and physician Dr. Priya Khanna is no longer with us Thank you to all that tried to save her, a young doctor from #COVID19 #HealthcareHeroes @DrRupaliGandhi @CardiacConsult @DBelardoMD @CMichaelGibson @Atul_SharmaMD.
PLEA for help! . Plasma donor needed urgently for Dr. Priya Khanna, a nephrologist in NJ currently in critical condition w/ COVID 19, intubated & fighting for her life!. Anyone that was COVID+ & symptom free for 2 weeks is an eligible donor. Contact group below. Please RT🙏.
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New 3D “Glass” #echofirst .tool -transillumination (TI) integrates a virtual light source into data set :better depth perception & orifice definition:shape, size,borders .@JournalASEcho @ASE360 @rajdoc2005 @ilya_tweets @robertomlang @DocStrom @LucySafi
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🔺aortopulmonary window connection b/w ascending aorta & main PA.🔺presence of 2 semilunar valves distinguishes this anomaly from truncus arteriosus.🔺Both semilunar valves normal in position .from @ASE360 member Pamela Henderson @CASEfromASE #echofirst @kgzimmerman @rajdoc2005
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Multichamber myxoma: Carney complex (autosomal dominant, rare) . @ASE360 @CASEfromASE . By age 30, 35% of females & 45% of males had at least one myxoma .#echofirst
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Commotio Cordis is sudden blunt impact to chest ➡️sudden death in absence of cardiac damage .Most important variable is timing of impact relative to cardiac cycle:upstroke of Tw. 🆚Contusio Cordis(contusion) blunt chest trauma➡️ structural cardiac damage .
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pedunculated large mass with irregular borders attached to posterior P2 mitral annulus prolapsing into LV & smaller, secondary mass attached to Interatrial septum #echofirst. Rare deadly spindle cell sarcoma
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Cutest #Echofirst ever:. in a #African pygmy #hedgehog 🦔 examined due to a systolic heart murmur. Findings: dilated & hyperechoic LV, dilated LA & mitral regurgitation #Preview will be in @CASEfromASE from Rebecca Stepien @uwvetmed
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@RoxanaDaneshjou In our home, it was filled with atta (flour) used to make daily roti’s (bread):the round shape of the container was the perfect shape to coat the rolled rotis in flour- thanks for bringing up a happy memory.
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Rare cause of aortic stenosis: unicuspid unicommisural .aortic valve h/t @echo_stepbystep @DrBrianSolomon
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#Timing of #Mitral #Regurgitation .Early systole.Late systole .Holosystolic .Biphasic .#color #doppler #echofirst h/t @BonitaEcho
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#GetVaccinatedNow . @Nature meta analysis. #Covid19 long term effects happen in 80% pts. 5 most common .fatigue 58%.headache 44%.attention disorder 27% hair loss 25% .dyspnea 24%. If #SARSCoV2➡️ substantial tissue damage leading to chronic dz still unknown
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Remember by #echofirst we measure at #vena #contracta where the velocity is highest( kinetic) and pressure is lowest & you can see same from herding 🐑 🐑 🐑 #ASEchoJC @AragamJayashri @DavidWienerMD @DocStrom @ash71us @kgzimmerman @rajdoc2005 @DrMarthaGulati @ErinMichos
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In Atrial Functional MR can get “Hamstringing”of posterior MV leaflet due to massive LA dilation;this “atriogenic” leaflet tethering is from displaced posterior annulus onto crest of LV inlet resulting in⬆️in annulopapillary distance restricting leaflet motion #echofirst
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Don’t be #Patient31 . who did not follow #socialdistancing . Caused 2 clusters responsble for 80% of South Koreas infections. Do you want🩸on your 🤚?. #CancelEverything .#SocialDistancingNow .#Covid19
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Tiny primary chordae rupture of #anterior #mitral #valve #leaflet(excessive leaflet motion) & inferolateral MI/WMA with posterior leaflet tethering(restricted leaflet motion) both causing posteriorly directed #mitral #regurgitation #EchoFirst
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Another Pickelhaube sign but not on #echofirst but on #EKG . spiked-helmet sign (SHS):.elevation of isoelectric line precedes QRS, followed by a sharp R wave & then convex ST-segment elevation. mimics acute MI. Adrenergic excess/prolonged repolarization.
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Almost 50% of angina pts have non obstructive CAD on cath: 3 types of ANOCA & each has its’ own Rx:.🫀Coronary micro vascular dz B blockers.🫀Coronary endothelial dysfunction (? Rx).🫀Coronary vasospasm (Ca channel blockers/nitrates) @minissianm .
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#TopTenThings to tell surgeon #echofirst👇@Baselalanazi6 .1.What type of dissection?.2.What’s the extent? .3.Entry site .4.Exit site .5.Any rupture? .6.Any leak? .7. Aortic Regurgitation?.8.Pericardial fluid? .9.Great vessels? .10.Coronaries involved? .
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That feeling when your Dad’s @iRhythmTech has a 9.1 second pause .& you end up taking him to @HackensackUMC for dual chamber ppm #sicksinussyndrome
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🆕📝optimal cutoff points for severe AS vary by range of LVEF (<35%, 35%-50%, >50%) 🫀If LVEF <35%, use MG of 30 rather than 40 for severe AS .🫀MG & Vmax better than AVA in Dx severe AS adjudicated by C-CT.🫀In LG AS w LVEF <35%, DSE finds contractile
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Possible ⬆️ risk of #COVID19 in people with HTN & heart disease may be related to ACEI ARB use:.these drugs upregulate ACE2 receptor expression which the virus 🦠 uses for entry #SARSCoV2 .ICU pts use AngII infusions if they need pressors #cardiotwitter
What can #COVID19 #SARSCoV2 can do 2the CV system! .Published in the nature reviews! 🦠 myocarditis.🦠 heart failure .🦠 increased biomarkers .🦠 can present as chest tightness or heart palpitations rather than respiratory symptoms .🦠 ACS poor prognosis
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I'm grateful to have contributed to this #WellnessTextbook on #burnout. Thank you to the other editors:.@drbrowncares.@KTamirisaMD. Available here (and free on Kindle Unlimited!):.
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@LopezOpitz @almasthela @falcardio @KCL_CardiacMR @tavoave @omorenou @purviparwani @KemalogluOz @vass_vassiliou @cshenoy3 @venkmurthy @rajdoc2005 @josejgdnews @JRodriPalomares @danilorenzatti @fabrizioricci @ohanloncmr @drzgezdentok1 @DrFuisz @chiarabd @SISIACOficial Beautiful case of constrictive pericarditis showing exaggerated RV LV interdependence w ⬆️ right sided filling w inspiration & septal shift/bounce t/w left : beautiful views of inspiration/expiration by #WhyCMR @MayoClinicCV @JaeKOh2 @ASE360
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@strain_rate @SBarrosGomes @garvankane @jeffreygeske @VLSorrellImages @mariovar55 @aelsab @AlexBJanjic @lpbadano @gb_mackensen @ottoecho @BonitaEcho @BartsEcho @DavidWienerMD @donoxorn @ErinMichos @edwardagill @fpmorcerf @GARCIAEDINSON95 @GWhalleyPhD @onco_cardiology Nice V cut-off sign on CWD TR trace ;reflects very high RA v-wave pressure due to 'wide-open' TR & broad, laminar flow, Doppler-derived RVSP via the simplified Bernoulli equation is inaccurate because inertial component of Bernoulli equation can’t be neglected (RSVP underestima
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Tweetorial on Challenges in Quantification of Aortic stenosis before tonight’s #ASEchoJC on @PPibarot & @E_Guzzetti 📝 . ~1/3 pts have DISCORDANT indices: AVA is severe <1 cm2 yet mean gradient is low <40 mmHG . Low Gradient types👇
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#COVID19 #echofirst Fulminent myocarditis .🔺⬆️ wall thickness& hypocontractility 2nd to inflammation/interstitial edema.🔺affects septum & inferior/infero-lateral walls.🔺best window PLAX & PSAX mid level .This is not acute myocarditis:1-2 mo after🦠 h/t @The_Echo_Nerd @ASE360
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“Flying W” sign Mid systolic notching,an abrupt⬇️in antegrade systolic velocity in pulmonary artery due to poor PA capacitance &reflectance waves out of pulmonary vasculature impeding RV systolic forward flow;Can see it w pulmonary embolism also #echofirst
Simple quiz for residents. One hemodynamic finding from this M mode of pulmonary valve
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#Gerbode AV septal defect w LV-RA shunt .🫀systole, LV-RA (L to R) shunt since LVSP > RAP.🫀diastole,R-to-L shunt since RAP >LVDP .🫀Why is RAP⬆️?⬆️ RAP from severe TR #echofirst @CASEfromASE @BonitaEcho .@JournalASEcho @LucySafi @NadeenFaza @rajdoc2005
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#COVID19 #myocarditis .37yo👨 Rx with 🔺methylprednisolone 200 mg/day x4 d 🔺immunoglobulin 20 g/day x 4 d .🔺norepinephrine 🔺toracemide &lasix .🔺milrinone .🚫#echofirst images @ESC_Journals #CHF .
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confusing LVOT Doppler signal w mitral regurgitation due to SAM in hypertrophic CM? . double check if it’s really the LVOT signal by estimating LVOT gradient with SBP/peak MR jet.& see if this matches measured LVOT (4v2) gradient. 1.Peak MR signal(velocity) gives LVP-to–LAP
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@Dr_DanMD @mmamas1973 @mirvatalasnag @AnastasiaSMihai @purviparwani @ErinMichos @MusaSharkawi @DrJayMohan @HeartOTXHeartMD @DavidWienerMD @dr_chirumamilla @NadeenFaza @evandrofilhobr @GARCIAEDINSON95 @ShariqShamimMD @PushpaShivaram @AmitGoyalMD 😎#EchoFirst tissue doppler shows ⬆️medial E’ velocity in #constriction since lateral wall is tethered to the pericardium which is the reverse(annulus reversus)of normal where lateral 10-15 cm/s E’velocity is > medial 8-10 cm/s🆚CM both medial &lateral E’ velocity⬇️ h/t @JaeKOh2
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1/Tweetorial #ASEchoJC .@CASEfromASE 86-yo man w class III CHF severe eccentric mitral regurgitation w ⬇️ functional capacity,🚫Sx candidate.Q:Can we treat w #mitraclip? .(Not typical central #echofirst regurgitantion) .A:Yes!how?start w nonstandard views
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.For aortic stenosis.🔺measure LVOT diameter 5-10 mm below annulus??.🔺this UNDERestimates SV/AVA & OVERestimates AS severity & low flow status 🆚 #WhyCMR .🔺Measure LVOT diameter at annulus: agrees best with #WhyCMR SV & AVA #echofirst @JournalASEcho
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New #CholesterolGuidelines #AHA18 .1 ❤️#healthy #lifestyle.2 ⬇️LDL 50%.3 if High Risk, + ezetimibe or PCSK9.4 LDL>190 Rx high statin.5 DM, age 40-70, & LDL>70 Rx moderat statin.6 👩🏻⚕️➡️pt talk.7 age 40-70,& intermed Risk ⬇️LDL 30%.8 risk enhancers?.9 intermed risk ➡️CAC.10 asses
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Pulmonary Regurgitation is.often an overlooked window to PA hemodynamics (PR CWD end velocity for PA diastolic pressure & peak PR CWD velocity for PA mean) #echofirst
#echofirst TEE in 2 yo boy with PR over a 16mm Contegra pulmonary valve. PR can be used to calculate the mean & diastolic pulmonary pressures. MPAP = CVP + early diastolic PR gradient . DPAP = CVP + late diastolic PR gradient
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Happy to see our 📝 on @twitter & #cme? accelerated by #COVID19 #pandemic published today by @ESC_Journals Thanks to my co authors @DrMarthaGulati @mmamas1973 @AkhilNarangMD @audvin & @DLBHATTMD for making this paper a timely read
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5 Abnormal septum motion patterns on #echofirst that are nonischemic @BijoyKhandheria . . 1.LBBB septal flash-apical rocking .🔺LV apex moves t/w RV due to early septal shortening & posterolateral stretch .🔺delayed posterolateral.contraction leads to
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A rare case of Mitral Arcade direct attachment of papillary muscles into mitral valve leaflets & results in a fibrous or muscular “arcade” formed by papillary muscles, short chords,& edge of anterior leaflet #echofirst .
Not the best image quality in this technically difficult study, but here’s an example of mitral arcade. #echofirst #CardioTwitter #mitralvalve .@ASE360 @chiles_md @HeartOTXHeartMD @BonitaEcho @BSWTemple_CVdoc @VLSorrellImages @MayoClinicCV @CASEfromASE @DrJUrbanczyk
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1/Tweetorial on #Subaortic #membrane prior to #ASEchoJC .#Prevalence-?, male predominance 2:1 .Acquired,progresses over time .Theory: LVOT architectural irregularity,steepened aortoseptal angle,creates turbulence.Isolated lesion 40% assoc with valvular AS & other congenital lesio
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Gave a mutual friend of @BethFratesMD Mike Parkinson a Christmas 🎁 tonight: The beautiful #Calendar made with her quotes & @Havenlust Scott Hefti’s photos Still time to order the 2019 calendar. Worldwide shipping . 💌 all proceeds to.@worldheartfed.
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42,000 Chinese medical staff working for over 1 month w severe #covid19 patients and NONE infected because of stringent #PPE @mswami001 @DrMarthaGulati @hmkyale @mmamas1973 @HeartBobH @JGrapsa @WilliamZoghbi @ASlavitt @ErinMichos @rajdoc2005 @wendywangmd #GetMePPE @choo_ek
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Systolic anterior motion #3DEcho #echofirst .Watch the anterior mitral leaflet be sucked up & cover the aortic opening - a view from LV side
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No time to exercise?. RCT of ESKD patients doing intradialytic cycling (🚲while getting dialyzed) for 6 mo shows .🔺⬇️ in LV mass .🔺better T1 times & aortic pulse wave velocity( less fibrosis) c/w standard of care by #whyCMR @nephondemand
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@gonzaeperez @smithECGBlog @EM_RESUS @Dr_DanMD @jpcostabel @edurontoFF @ShariqShamimMD @SIAC_cardio @adribaran @JuanM_Farina @drdargaray @rafavidalperez @fazalabul @GARCIAEDINSON95 @leonardo_seoane @mencardio Great case! Kounis syndrome (KS) hypersensitivity reactions by triggered mast cells from environmental/ pharmacological factors ➡️ acute coronary syndromes 🔺vasospasm (type I) 🔺native plaque destabilization (type II) or 🔺stent thrombosis (type III).
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What is the most common cause of aortic cusp prolapse?. transverse fold of right coronary cusp producing a partial & distal cusp prolapse. Leads to a very eccentric aortic regurgitation jet toward anterior mitral leaflet #echofirst
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calcific MS review .🔺calcium extends into mitral leaflet base,forms shelf,displaces mitral valve hinge into LV inlet, ⬇️mitral valve EROA.🔺calcific MS tubular🆚 rheumatic MS funnel impedance to LA emptying by LA y-descent & E-wave deceleration less steep
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Our @JACCJournals 📝 “Misinterpretation of @ASE360 Mitral regurgitation algorithm ?” @JudyHungMD @VLSorrellImages #echofirst - know the limitations of imaging for the best outcomes in mitral regurgitation patients @JGrapsa @argulian @WilliamZoghbi
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Rare find <0.05% IRL but more common on @twitter #echofirst quadricuspid aortic valve.
Seeing Quad! A real rarity (<0.05%) - quadricuspid aortic valve #echofirst @amerjohri @HeartDocSharon @RodrigoBagur @VLSorrellImages
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B lines lung pocus. vertical reverberation artifacts impedance mismatch b/w 🌬️&💦. arise from pleural line:set focal zone to level of pleura. extend vertically into farfield ⬆️ gain in far field. use scan depth~ 15 cm. number of B lines correlate w extra vascular water
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why do most sinus of valsalva aneurysms involve the RCC?. Form follows function. Incomplete fusion of aorta pulmonary septum &inter ventricular septum creates weakness in the central fibrous body? #echofirst .
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#EchoFirst #VisualGraphic .The worse the #aortic #stenosis.The higher the peak velocity.The later (#tardus) peak velocity.The longer the ejection time .#ACCFIT #CardioEd #FOAMed .#TAVR #RadialFirst @ASE360
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Which is better Night 🌖 Or Day 🌞 to take medications?.#Circandian #Regulated #apoptosis in #CVD.Night time. is the right time .
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Mitral Arcade .🔺severe shortening or complete absence of chordae tendinae.🔺direct attachment of papillary muscles into mitral valve leaflets.🔺results in a fibrous or muscular “arcade” formed by papillary muscles, short chords,& edge of anterior leaflet .
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Thank you @PittsburghMag for naming me a top cardiologist in #Pittsburgh (out of 46 named only 4 female cardiologists).#ACCWIC #DiversityandInclusion #WomenInScience #ILookLikeACardiologist
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Was asked “Can you suggest a few best reviews on ischemic MR” #Echofirst . @ESC_Journals . @JudyHungMD . Secondary MR assessment & severity grading challenging. Need to treat underlying LV dilation/remodeling by GDMT
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aortic root sinus shape matters. Normals: sinuses have vortices that allow for smooth closure. Aortic root replacement:(straight tube) lacks sinus architecture & vortices are not formed Loss of this function after root replacement may⬆️stress on leaflets
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Mask = Love.Love yourself.Love your neighbor.Love the stranger you pass on the street .Love in the form of a mask .#COVID19 .#ShowLoveWearAMask .#LoveIsLoveIsLoveIsAMask @linmanuel_m @ReneeGoldsberry.
@DrMarthaGulati @MassGenBrigham @ACCinTouch @DBelardoMD @CardioSmart @HeartOTXHeartMD @fischman_david @DocSavageTJU @mmamas1973 @iamritu @CDCgov @mirvatalasnag @keaglemd @cardiojaydoc02 @willsuh76 @cardioPCImom Thank you @DrMarthaGulati for amplifying this important public health message - time to wear a mask!.
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What is the most common BENIGN coronary anomaly? .Coronary artery dual ostia (LAD & LCX) arising from left SOV found in 0.4% of coronary angiograms; this incidence may change with #Yessct #echofirst
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Unroofed coronary sinus.🔺shunt direction is predominantly L to R: .LA to CS (conduit) to RA .🔺atrial-level shunt to RA, due to lower diastolic compliance of RV relative to LV.🔺When LV diastolic dysfunction develops,⬆️in L-to-R shunt.🔺> 60% unroofed CS have persistent LSVC to
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PFO’s are associated w cryptogenic stroke: here’s a thrombus in transit through a PFO h/t @Bertolin_Car .PFO size,R-L shunt grade, length(long-tunneled PFO), ASA,Chiari's ⬆️stroke risk by flow deceleration,🩸stagnation/thrombi formation w/in PFO #echofirst
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#Tapse is a Distance .T Tricuspid .A Annular.P Plane.S Systolic.E Excursion .#ASEchoJC .Use M-Mode to measure the height of excursion, NOT the slope! #Longitudinal mvmt.Correlates with RVEF, nl>16.⬇️ with severe TR, LV systolic dysfunction, prior Cardiac Sx
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The #echofirst legend .Happy 90th Dr. Feigenbaum!!
Happy 90th birthday to ASE’s founder and first president, Harvey Feigenbaum, MD, FASE! ❤️. You have touched the lives of so many and your impact on the field of echocardiography is immeasurable. We hope you have a wonderful birthday.
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Strain is not a pain.There’s much to gain.It’s not arcane.Don’t rack your brain .Know enough to come in out of the rain .Pre #ASEchoJC tomorrow 8 pm .@VicFerrariMD @JiwonKimMD @ambergtaylorgm1 @mariellesc1 @juancplana @onco_cardiology @alexFASE27
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🔺Abnormal coagulation is common in severe #COVID19 . 🔺D-Dimer >1ug/dL is an independent risk factor for in 🏥 death. 🔺Extensive intravascular microthrombosis seen at autopsy . 🔺Rx w anticoagulation if possible @ACCinTouch
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@DrRajeshG1 @CASivaram1 @argulian @purviparwani 1-IVCT.2,3 - s’ which shows a mid systolic septal deceleration likely LVOTO due to HCM.4,5 IVRT(Prolonged from HCM).6-e’.7,8 -a’ .#EchoFirst
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#EchoFirst to #Stage Cardiac Damage in #AorticStenosis 💀.Stage 0 🚫cardiac damage 8%.Stage 1 left ventricular damage 24%.Stage 2 mitral valve or left atrial damage 49%.Stage 3 tricuspid valve or pulmonary artery vasculature damage 7%.Stage 4 RV damage 12%.
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Flow velocity vectors superimposed on the color Doppler flow images in a dilated LV . With the opening of the mitral valve, there’s a shift in the filling jet direction t/w posterolateral LV wall which creates a swirling motion during diastole. #echofirst
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Amazing rare case Takotsubo with free LV wall rupture.
Watch this INCREDIBLE 3 second video clip. It’s an LV Gram showing Takotsubo with free wall rupture of the Left Ventricle. You can actually see the blood spurting out into the pericardial space with every heartbeat!. Courtesy: @Julio_Farjat .#FOAMed .
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#covid19 #acute #myocaditis 🆚 Stess CM.53 yo female 2d fatigue ( 1 wk before had fever/cough).diffuse edema w wall thickening by #whycmr tropT .24-.89, bnp 5647, EF 35%,EKg diffuse st⬆️ h/t @cshenoy3 @venkmurthy .@rajdoc2005 @purviparwani @onco_cardiology
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moderate Aortic stenosis .has mortality ratio> 2x controls (P < .001)even if LVEF or SVI preserved. ⬆️ average E/e′ ≥ 14(w atrial fib E/e′ ≥ 11)discriminates patients at higher risk(HR 2.71) even after aortic valve replacement #echofirst @MayoClinicCV
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For your next meta-analysis make your forest plots with emoji effect sizes in #RStats by @dsquintana @LesleyUttley
This is just a quick hack, but here you go people, knock yourselves out: (the text emojis probably won't on Windows) Credit to @dsquintana and ultimately @LesleyUttley for the idea.
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Type 1 acute aortic dissection:circumferential primary intimal tear leads to ascending aortic intima detachment: intimo-intimal intussusception into LV w aortic commissure detachment, impaired aortic valve coaptation by diastolic intimal flap prolapse into LV.h/t @EllenWoodcock6
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@DBelardoMD @ajaykirtane @ErinMichos @purviparwani @CMichaelGibson @medicalaxioms @netta_doc @DocSavageTJU @DrMarthaGulati @mmamas1973 This can kill us:We need #proper protection #COVID19 can infect via hair/eyelashes. #PPE includes Dedicated #covid units, centralize pts & proper PPE, that you leave on/avoid need to take off #ppe, save time & gear. Slide deck by @XihongLin 🇨🇳 .
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#visualgraphic #acute #mitral #regurgitation 1 endocarditis.2 PM rupture.3 ischemia .4 iatrogenic devices .5 transient SAM fr Takotsubo
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🧵SVC Imaging by TEE from @JournalASEcho. Midesophageal bicaval view.mouth of SVC in upper right atrium (star in image A). Slight withdrawal of probe & possible adjustment of angulation shows part of mid SVC(image B) & crista terminalis & RAA #echofirst .
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@NEJM A sense of Belonging .#ILookLikeADoctor #RepresentationMatters #BlackLivesMatter .#payitforward #YouBelongHere
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How to measure #Left #atrial #volumes #ASEchoJC @carron_hollie @kgzimmerman @carolKCW @DavidWienerMD @rajdoc2005 @KamuMaganti
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Difference b/w a posterior mitral valve cleft(goes all the way down to annulus) 🆚indentation(exaggerated demarcations typically involve posterior leaflet) #EchoFirst @AlsidawiMD @adnanalkhouli @AkhilNarangMD @JoaoLCavalcante @Pooh_Velagapudi @atunuguntla1 @rajdoc2005 @JGrapsa
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Bicuspid Aortic Valve in @escardio Sports Cardiology guidelines .🔺Unclear if bicuspid aortic valve accelerates aortic dilatation.🔺if Aortic root is >40 mm, exercise with less intensity.🔺if aortic root size is nl, no restrictions on exercise .🔺no intensive exercise w severe AS
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E/e’ on stress echo predicts ☠️beyond ischemia & LVEF .@MayoClinicCV📝>14k pts. Pts w E/e’≥15 post exercise 1.39x⬆️risk(95% CI 1.18-1.65, p<0.0001)of all-cause☠️c/w pts w/o⬆️LV filling pressures.adjusted for age, sex, exercise capacity, LVEF, pulm htn. E
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