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Cardiovascular Comorbidity in Chronic Lung Disease: Epidemiology, Clinical Manifestations, and Diagnosis

  • Surya P. BhattEmail author
Chapter
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Part of the Respiratory Medicine book series (RM)

Abstract

Chronic lung diseases account for a substantial amount of morbidity and disability. Chronic lung diseases and cardiovascular disease are both very prevalent but their co-existence is not explained by chance but by the risk of atherosclerosis and deranged cardiopulmonary interactions conferred by the presence of chronic lung disease. A low index of suspicion should be maintained to evaluate for chronic lung or cardiovascular disease when one of these is present, especially when symptoms and functional impairment is deemed to be out of proportion for the existing diagnosis.

Keywords

Chronic lung disease Coronary artery disease Congestive heart failure Epidemiology 

References

  1. 1.
    Ma J, Ward EM, Siegel RL, Jemal A. Temporal trends in mortality in the United States, 1969-2013. JAMA. 2015;314:1731–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Mannino DM, McBurnie MA, Tan W, Kocabas A, Anto J, Vollmer WM, Buist AS, BOLD Collaborative Research Group. Restricted spirometry in the Burden of Lung Disease Study. Int J Tuberc Lung Dis. 2012;16(10):1405–11.PubMedGoogle Scholar
  3. 3.
    Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH. COPD surveillance – United States, 1999-2011. Chest. 2013;144:284–305.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Mazurek JM, Syamlal G. Prevalence of asthma, asthma attacks, and emergency department visits for asthma among working adults – National Health Interview Survey, 2011-2016. MMWR Morb Mortal Wkly Rep. 2018;67:377–86.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jimenez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135:e146–603.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Bhatt SP, Dransfield MT. Chronic obstructive pulmonary disease and cardiovascular disease. Transl Res. 2013;162:237–51.PubMedCrossRefGoogle Scholar
  7. 7.
    Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc. 2005;2:8–11.PubMedCrossRefGoogle Scholar
  8. 8.
    Chen W, Thomas J, Sadatsafavi M, FitzGerald JM. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2015;3:631–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Hole DJ, Watt GC, Davey-Smith G, Hart CL, Gillis CR, Hawthorne VM. Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study. BMJ. 1996;313:711–5; discussion 715–6.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Anthonisen NR, Connett JE, Enright PL, Manfreda J, Lung Health Study Research Group. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med. 2002;166:333–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Duong M, Islam S, Rangarajan S, Leong D, Kurmi O, Teo K, Killian K, Dagenais G, Lear S, Wielgosz A, Nair S, Mohan V, Mony P, Gupta R, Kumar R, Rahman O, Yusoff K, du Plessis JL, Igumbor EU, Chifamba J, Li W, Lu Y, Zhi F, Yan R, Iqbal R, Ismail N, Zatonska K, Karsidag K, Rosengren A, Bahonar A, Yusufali A, Lamelas PM, Avezum A, Lopez-Jaramillo P, Lanas F, O’Byrne PM, Yusuf S, PURE Investigators. Mortality and cardiovascular and respiratory morbidity in individuals with impaired FEV1 (PURE): an international, community-based cohort study. Lancet Glob Health. 2019;7:e613–23.PubMedCrossRefGoogle Scholar
  12. 12.
    Cazzola M, Bettoncelli G, Sessa E, Cricelli C, Biscione G. Prevalence of comorbidities in patients with chronic obstructive pulmonary disease. Respiration. 2010;80:112–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Curkendall SM, DeLuise C, Jones JK, Lanes S, Stang MR, Goehring E Jr, She D. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients. Ann Epidemiol. 2006;16:63–70.PubMedCrossRefGoogle Scholar
  14. 14.
    Feary JR, Rodrigues LC, Smith CJ, Hubbard RB, Gibson JE. Prevalence of major comorbidities in subjects with COPD and incidence of myocardial infarction and stroke: a comprehensive analysis using data from primary care. Thorax. 2010;65:956–62.PubMedCrossRefGoogle Scholar
  15. 15.
    Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J. 2008;32:962–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Sode BF, Dahl M, Nordestgaard BG. Myocardial infarction and other co-morbidities in patients with chronic obstructive pulmonary disease: a Danish nationwide study of 7.4 million individuals. Eur Heart J. 2011;32:2365–75.PubMedCrossRefGoogle Scholar
  17. 17.
    Kannel WB, Hubert H, Lew EA. Vital capacity as a predictor of cardiovascular disease: the Framingham study. Am Heart J. 1983;105:311–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Schroeder EB, Welch VL, Couper D, Nieto FJ, Liao D, Rosamond WD, Heiss G. Lung function and incident coronary heart disease: the Atherosclerosis Risk in Communities Study. Am J Epidemiol. 2003;158:1171–81.PubMedCrossRefGoogle Scholar
  19. 19.
    Kizer JR, Zisman DA, Blumenthal NP, Kotloff RM, Kimmel SE, Strieter RM, Arcasoy SM, Ferrari VA, Hansen-Flaschen J. Association between pulmonary fibrosis and coronary artery disease. Arch Intern Med. 2004;164:551–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Izbicki G, Ben-Dor I, Shitrit D, Bendayan D, Aldrich TK, Kornowski R, Kramer MR. The prevalence of coronary artery disease in end-stage pulmonary disease: is pulmonary fibrosis a risk factor? Respir Med. 2009;103:1346–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Hubbard RB, Smith C, Le Jeune I, Gribbin J, Fogarty AW. The association between idiopathic pulmonary fibrosis and vascular disease: a population-based study. Am J Respir Crit Care Med. 2008;178:1257–61.PubMedCrossRefGoogle Scholar
  22. 22.
    Liu H, Fu Y, Wang K. Asthma and risk of coronary heart disease: a meta-analysis of cohort studies. Ann Allergy Asthma Immunol. 2017;118:689–95.PubMedCrossRefGoogle Scholar
  23. 23.
    Behar S, Panosh A, Reicher-Reiss H, Zion M, Schlesinger Z, Goldbourt U. Prevalence and prognosis of chronic obstructive pulmonary disease among 5,839 consecutive patients with acute myocardial infarction. SPRINT Study Group. Am J Med. 1992;93:637–41.PubMedCrossRefGoogle Scholar
  24. 24.
    Soriano JB, Rigo F, Guerrero D, Yanez A, Forteza JF, Frontera G, Togores B, Agusti A. High prevalence of undiagnosed airflow limitation in patients with cardiovascular disease. Chest. 2010;137:333–40.PubMedCrossRefGoogle Scholar
  25. 25.
    Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity. Int J Chron Obstruct Pulmon Dis. 2009;4:337–49.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Schnell K, Weiss CO, Lee T, Krishnan JA, Leff B, Wolff JL, Boyd C. The prevalence of clinically-relevant comorbid conditions in patients with physician-diagnosed COPD: a cross-sectional study using data from NHANES 1999-2008. BMC Pulm Med. 2012;12:26.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Strachan DP. Ventilatory function as a predictor of fatal stroke. BMJ. 1991;302:84–7.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Wannamethee SG, Shaper AG, Ebrahim S. Respiratory function and risk of stroke. Stroke. 1995;26:2004–10.PubMedCrossRefGoogle Scholar
  29. 29.
    Truelsen T, Prescott E, Lange P, Schnohr P, Boysen G. Lung function and risk of fatal and non-fatal stroke. The Copenhagen City Heart Study. Int J Epidemiol. 2001;30:145–51.PubMedCrossRefGoogle Scholar
  30. 30.
    Gulsvik AK, Gulsvik A, Skovlund E, Thelle DS, Mowe M, Humerfelt S, Wyller TB. The association between lung function and fatal stroke in a community followed for 4 decades. J Epidemiol Community Health. 2012;66:1030–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Portegies ML, Lahousse L, Joos GF, Hofman A, Koudstaal PJ, Stricker BH, Brusselle GG, Ikram MA. Chronic obstructive pulmonary disease and the risk of stroke. The Rotterdam Study. Am J Respir Crit Care Med. 2016;193:251–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Wen LY, Ni H, Li KS, Yang HH, Cheng J, Wang X, Zhao DS, Xie MY, Su H. Asthma and risk of stroke: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2016;25:497–503.PubMedCrossRefGoogle Scholar
  33. 33.
    Kim SY, Lim H, Lim JS, Choi HG. Analysis of the relationship between adult asthma and stroke: a longitudinal follow-up study using the Korean National sample cohort. Biomed Res Int. 2019;2019:8919230.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Strand LB, Tsai MK, Wen CP, Chang SS, Brumpton BM. Is having asthma associated with an increased risk of dying from cardiovascular disease? A prospective cohort study of 446 346 Taiwanese adults. BMJ Open. 2018;8:e019992.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Houben-Wilke S, Jorres RA, Bals R, Franssen FM, Glaser S, Holle R, Karch A, Koch A, Magnussen H, Obst A, Schulz H, Spruit MA, Wacker ME, Welte T, Wouters EF, Vogelmeier C, Watz H. Peripheral artery disease and its clinical relevance in patients with chronic obstructive pulmonary disease in the COPD and Systemic Consequences-Comorbidities Network Study. Am J Respir Crit Care Med. 2017;195:189–97.PubMedCrossRefGoogle Scholar
  36. 36.
    Camiciottoli G, Bigazzi F, Magni C, Bonti V, Diciotti S, Bartolucci M, Mascalchi M, Pistolesi M. Prevalence of comorbidities according to predominant phenotype and severity of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2016;11:2229–36.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Liao KM, Kuo LT, Lu HY. Increased risk of peripheral arterial occlusive diseases in patients with chronic obstructive pulmonary disease: a nationwide study in Taiwan. Int J Chron Obstruct Pulmon Dis. 2019;14:1455–64.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Terzikhan N, Lahousse L, Verhamme KMC, Franco OH, Ikram AM, Stricker BH, Brusselle GG. COPD is associated with an increased risk of peripheral artery disease and mortality. ERJ Open Res. 2018;4:00086.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Tschopp J, Dumont P, Hayoz D. True prevalence of COPD and its association with peripheral arterial disease in the internal medicine ward of a tertiary care hospital. Swiss Med Wkly. 2017;147:w14460.PubMedGoogle Scholar
  40. 40.
    Pecci R, De La Fuente Aguado J, Sanjurjo Rivo AB, Sanchez Conde P, Corbacho Abelaira M. Peripheral arterial disease in patients with chronic obstructive pulmonary disease. Int Angiol. 2012;31:444–53.PubMedGoogle Scholar
  41. 41.
    Yao CW, Shen TC, Lu CR, Wang YC, Lin CL, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC. Asthma is associated with a subsequent risk of peripheral artery disease: a longitudinal population-based study. Medicine (Baltimore). 2016;95:e2546.CrossRefGoogle Scholar
  42. 42.
    Rutten FH, Cramer MJ, Grobbee DE, Sachs AP, Kirkels JH, Lammers JW, Hoes AW. Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease. Eur Heart J. 2005;26:1887–94.PubMedCrossRefGoogle Scholar
  43. 43.
    Georgiopoulou VV, Kalogeropoulos AP, Psaty BM, Rodondi N, Bauer DC, Butler AB, Koster A, Smith AL, Harris TB, Newman AB, Kritchevsky SB, Butler J. Lung function and risk for heart failure among older adults: the Health ABC Study. Am J Med. 2011;124:334–41.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Engstrom G, Melander O, Hedblad B. Population-based study of lung function and incidence of heart failure hospitalisations. Thorax. 2010;65:633–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Alter P, Watz H, Kahnert K, Pfeifer M, Randerath WJ, Andreas S, Waschki B, Kleibrink BE, Welte T, Bals R, Schulz H, Biertz F, Young D, Vogelmeier CF, Jorres RA. Airway obstruction and lung hyperinflation in COPD are linked to an impaired left ventricular diastolic filling. Respir Med. 2018;137:14–22.PubMedCrossRefGoogle Scholar
  46. 46.
    Kubota Y, Asai K, Murai K, Tsukada YT, Hayashi H, Saito Y, Azuma A, Gemma A, Shimizu W. COPD advances in left ventricular diastolic dysfunction. Int J Chron Obstruct Pulmon Dis. 2016;11:649–55.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Malerba M, Ragnoli B, Salameh M, Sennino G, Sorlini ML, Radaeli A, Clini E. Sub-clinical left ventricular diastolic dysfunction in early stage of chronic obstructive pulmonary disease. J Biol Regul Homeost Agents. 2011;25:443–51.PubMedGoogle Scholar
  48. 48.
    Sabit R, Bolton CE, Fraser AG, Edwards JM, Edwards PH, Ionescu AA, Cockcroft JR, Shale DJ. Sub-clinical left and right ventricular dysfunction in patients with COPD. Respir Med. 2010;104:1171–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Funk GC, Lang I, Schenk P, Valipour A, Hartl S, Burghuber OC. Left ventricular diastolic dysfunction in patients with COPD in the presence and absence of elevated pulmonary arterial pressure. Chest. 2008;133:1354–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Schena M, Clini E, Errera D, Quadri A. Echo-Doppler evaluation of left ventricular impairment in chronic cor pulmonale. Chest. 1996;109:1446–51.PubMedCrossRefGoogle Scholar
  51. 51.
    Freixa X, Portillo K, Pare C, Garcia-Aymerich J, Gomez FP, Benet M, Roca J, Farrero E, Ferrer J, Fernandez-Palomeque C, Antó JM, Barbera JA, PAC-COPD Study Investigators. Echocardiographic abnormalities in patients with copd at their first hospital admission. Eur Respir J. 2013;41(4):784–91.PubMedCrossRefGoogle Scholar
  52. 52.
    Barr RG, Bluemke DA, Ahmed FS, Carr JJ, Enright PL, Hoffman EA, Jiang R, Kawut SM, Kronmal RA, Lima JA, Shahar E, Smith LJ, Watson KE. Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med. 2010;362:217–27.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    McCord J, Borzak S. Multifocal atrial tachycardia. Chest. 1998;113:203–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Levine JH, Michael JR, Guarnieri T. Multifocal atrial tachycardia: a toxic effect of theophylline. Lancet. 1985;1:12–4.PubMedCrossRefGoogle Scholar
  55. 55.
    Shih HT, Webb CR, Conway WA, Peterson E, Tilley B, Goldstein S. Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease. Chest. 1988;94:44–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Buch P, Friberg J, Scharling H, Lange P, Prescott E. Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study. Eur Respir J. 2003;21:1012–6.PubMedCrossRefGoogle Scholar
  57. 57.
    Li J, Agarwal SK, Alonso A, Blecker S, Chamberlain AM, London SJ, Loehr LR, McNeill AM, Poole C, Soliman EZ, Heiss G. Airflow obstruction, lung function, and incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2014;129:971–80.PubMedCrossRefGoogle Scholar
  58. 58.
    Konecny T, Park JY, Somers KR, Konecny D, Orban M, Soucek F, Parker KO, Scanlon PD, Asirvatham SJ, Brady PA, Rihal CS. Relation of chronic obstructive pulmonary disease to atrial and ventricular arrhythmias. Am J Cardiol. 2014;114:272–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Tukek T, Yildiz P, Akkaya V, Karan MA, Atilgan D, Yilmaz V, Korkut F. Factors associated with the development of atrial fibrillation in COPD patients: the role of P-wave dispersion. Ann Noninvasive Electrocardiol. 2002;7:222–7.PubMedCrossRefGoogle Scholar
  60. 60.
    Bhatt SP, Nanda S, Kintzer JS. Arrhythmias as trigger for acute exacerbations of chronic obstructive pulmonary disease. Respir Med. 2012;106:1134–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Sarubbi B, Esposito V, Ducceschi V, Meoli I, Grella E, Santangelo L, Iacano A, Caputi M. Effect of blood gas derangement on QTc dispersion in severe chronic obstructive pulmonary disease: evidence of an electropathy? Int J Cardiol. 1997;58:287–92.PubMedCrossRefGoogle Scholar
  62. 62.
    Warnier MJ, Blom MT, Bardai A, Berdowksi J, Souverein PC, Hoes AW, Rutten FH, de Boer A, Koster RW, De Bruin ML, Tan HL. Increased risk of sudden cardiac arrest in obstructive pulmonary disease: a case-control study. PLoS One. 2013;8:e65638.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Lahousse L, Niemeijer MN, van den Berg ME, Rijnbeek PR, Joos GF, Hofman A, Franco OH, Deckers JW, Eijgelsheim M, Stricker BH, Brusselle GG. Chronic obstructive pulmonary disease and sudden cardiac death: the Rotterdam study. Eur Heart J. 2015;36:1754–61.PubMedCrossRefGoogle Scholar
  64. 64.
    van den Berg ME, Stricker BH, Brusselle GG, Lahousse L. Chronic obstructive pulmonary disease and sudden cardiac death: a systematic review. Trends Cardiovasc Med. 2016;26:606–13.PubMedCrossRefGoogle Scholar
  65. 65.
    Iribarren C, Round AD, Peng JA, Lu M, Klatsky AL, Zaroff JG, Holve TJ, Prasad A, Stang P. Short QT in a cohort of 1.7 million persons: prevalence, correlates, and prognosis. Ann Noninvasive Electrocardiol. 2014;19:490–500.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Tukek T, Yildiz P, Atilgan D, Tuzcu V, Eren M, Erk O, Demirel S, Akkaya V, Dilmener M, Korkut F. Effect of diurnal variability of heart rate on development of arrhythmia in patients with chronic obstructive pulmonary disease. Int J Cardiol. 2003;88:199–206.PubMedCrossRefGoogle Scholar
  67. 67.
    Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJ. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology. Eur J Heart Fail. 2009;11:130–9.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Le Jemtel TH, Padeletti M, Jelic S. Diagnostic and therapeutic challenges in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure. J Am Coll Cardiol. 2007;49:171–80.PubMedCrossRefGoogle Scholar
  69. 69.
    Naum CC, Sciurba FC, Rogers RM. Pulmonary function abnormalities in chronic severe cardiomyopathy preceding cardiac transplantation. Am Rev Respir Dis. 1992;145:1334–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Light RW, George RB. Serial pulmonary function in patients with acute heart failure. Arch Intern Med. 1983;143:429–33.PubMedCrossRefGoogle Scholar
  71. 71.
    Guder G, Rutten FH, Brenner S, Angermann CE, Berliner D, Ertl G, Jany B, Lammers JW, Hoes AW, Stork S. The impact of heart failure on the classification of COPD severity. J Card Fail. 2012;18:637–44.PubMedCrossRefGoogle Scholar
  72. 72.
    Thomason JW, Ely EW, Chiles C, Ferretti G, Freimanis RI, Haponik EF. Appraising pulmonary edema using supine chest roentgenograms in ventilated patients. Am J Respir Crit Care Med. 1998;157:1600–8.PubMedCrossRefGoogle Scholar
  73. 73.
    Martin GS, Ely EW, Carroll FE, Bernard GR. Findings on the portable chest radiograph correlate with fluid balance in critically ill patients. Chest. 2002;122:2087–95.PubMedCrossRefGoogle Scholar
  74. 74.
    Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134:117–25.PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Picano E, Frassi F, Agricola E, Gligorova S, Gargani L, Mottola G. Ultrasound lung comets: a clinically useful sign of extravascular lung water. J Am Soc Echocardiogr. 2006;19:356–63.PubMedCrossRefGoogle Scholar
  76. 76.
    Mayo PH, Copetti R, Feller-Kopman D, Mathis G, Maury E, Mongodi S, Mojoli F, Volpicelli G, Zanobetti M. Thoracic ultrasonography: a narrative review. Intensive Care Med. 2019;45:1200–11.PubMedCrossRefGoogle Scholar
  77. 77.
    Gerges C, Gerges M, Lang MB, Zhang Y, Jakowitsch J, Probst P, Maurer G, Lang IM. Diastolic pulmonary vascular pressure gradient: a predictor of prognosis in “out-of-proportion” pulmonary hypertension. Chest. 2013;143:758–66.PubMedCrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Division of Pulmonary, Allergy and Critical Care MedicineUniversity of Alabama at BirminghamBirminghamUSA

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