End-Stage Heart Failure: Surgical Options
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A lternative SurgicalStrategies Alternative SurgicalStrategies for H eartFailure for H eartFailure R obertA E D ion R obertA E D ion D epartm entof D epartm entofCardio Cardio- thoracic thoracic Surgery Surgery Leiden U niversity M edicalCenter Leiden U niversity M edicalCenter
description
ischemia (CABG) mitralis insuf. (RMA) "Dor" aneurysmectomy S urgical V entricular R estoration mechanical /assistance replacement HTX. End-Stage Heart Failure: Surgical Options. REPAIR. RESHAPE. REPLACE. Systolic restrictive motion. ECHO CRITERIA OF SEVERE MR. ORGANIC. ERO (cm 2 ) - PowerPoint PPT Presentation
Transcript of End-Stage Heart Failure: Surgical Options
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Alternative Surgical Strategies for Heart Failure
Robert AE Dion
Department of Cardio-thoracic SurgeryLeiden University Medical Center
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End-Stage Heart Failure: Surgical Optionsischemia (CABG)mitralis insuf. (RMA)
"Dor" aneurysmectomySurgical Ventricular Restoration
mechanical /assistance replacementHTX
REPAIRRESHAPEREPLACE
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Systolic restrictive motion
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> 30
> 0.2
IMRRV (ml)
> 60ERO (cm2)
> 0.4
ORGANICECHO CRITERIA OF SEVERE MRM. Enriquez-Sarano
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Restrictive Mitral Annuloplasty:two sizes under
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Postoperative echo result
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Restrictive Annuloplasty for Ischaemic Mitral Regurgitation results in Reverse Left Ventricular RemodelingJ. Braun, J.J. Bax, M.I.M. Versteegh, P.G. Voigt,E.R. Holman, R.J.M. Klautz, R.A.E. Dion Departments of Cardiothoracic Surgery and Cardiology,Leids Universitair Medisch Centrum
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Patient characteristicsEACTS 15/09/04Jan 2000 March 200487 patientsage 66 10 yrsNYHA 3.0 0.9III / IV: 82 %log EuroSCORE11.0 10.8previous CABG7 %
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Baseline echocardiographyMR grade3.1 0.53+ / 4+ : 81 %LA size (mm)54 6LVESD (mm)52 8LVEDD (mm)64 8LVEF (%)32 10EACTS 15/09/04
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Surgerymedian annuloplasty ring size26
CABG86 %mean distal anastomoses3.3 1.3
CPB time (min)189 52Ao-clamp (min)125 37EACTS 15/09/04
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Results (1)Time (years)543210Cumulative Survival1,0,9,8,7,6,5,4,3,2,10,0Early mortality 8.0 % (n=7)Late mortality 7.5 % (n=6)87 65 43 25 9
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Results (3)
Baseline3.1 0.5
Coaptation height 8 1 mmMV diastolic gradient 2.4 0.6 mmHgEACTS 15/09/04Mitral regurgitationEarly 0.4 0.3Late 0.6 0.6
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Results (4)LVESD (mm)Baseline52 8Late FU 44 11(p < 0.01)
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Results (5)LVEDD (mm)Baseline64 8Late FU 58 10EACTS 15/09/04(p < 0.01)
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LVESD and Reverse RemodelingLVESD (mm)specificitysensitivityEACTS 15/09/04
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LVEDD (mm)specificitysensitivityLVEDD and Reverse RemodelingEACTS 15/09/04
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RESULTS
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Long-Term Durability after restrictive MVP11 patients MRI pre-surgery and follow-up MRI 7 men / 4 women mean age SD: 53 14 years mean follow-up period SD: 42 7 months
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Long-Term Durability after restrictive MVP PRE POST (note: MI jet)(note: restrictive ring)
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Long-Term Durability after restrictive MVP
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ConclusionsRMA + CABG yield reverse remodeling
Preoperative LV dimensions limit extent of reverse remodeling
Additional techniques may be needed whenLVEDD > 65EACTS 15/09/04
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Restrictive Mitral Annuloplasty in Non-ischemic Dilating CardiomyopathyJ. Braun, J.J. Bax, M.I.M. Versteegh, P.G. Voigt,E.R. Holman, R.J.M. Klautz, R.A.E. Dion Departments of Cardiothoracic Surgery and Cardiology,Leids Universitair Medisch Centrum
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Patient Characteristics02/02/05July 2000 March 2004
29 patients6 RMA + CorCap
23 RMA
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Baseline echocardiographyMR grade3.7 0.53+ / 4+ : 100 %
LVESD (mm)62 10
LVEDD (mm)74 1102/02/05
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Surgerymean annuloplasty ring size26 2size 24 : n = 10
TVP12 ( 52 %)TEE coaptation (mm) 8 1
CPB time (min)120 27Ao-clamp (min) 70 2102/02/05
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Results (1)
POD 3: F 63 y NYHA III LV 73 / 63 RMA 26 postop tamponade persisting AF IABP CVVH - MOFEarly mortality 8.6 % (n=2)
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Results (3)
Late mortality 14.2 % (n=3)10 mo :VF resuscitation18 mo :collapse27 mo :septicaemia02/02/05
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Results (4)Clinical follow-up ( 27 13 months)NYHA3.3 0.5 1.7 0.6
21330517621031241IIIIIIIVdeath02/02/05
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Results (5)
Follow up17 9 monthsMR 0.7 0.91 MR grade 21 MR grade 3
LVEDD (mm)75 9 mm64 10LVESD (mm)62 9 mm58 13Echocardiography02/02/05
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CorCap NVT 08/10/04
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PATIENTSNov 2002 June 2005: 25 pts
age (y)62.5 (34-76)
males17
NYHA 3.4
EuroSCORE14
LVEF (%)22 (15-26)
LUMC 06-05
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Concomitant ProceduresMVP24TVP19AF ablation 4CABG 5AVR 1CPB (min) 128 + 23X clamptime (min) 66 + 21LUMC 06-05
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EchocardiographyLUMC 06-05
Pre-opDischargeFollow-up (6 m)MR3.10.30.7LVEDD (mm)72.769.668.3LVESD (mm)62.56162
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Left ventricular restoration in ischemic congestive heart failure: The Leiden ExperienceKlein P.1, Versteegh M.I.M.1, Klautz R.J.M.1, de Weger A.1, Tavilla G.1, Holman E.R.2, Bax J.J.2, Dion R.A.E.1
1Department of Cardiothoracic Surgery, 2Department of CardiologyLeids Universitair Medisch Centrum
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Study population (I) 39 patients with ICHF
30 males, mean age 62 11 years
NYHA-class 3.1 0.5
LVEF 20.5 6.4%
median interval after infarction 36 months (1-240)
EuroSCORE 14 13
5 patients were operated in emergency (13%)2 pre-op IABP1 pre-op ventilation1 acute infarction
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Surgical procedure
according to DOR
Fontan stitch
sizing of residual LV using a saline-filled balloon (55 ml / m2BSA)
elliptical shape !
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Dor / SVR
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Concomitant proceduresCABG in 28 patients (72%)Mean number of distal anastomoses 2.4 1.2
Restrictive mitral annuloplasty in 25 patients (64%) Mean ring size 26 2
Tricuspid annuloplasty 10 (26%)
VT-ablation 1 (3%)
VSR-repair 1 (3%)
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Mortality / morbidityHospital mortality10,3%
Post-operative complicationsperi-operative MI0%postoperative IABP26%bleeding needing reoperation3%CVA3%dialysis8% 1 pre-op chronic dialysis
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Echocardiographic data
Pre-operativePost-operativep-valueLVEF (%)20.5 6.433.9 9.8
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LVR and mitral valve repairApical four chamber view before restoration
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LVR and mitral valve repairApical four chamber. Note the patch at the apical region and the improved contraction.
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Results: RMA + DOR + CABG
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Sustained left ventricular reverse remodeling, improved systolic function and unchanged diastolic function six months after surgical ventricular restoration
S.A.F. Tulner, P. Steendijk, R.J.M. Klautz, J.J. Bax, P.Oemrawsingh, H.F. Verwey, M.J. Schalij, E.E. van der Wall, R.A.E. Dion Departments of Cardio-Thoracic Surgery and Cardiology
Leiden University Medical Center
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Clinical resultsICU stay 6 days (1-35)
Hospital stay 14 days (8-47)
Mean follow-up 13 10 months
Late mortality 11.4% (4 patients) CHF 2 (+10mo, +1mo) Cancer 1, CVA 1
Mean NYHA at follow-up 1.1 0.3
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0IDeathNYHA classPost0II28III11IV01083023447Pre
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Conclusions
LVR for ischemic CHF with mitral insufficiency can be
performed with acceptable mortality.
At follow-up there is a sustained improvement of LVEF
and reduction of LV volumes with a tendency towards
reverse remodeling of the remote myocardium.
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The "Leiden Algorithm" Preop LVEDD < 65:RMA
> 65 < 80:RMA + CorCapRMA + "Dor"
> 80:HTXSVR (+ RMA)
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Reversible cause? NoCorrectionRecoveryFollow UpNON-ISCHEMIC(medication+ lifestyle)No complete recoveryRESYNCHRONIZATION?SignificantValve disease?Indication SVR?Valve surgery + SVRSVRValve surgery CorCapYesYesYes NoIndication SVR?Yes NoINVASIVESURGERYREVASCULARISATION/SURGERYNoISCHEMICIschemia and/or viability? AP and significant CAD?CABG + valve-surgerySignificantValve disease?CABG + SVR/Dor + valve surgeryIndication LV-reconstruction?SVR/DorIndication LV-reconstruction?Valve surgery + SVR/DorIndication SVR/Dor?SignificantValve disease?CABG + SVR/DorPCI or CABGYes No NoYesNoValve surgery ( CorCap) No No NoYesIndication SVR?YesYes NoFOLLOW UPFOLLOW UPMISSION! HF
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INVASIVEMISSION! HFREVASCULARISATION/SURGERYISCHEMICIschemia and/or viability? AP and significant CAD?CABG + valve-surgerySignificantValve disease?CABG + SVR/Dor + valve surgeryIndication LV-reconstruction?SVR/DorIndication LV-reconstruction?Valve surgery + SVR/DorIndication SVR/Dor?SignificantValve disease?CABG + SVR/DorPCI or CABGYes No NoYesNoValve surgery ( CorCap) No No NoYesIndication SVR?YesYes NoFOLLOW UPRESYNCHRONIZATION?
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Reversible cause? NoCorrectionRecoveryFollow UpNON-ISCHEMIC(medication+ lifestyle)No complete recoveryRESYNCHRONIZATION?SignificantValve disease?Indication SVR?Valve surgery + SVRSVRValve surgery CorCapYesYesYes NoIndication SVR?Yes NoINVASIVESURGERYNoFOLLOW UPMISSION! HF
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MISSION! HFSCREENING & ETIOLOGYHistoryNYHA classExaminationLAB ECGX-ray ChestTTEFurther analysisChronic heart failure? NoLVEF < 40%NYHA III or IVExercise testing with VO2 maxMyoview stress and rest, FDGCAG (left & right)24 hour Holter monitoringadditional LABQOL score + 6 min. walk testOld myocardial infarction and/or 1 coronair with > 50% stenosis?YesISCHEMIC causeNON-ISCHEMIC causeNoLAB NT-proBNPComplete blood countESR, CRPElectrolytes, Creat, BUNLiver panelLipid profileTSH, fT4GlucoseYesTHERAPYFurther analysis
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MISSION! HFBASISNYHA IContinue medication(!), lower dosis diureticsNYHA IIAtrial fibrillation VR > 100: DigoxineDiureticsACE-inhibitoreta blocker++Thiazide 1 dd when mild HF and clearance > 30- start ATB in case of ACE-intolerance- c.i.: potassium > 5.5, dubbelsided renal arterystenosis- raise every 2 weeks untill (individual) maximumPersisting low potassium: start spironolacton 1 dd 12.5 mg or Inspra 1 dd 12.5 mgLoopdiuretics 1 ddLoopdiuretics 2 dd - start when no signs of decompensation raise every 2 weeks until (individual) maximumLoopdiuretics 2 dd + ThiazideNitrate in case of orthopnoeaConsider Nitrate i.c.w. Hydralazine in case of ACE-intoleranceSpironolacton 1dd 25 mg in case of gynaecomasty: eplerenone 1 dd 25-50 mg c.i.: potassium > 5.0, Creat > 250 if needed, consider ATB in stead of spironolacton NYHA III or IVNYHA IVDigoxin(sinusrhythm)NYHA IIIMEDICATION
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MISSION! HFRESYNCHRONIZATION?Biventricular ICDFOLLOW UPEF < 30%VF or haemodynamicunstable VTICDICDEF 30 - 40 % +VT/NSVTEFOIndication HTx?Stemcell therapy?ICDWhen pre-operative: LVEF < 30% and SL-delay > 40 or QRS > 120ms: - epicardial LV-lead peri-operative - post-operative biventricular ICD When pre-operative: - LVEF < 30%: ICD post-operative LVEF > 30% + (NS)VT: EFO + ICDWhen surgery waitinglist is long and (biv) ICD indication: consider (biv) ICD implantation pre-operativelySL delay > 40 ms(EF < 30% + NYHA III or IV)Yes NoSCD RISK ASSESSMENT
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MISSION! HFFOLLOW UP and RE-EVALUATIONMonth 3 + Month 9Week 2-3AFTER INVASIVE PROCEDUREDOCTOR + HF nurseHistory, NYHAclass ExaminationLAB ECGTTE (only Month3 visit)HF nurseHistory, NYHA classExaminationLAB (incl. NT-proBNP)ECGREGULAR FOLLOW UPMonth 6 + Month 12 DOCTOR + HF nurseHF nurseHistory, NYHA classExaminationLAB (incl. NT-proBNP)ECGQOL + 6 min. walk testExercise + VO2maxTTEOnly month 12 visit:24 hour holterRE-EVALUATIONEvery year orworsening NYHAWhen appropriate,re-evaluate indication for: revascularisation valve / LV surgery resynchronization therapy ICD HTx stemcell therapyevery 3 monthsDOCTOR + HF nurseHistory, NYHA classExaminationLAB (incl. NT-proBNP) ECGExercise + VO2maxTTELUMC every yearOWN CARDIOLOGISTNYHA class III / IV NYHA class I / II History, NYHAclass ExaminationLAB ECGDOCTOR + HF nurseHistory, NYHA classExaminationLAB (incl. NT-proBNP)ECGTTEExercise + VO2maxQOL + 6 min. walk testHolter (CAG) ( Myoview)PRE-OP2 weeks before surgeryHF nurseHistory, NYHA classExaminationLAB ECGRE-EVALUATIONDOCTORevery 6 monthsHistory, NYHA class ExaminationLAB ECG
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Acute hemodynamic effects of restrictive mitral annuloplasty in patients with end-stage heart failureS.A.F. Tulner, P. Steendijk, R.J.M. Klautz, J.J. Bax, M.I.M. Versteegh, E.E. van der Wall, R.A.E. DionJ Thorac Cardiovascular Surgery (in press)Departments of Cardio-Thoracic Surgery and CardiologyLeiden University Medical Center
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Results: typical example of RMA
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331.66302.797.476215.094
332.38302.947.565915.709
333.2302.937.658616.459
333.96302.797.75817.368
334.67302.687.863318.488
335.15302.587.987619.817
335.55302.598.134921.363
335.86302.448.319623.101
336.18302.328.550525.049
336.42301.98.847827.183
336.44301.429.232229.466
336.14300.749.708531.839
335.430010.28934.275
334.24299.2410.98136.769
332.67298.5911.79739.32
330.8729812.7641.905
328.97297.4613.89944.473
327.04297.0515.18246.979
325.09296.7616.55649.404
323.2296.6918.01951.716
321.47296.5819.59653.919
319.85296.4821.32555.978
318.22296.4323.19557.911
316.6296.5725.19459.708
315.07296.7227.29161.391
313.68297.1329.44662.954
312.47297.7831.65464.414
311.4298.8933.92765.783
310.45300.2636.25767.069
309.62301.6538.65568.289
308.87302.7541.11169.43
308.2303.2943.60570.512
307.59303.4246.09271.515
307.05303.0248.53272.454
306.56302.2150.93473.334
306.01300.8553.2974.156
305.32299.1955.60474.933
304.39297.1957.83475.631
303.27294.9959.95876.272
302.08292.7661.95376.847
300.9290.6163.81177.376
299.79288.4865.53977.851
298.7286.3867.13978.283
297.65284.2668.61878.665
296.61282.1369.98278.989
295.51279.8871.24779.26
294.31277.4372.4379.475
292.95274.7873.53579.662
291.42272.174.57979.793
289.79269.4475.55679.879
288.11266.8676.47679.908
286.45264.3777.32579.9
284.81261.9678.11179.856
283.2259.7478.83679.78
281.61257.579.49579.658
280255.2980.09479.492
278.37252.9280.62679.254
276.71250.6181.10578.963
275.06248.2981.52978.616
273.43246.0781.89878.206
271.8243.7382.21977.73
270.16241.3782.48977.176
268.52238.9582.71176.565
266.87236.6982.8975.867
265.27234.683.02375.096
263.7232.6983.12474.237
262.18230.8783.1873.308
260.69229.1883.20472.281
259.22227.5883.18971.158
257.79226.1583.14469.934
256.37224.8883.06968.595
254.96223.882.95667.138
253.54222.982.8265.552
252.12222.1882.65663.841
250.71221.6482.47261.983
249.32221.2882.25759.982
247.95221.0682.01657.825
246.6522181.75455.514
245.39220.8881.46753.043
244.18220.5881.16650.433
242.99220.2980.83547.772
241.85220.3380.48345.103
240.73220.6780.09542.488
239.63221.2179.67639.928
238.56221.7179.21237.444
237.53222.2978.67935.055
236.58222.8478.06432.769
235.71223.4377.34330.584
234.93224.0476.50528.485
234.26224.6675.53126.473
233.74225.1174.39624.546
233.37225.4473.09422.722
233.12225.5671.60121
233.01225.6269.92719.391
233.02225.5268.06217.897
233.15225.4666.01716.516
233.3225.4563.79615.258
233.44225.6761.414.109
233.45226.1458.8213.084
233.32226.7956.05312.171
233.18227.4953.12411.386
233.17228.1150.15710.702
233.36228.7247.26310.121
233.61229.2344.4999.6245
233.85229.7241.8489.2154
234.05230.1639.2938.8905
234.25230.6436.8558.6407
234.47231.3134.5238.4529
234.71232.1132.3038.3175
235233.230.1748.2245
235.36234.5428.1388.177
235.83236.3126.1888.1613
236.4238.3924.3298.1664
237.05240.822.5628.1785
237.79243.3920.8838.1926
238.61245.9919.3058.2138
239.49248.3917.8228.2351
240.42250.5616.4328.2649
241.39252.5415.1328.2822
242.42254.3213.9258.3005
243.47255.9412.828.313
244.57257.5811.8078.3298
245.72259.2610.8878.3463
246.95261.0710.0528.3565
248.25262.79.31478.3725
249.64264.198.66328.3831
251.11265.488.08758.3937
252.67266.727.57938.4033
254.29267.867.1438.4055
256268.756.7818.4239
257.8269.566.48068.4387
259.76270.16.22938.4861
261.85270.496.0228.5341
264.07270.595.85548.6064
266.42270.685.73068.6696
268.9270.85.64198.7393
271.47271.055.588.8156
274.1271.275.54468.8962
276.68271.725.52428.9862
279.18272.135.52569.0665
281.55272.695.5339.1503
283.82273.155.5589.2311
285.97273.675.58899.3013
287.99274.145.63169.3652
289.87274.765.67549.4115
291.63275.415.71799.4727
293.25276.235.7599.5385
294.81276.875.79759.6154
296.27277.585.8359.6759
297.74278.195.86849.7372
299.16278.85.90479.797
300.54279.435.94129.8585
301.85279.965.97739.9236
303.14280.586.01169.9862
304.42281.046.044310.054
305.68281.586.072610.113
306.89281.916.09610.173
308.09282.166.114610.234
309.25282.296.134610.308
310.38282.366.152910.391
311.46282.416.177810.484
312.49282.496.20210.574
313.48282.536.229710.657
314.4282.736.260310.741
315.33282.886.294110.835
316.28283.126.333810.936
317.33283.416.378611.053
318.47283.846.4311.172
319.76284.526.484611.311
321.14285.386.542911.457
322.62286.356.613211.622
324.1287.56.692511.791
325.56288.86.784311.957
326.93290.276.876812.12
328.15291.836.974212.278
329.16293.27.072812.442
329.91294.547.172312.6
330.46295.747.266812.755
296.87
298
299.02
300.17
301.02
301.7
302.15
302.6
303.11
PRE
POST
Time (s)
LV volume (ml)
P
7.476215.094
7.565915.709
7.658616.459
7.75817.368
7.863318.488
7.987619.817
8.134921.363
8.319623.101
8.550525.049
8.847827.183
9.232229.466
9.708531.839
10.28934.275
10.98136.769
11.79739.32
12.7641.905
13.89944.473
15.18246.979
16.55649.404
18.01951.716
19.59653.919
21.32555.978
23.19557.911
25.19459.708
27.29161.391
29.44662.954
31.65464.414
33.92765.783
36.25767.069
38.65568.289
41.11169.43
43.60570.512
46.09271.515
48.53272.454
50.93473.334
53.2974.156
55.60474.933
57.83475.631
59.95876.272
61.95376.847
63.81177.376
65.53977.851
67.13978.283
68.61878.665
69.98278.989
71.24779.26
72.4379.475
73.53579.662
74.57979.793
75.55679.879
76.47679.908
77.32579.9
78.11179.856
78.83679.78
79.49579.658
80.09479.492
80.62679.254
81.10578.963
81.52978.616
81.89878.206
82.21977.73
82.48977.176
82.71176.565
82.8975.867
83.02375.096
83.12474.237
83.1873.308
83.20472.281
83.18971.158
83.14469.934
83.06968.595
82.95667.138
82.8265.552
82.65663.841
82.47261.983
82.25759.982
82.01657.825
81.75455.514
81.46753.043
81.16650.433
80.83547.772
80.48345.103
80.09542.488
79.67639.928
79.21237.444
78.67935.055
78.06432.769
77.34330.584
76.50528.485
75.53126.473
74.39624.546
73.09422.722
71.60121
69.92719.391
68.06217.897
66.01716.516
63.79615.258
61.414.109
58.8213.084
56.05312.171
53.12411.386
50.15710.702
47.26310.121
44.4999.6245
41.8489.2154
39.2938.8905
36.8558.6407
34.5238.4529
32.3038.3175
30.1748.2245
28.1388.177
26.1888.1613
24.3298.1664
22.5628.1785
20.8838.1926
19.3058.2138
17.8228.2351
16.4328.2649
15.1328.2822
13.9258.3005
12.828.313
11.8078.3298
10.8878.3463
10.0528.3565
9.31478.3725
8.66328.3831
8.08758.3937
7.57938.4033
7.1438.4055
6.7818.4239
6.48068.4387
6.22938.4861
6.0228.5341
5.85548.6064
5.73068.6696
5.64198.7393
5.588.8156
5.54468.8962
5.52428.9862
5.52569.0665
5.5339.1503
5.5589.2311
5.58899.3013
5.63169.3652
5.67549.4115
5.71799.4727
5.7599.5385
5.79759.6154
5.8359.6759
5.86849.7372
5.90479.797
5.94129.8585
5.97739.9236
6.01169.9862
6.044310.054
6.072610.113
6.09610.173
6.114610.234
6.134610.308
6.152910.391
6.177810.484
6.20210.574
6.229710.657
6.260310.741
6.294110.835
6.333810.936
6.378611.053
6.4311.172
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6.542911.457
6.613211.622
6.692511.791
6.784311.957
6.876812.12
6.974212.278
7.072812.442
7.172312.6
7.266812.755
12.903
13.054
13.217
13.377
13.554
13.747
13.976
14.238
14.558
PRE-stst
POST-stst
Time (s)
LV pressure (mmHg)
PV
7.476215.094
7.565915.709
7.658616.459
7.75817.368
7.863318.488
7.987619.817
8.134921.363
8.319623.101
8.550525.049
8.847827.183
9.232229.466
9.708531.839
10.28934.275
10.98136.769
11.79739.32
12.7641.905
13.89944.473
15.18246.979
16.55649.404
18.01951.716
19.59653.919
21.32555.978
23.19557.911
25.19459.708
27.29161.391
29.44662.954
31.65464.414
33.92765.783
36.25767.069
38.65568.289
41.11169.43
43.60570.512
46.09271.515
48.53272.454
50.93473.334
53.2974.156
55.60474.933
57.83475.631
59.95876.272
61.95376.847
63.81177.376
65.53977.851
67.13978.283
68.61878.665
69.98278.989
71.24779.26
72.4379.475
73.53579.662
74.57979.793
75.55679.879
76.47679.908
77.32579.9
78.11179.856
78.83679.78
79.49579.658
80.09479.492
80.62679.254
81.10578.963
81.52978.616
81.89878.206
82.21977.73
82.48977.176
82.71176.565
82.8975.867
83.02375.096
83.12474.237
83.1873.308
83.20472.281
83.18971.158
83.14469.934
83.06968.595
82.95667.138
82.8265.552
82.65663.841
82.47261.983
82.25759.982
82.01657.825
81.75455.514
81.46753.043
81.16650.433
80.83547.772
80.48345.103
80.09542.488
79.67639.928
79.21237.444
78.67935.055
78.06432.769
77.34330.584
76.50528.485
75.53126.473
74.39624.546
73.09422.722
71.60121
69.92719.391
68.06217.897
66.01716.516
63.79615.258
61.414.109
58.8213.084
56.05312.171
53.12411.386
50.15710.702
47.26310.121
44.4999.6245
41.8489.2154
39.2938.8905
36.8558.6407
34.5238.4529
32.3038.3175
30.1748.2245
28.1388.177
26.1888.1613
24.3298.1664
22.5628.1785
20.8838.1926
19.3058.2138
17.8228.2351
16.4328.2649
15.1328.2822
13.9258.3005
12.828.313
11.8078.3298
10.8878.3463
10.0528.3565
9.31478.3725
8.66328.3831
8.08758.3937
7.57938.4033
7.1438.4055
6.7818.4239
6.48068.4387
6.22938.4861
6.0228.5341
5.85548.6064
5.73068.6696
5.64198.7393
5.588.8156
5.54468.8962
5.52428.9862
5.52569.0665
5.5339.1503
5.5589.2311
5.58899.3013
5.63169.3652
5.67549.4115
5.71799.4727
5.7599.5385
5.79759.6154
5.8359.6759
5.86849.7372
5.90479.797
5.94129.8585
5.97739.9236
6.01169.9862
6.044310.054
6.072610.113
6.09610.173
6.114610.234
6.134610.308
6.152910.391
6.177810.484
6.20210.574
6.229710.657
6.260310.741
6.294110.835
6.333810.936
6.378611.053
6.4311.172
6.484611.311
6.542911.457
6.613211.622
6.692511.791
6.784311.957
6.876812.12
6.974212.278
7.072812.442
7.172312.6
7.266812.755
12.903
13.054
13.217
13.377
13.554
13.747
13.976
14.238
14.558
PRE-MVP
POST-MVP
LV volume (ml)
LV pressure (mmHg)
Chart1
11.50816.2187.476211.54915.094
11.69416.6417.565911.75615.709
11.86917.1797.658611.94416.459
12.03917.847.75812.12517.368
12.18618.6667.863312.2818.488
12.34719.6477.987612.45719.817
12.54520.8678.134912.63721.363
12.75322.2848.319612.85623.101
13.0323.9458.550513.11225.049
13.38125.7718.847813.44527.183
13.89727.8169.232213.89929.466
14.53930.0169.708514.48231.839
15.37732.38810.28915.25234.275
16.39534.84610.98116.22636.769
17.62637.39411.79717.41939.32
19.03239.95812.7618.77841.905
20.57642.58113.89920.28444.473
22.29845.2415.18221.93146.979
24.16247.87916.55623.71449.404
26.22850.44218.01925.66251.716
28.452.8319.59627.75253.919
30.69355.12921.32529.98155.978
33.0757.25823.19532.3157.911
35.54759.25625.19434.72659.708
38.1261.13727.29137.24961.391
40.7762.90829.44639.86562.954
43.49564.59631.65442.56964.414
46.26966.10833.92745.30565.783
49.04867.54936.25748.06567.069
51.81968.84338.65550.82868.289
54.5770.09341.11153.57369.43
57.27671.20743.60556.26570.512
59.8972.30546.09258.85271.515
62.3873.33348.53261.31872.454
64.72974.28650.93463.65373.334
66.88975.1953.2965.86774.156
68.92375.99155.60467.94974.933
70.79776.78157.83469.87475.631
72.57577.45159.95871.63776.272
74.18478.11461.95373.24576.847
75.66278.67363.81174.72477.376
77.04179.19165.53976.10377.851
78.31679.62167.13977.39478.283
79.5580.06568.61878.60778.665
80.67680.47469.98279.76578.989
81.79380.8471.24780.8479.26
82.80881.11272.4381.86979.475
83.78181.31873.53582.80579.662
84.66781.49274.57983.68379.793
85.46981.66575.55684.48379.879
86.21681.81376.47685.24479.908
86.87881.91677.32585.95579.9
87.51181.96678.11186.62879.856
88.10281.91978.83687.22979.78
88.6481.82279.49587.79379.658
89.15981.69580.09488.31579.492
89.62481.59280.62688.81779.254
90.03681.42981.10589.2678.963
90.38781.281.52989.64178.616
90.67680.86781.89889.96678.206
90.9880.52182.21990.28277.73
91.25580.07282.48990.55977.176
91.54679.6282.71190.79576.565
91.77779.0582.8990.99575.867
91.97978.43583.02391.17275.096
92.10477.74983.12491.33874.237
92.1777.0283.1891.46573.308
92.24776.1983.20491.55472.281
92.31575.31283.18991.60971.158
92.40274.34583.14491.63169.934
92.39473.33283.06991.62668.595
92.37172.11582.95691.60267.138
92.32670.7982.8291.55465.552
92.29369.32582.65691.47363.841
92.21867.75182.47291.37761.983
92.13865.99182.25791.27559.982
92.04964.09482.01691.16957.825
91.93762.03481.75491.03755.514
91.7659.85681.46790.88453.043
91.50757.48581.16690.70650.433
91.22554.97480.83590.49247.772
90.88452.29880.48390.22245.103
90.48649.52380.09589.87542.488
89.94846.73379.67689.42739.928
89.31143.99979.21288.88637.444
88.5141.37178.67988.23535.055
87.61738.83478.06487.47732.769
86.55536.37577.34386.5730.584
85.38334.02876.50585.51828.485
84.01831.77875.53184.30226.473
82.51529.62874.39682.91124.546
80.82827.53773.09481.35522.722
78.99825.55671.60179.63621
77.00623.64869.92777.77819.391
74.87521.85468.06275.76217.897
72.62420.15766.01773.58516.516
70.18518.59963.79671.24615.258
67.56717.14761.468.74114.109
64.66215.82358.8266.03813.084
61.58414.60456.05363.09412.171
58.43513.52853.12459.99211.386
55.39212.54250.15756.88510.702
52.45511.747.26353.86510.121
49.57910.92444.49950.969.6245
46.75610.26941.84848.1159.2154
44.0549.728739.29345.3648.8905
41.4659.274736.85542.7098.6407
38.988.880634.52340.1678.4529
36.568.535232.30337.718.3175
34.1928.289630.17435.3238.2245
31.9458.132328.13833.0158.177
29.7538.051826.18830.7838.1613
27.6938.004224.32928.6448.1664
25.6717.978622.56226.5948.1785
23.787.944420.88324.6558.1926
21.9627.932419.30522.8148.2138
20.2447.942817.82221.078.2351
18.6387.96216.43219.4358.2649
17.1537.967915.13217.8968.2822
15.7937.953313.92516.4838.3005
14.5217.951612.8215.1718.313
13.3897.967911.80713.9818.3298
12.3617.990410.88712.8958.3463
11.4417.998110.05211.9248.3565
10.6028.02379.314711.0448.3725
9.85958.04998.663210.2718.3831
9.25038.07978.08759.58898.3937
8.72618.07147.57939.01678.4033
8.28458.05627.1438.53158.4055
7.89618.05156.7818.12868.4239
7.55438.04756.48067.79478.4387
7.27158.06536.22937.50678.4861
7.02948.06816.0227.26918.5341
6.84638.09175.85547.05858.6064
6.70278.11655.73066.91418.6696
6.57878.16535.64196.82368.7393
6.50578.23865.586.78848.8156
6.46638.30215.54466.76718.8962
6.44388.3495.52426.75588.9862
6.47058.41015.52566.74159.0665
6.51048.49035.5336.73259.1503
6.60188.57715.5586.73569.2311
6.62818.66915.58896.7549.3013
6.67128.76355.63166.78959.3652
6.68518.85945.67546.83159.4115
6.7168.89745.71796.87449.4727
6.70548.92425.7596.91489.5385
6.70958.93725.79756.96279.6154
6.72778.96475.8357.01959.6759
6.75178.97285.86847.07559.7372
6.76019.01895.90477.12159.797
6.76669.08845.94127.16159.8585
6.80879.18965.97737.19439.9236
6.85749.28246.01167.21679.9862
6.89519.36026.04437.231610.054
6.9329.41396.07267.24310.113
6.96649.45976.0967.271710.173
7.00029.49916.11467.299210.234
7.03349.57486.13467.349510.308
7.08589.61736.15297.400310.391
7.1429.73866.17787.475210.484
7.18339.836.2027.531510.574
7.22239.98976.22977.573410.657
7.257910.0796.26037.620410.741
7.350910.2076.29417.68910.835
7.435210.3286.33387.790210.936
7.548810.4376.37867.882711.053
7.666510.5426.437.98411.172
7.790910.6236.48468.089211.311
7.917510.7786.54298.23211.457
8.026210.9426.61328.414411.622
8.151411.1236.69258.612311.791
8.315411.296.78438.809411.957
8.5111.4376.87688.997812.12
8.698911.5596.97429.215612.278
8.873211.6327.07289.472612.442
9.02411.7497.17239.739412.6
9.245311.8667.266810.01212.755
9.475912.0110.2812.903
9.742112.12110.57213.054
9.958612.28910.87513.217
10.19212.50111.16613.377
10.3812.71413.554
10.56112.93513.747
10.69413.15913.976
10.83513.46314.238
11.00713.86114.558
11.18614.392
11.35415.027
11.54115.769
11.80716.688
12.17117.821
12.6119.208
13.18120.806
13.9122.634
14.83424.647
15.96526.802
17.25529.1
18.71631.475
20.28233.933
22.0236.404
23.91138.952
25.98541.538
28.14544.166
30.39846.713
32.72649.174
35.14651.503
37.65853.731
40.24655.795
42.90757.727
45.61759.503
48.33161.182
51.05762.693
53.74764.152
56.41265.508
58.98766.773
61.42167.923
63.73268.992
65.91170.002
67.96270.945
69.84371.824
71.58672.657
73.20973.429
74.70374.18
76.06974.856
77.34475.492
78.55576.009
79.71776.513
80.79776.951
81.77277.394
82.69177.785
83.53978.147
84.32278.395
85.05878.576
85.73378.701
86.34878.82
86.91878.889
87.42878.887
87.89878.842
88.30978.794
88.7278.697
89.13878.57
89.4878.33
89.80778.062
9077.706
90.20177.327
90.33976.868
90.52476.349
90.64775.762
90.74875.072
90.81274.309
90.86473.433
90.86872.519
90.8471.497
90.73870.406
90.61469.183
90.49167.881
90.36366.477
90.25564.979
90.05163.344
89.89161.604
89.62359.718
89.36257.704
89.00255.498
88.62453.15
88.12550.638
87.51948.025
86.77145.398
85.93442.847
84.93340.385
83.76537.976
82.41335.674
80.89433.423
79.18731.282
77.3529.173
75.37227.191
73.24125.298
70.95523.488
68.48921.751
65.89820.085
63.03218.545
59.98717.103
56.87115.784
53.82314.548
50.8913.431
47.99512.434
45.24811.581
42.59610.859
40.0710.232
37.6099.7083
35.2259.2437
32.9488.8703
30.7468.5464
28.6398.3093
26.6058.1581
24.6648.0609
22.8148.0112
21.047.9623
19.3787.9621
17.8327.9522
16.4097.9698
15.0927.9713
13.97.9751
12.8127.9371
11.8287.9303
10.9267.9213
10.1397.9572
9.4497.9431
8.86077.967
8.35127.9494
7.89737.9897
7.48978.0138
7.14178.0657
6.87338.0809
6.67198.0748
6.53898.0571
6.4338.0524
6.38528.0674
6.33498.1085
6.31538.1588
6.28188.2162
6.27128.2572
6.26248.2964
6.23898.332
6.2528.3665
6.26958.3805
6.31478.4098
6.32728.4575
6.33878.5315
6.36318.6144
6.37028.6848
6.37658.7741
6.35978.8451
6.35768.8967
6.37338.9212
6.37618.9364
6.39938.9639
6.4248.9725
6.49228.9992
6.54989.0453
6.59459.1185
6.65419.2009
6.69449.2906
6.7349.3446
6.74999.3733
6.80019.4094
6.87199.481
6.95499.5806
7.04459.6734
7.13769.7901
7.25229.9101
7.371910.036
7.496910.143
7.62410.229
7.752510.326
7.862210.402
7.968410.515
8.070210.591
8.209510.688
8.355410.801
8.549110.96
8.714711.112
8.864711.252
9.005911.349
9.161811.456
9.338411.535
9.483111.612
9.64511.721
9.803911.856
9.965812.041
10.14712.223
10.35212.452
10.60612.73
10.91213.105
11.31713.567
11.8514.164
12.52614.903
13.35315.815
14.39616.946
15.6318.312
16.98419.905
18.45821.649
20.05923.606
21.84625.732
23.77328.092
25.84430.552
28.0533.078
30.31235.618
32.63138.175
35.03240.796
37.51943.413
40.09846.004
42.71348.491
45.37250.854
48.00953.074
50.61255.182
53.18357.141
55.74158.97
58.25160.646
60.69162.226
62.98963.678
65.12865.046
67.1166.332
68.94967.566
70.65168.735
72.19969.821
73.6570.857
74.97271.79
76.26972.672
77.45773.445
78.61874.206
79.67474.903
80.68475.605
81.62476.178
82.48376.686
83.25377.117
83.9577.559
84.59577.968
85.21578.295
85.7878.54
86.29178.693
86.7678.831
87.20978.909
87.60878.952
87.95478.918
88.2278.841
88.47978.78
88.68178.674
88.89178.524
89.05178.258
89.20377.94
89.32577.569
89.39977.1
89.43876.6
89.42176.015
89.34875.408
89.23274.681
89.09773.887
88.94973.016
88.81472.039
88.6470.966
88.48169.794
88.25868.544
87.98667.201
87.67265.725
87.30164.145
86.87262.421
86.3460.589
85.71858.627
84.9856.54
84.12254.285
83.09951.835
81.96249.273
80.61246.649
79.09844.069
77.39341.524
75.55839.093
73.56136.731
71.40734.463
69.09332.268
66.61730.145
63.92128.129
60.99226.149
57.91424.275
54.83822.469
51.84920.796
48.93719.221
46.13517.751
43.4316.381
40.86415.109
38.38413.936
36.00812.862
33.70811.904
31.46411.068
29.32510.338
27.2389.7323
25.2799.1722
23.3968.7436
21.6318.3701
19.9648.1315
18.3797.931
16.9287.7846
15.5597.6761
14.3317.5861
13.2067.5269
12.1697.4775
11.2297.4557
10.3857.4611
9.61757.4382
8.96317.4543
8.38597.4724
7.92477.4988
7.46317.4882
7.06377.4913
6.75487.5094
6.55457.5332
6.41367.522
6.24777.5245
6.14737.5228
6.0557.5425
6.01647.5656
5.97077.5937
5.95397.6039
5.96097.6116
5.95897.5956
5.95997.594
5.95987.5709
5.97947.6051
6.02247.6463
6.05457.7395
6.10857.8055
6.12587.8764
6.15967.9038
6.16987.9234
6.17867.9328
6.20197.9582
6.18888.0042
6.21048.038
6.21218.0539
6.23628.0444
6.24148.0261
6.26688.0596
6.27298.1017
6.25978.195
6.23888.2611
6.23198.332
6.26548.3594
6.29038.3791
6.32158.4081
6.33278.4764
6.38038.5544
6.45068.6423
6.55238.7145
6.64538.8052
6.76248.8768
6.88258.9092
7.00818.9105
7.13538.9368
7.2648.9618
7.39349.0307
7.50359.1081
7.64919.2155
7.77849.311
7.91159.3711
7.98359.4804
8.08319.5728
8.1769.7304
8.27319.839
8.38929.9898
8.529510.1
8.69810.192
8.818410.291
8.973810.387
9.126610.505
9.36410.586
9.637410.665
10.03310.776
10.51810.931
11.12411.14
11.8511.388
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74.57632.75
74.90234.919
75.2137.051
75.47339.161
75.66641.182
75.83543.121
75.94644.987
76.02246.745
76.0248.387
75.99649.907
75.93251.34
75.81752.712
75.62553.996
75.38855.211
75.14656.355
74.87457.432
74.55758.443
74.14659.349
73.70760.22
73.16660.986
72.59961.723
71.96762.356
71.27862.982
70.50663.546
69.62864.077
68.65464.53
67.5664.942
66.36665.291
65.06865.58
63.65265.785
62.11365.904
60.46765.988
58.65866.009
56.71866.011
54.665.937
52.34365.766
49.92665.542
47.3565.228
44.7564.886
42.15264.462
39.66763.977
37.26463.424
34.95862.767
32.74762.076
30.61361.318
28.57260.501
26.62459.58
24.77158.569
23.01557.499
21.33656.34
19.75155.074
18.23953.71
16.83852.267
15.53350.767
14.28849.163
13.13447.527
12.04945.805
11.07344.059
10.17342.193
9.387840.319
8.699138.321
8.072336.257
7.496734.116
6.982732.065
6.5530.093
6.165328.215
5.845626.37
5.56824.61
5.331422.913
5.150421.323
5.027819.806
4.947518.384
4.867917.015
4.816415.753
4.770714.563
4.751213.467
4.718612.444
4.708211.532
4.699610.715
4.71549.9784
4.73639.3162
4.76328.7435
4.79238.2426
4.8237.8326
4.85457.4941
4.86697.2077
4.87576.946
4.86056.7192
4.85926.5629
4.85586.4473
4.87446.3733
4.87756.3159
4.90146.2896
4.90676.2533
4.91266.2213
4.89536.2076
4.8936.218
4.88916.2369
4.88796.2427
4.88686.2477
4.88646.2498
4.88616.2513
4.90556.252
4.92886.2524
4.95696.2526
5.00626.2332
5.04136.2294
5.09726.2248
5.09596.2426
5.14586.2257
5.19466.2259
5.2736.2225
5.31796.2414
5.34266.2446
5.39566.2294
5.46976.2075
5.55376.2001
5.60496.2333
5.65146.258
5.71016.2695
5.77026.2573
5.8336.2766
5.85756.2976
5.8756.3057
5.88346.3115
5.92776.3142
5.99686.355
6.07816.3833
6.14726.4166
6.27496.4485
6.4516.5006
6.72666.5369
7.05146.5546
7.46446.5654
7.96356.5906
8.61476.5978
9.39166.6238
10.3226.6305
11.3866.6565
12.5666.6435
13.7576.6461
15.0126.6636
16.3426.6871
17.8166.7149
19.3726.7447
21.0926.7757
22.8996.8074
24.7576.859
26.5846.9147
28.4346.9948
30.3227.061
32.2617.1293
34.2577.1758
36.2547.2182
38.2847.2751
40.37.3145
42.347.3533
44.3427.3884
46.3427.4813
48.3147.546
50.2617.5971
52.1397.6202
53.9197.6546
55.6087.7247
57.227.8042
58.7397.8732
60.1277.9224
61.4127.946
62.5918.0583
63.7098.2221
64.7158.4727
65.6868.7509
66.579.1301
67.439.574
68.20810.149
68.96510.821
69.62411.676
70.25912.665
70.79113.835
71.29815.146
71.7416.618
72.14418.23
72.4920.018
72.73721.929
72.95323.918
73.12425.949
73.2828.002
73.36530.069
73.41332.124
73.434.159
73.34936.169
73.25838.149
73.13240.08
72.95241.937
72.69543.69
72.39345.369
72.06646.935
71.70648.384
71.29549.749
70.80951.054
70.25952.291
69.62253.425
68.95454.485
68.20555.47
67.39556.387
66.47757.256
65.46858.062
64.35958.827
63.13559.473
61.80960.127
60.34260.719
58.76861.28
57.04661.726
55.23562.103
53.29862.424
51.25962.72
49.03862.96
46.68263.146
44.20463.231
41.73463.265
39.27963.211
36.90763.09
34.61462.899
32.45162.719
30.38762.489
28.42962.172
26.53161.75
24.72461.271
23.00760.739
21.36460.146
19.81359.452
18.29658.707
16.88157.852
15.55356.966
14.3455.973
13.20754.933
12.15253.785
11.14852.585
10.24851.295
9.437149.958
8.743448.514
8.09146.981
7.509345.37
7.008543.706
6.557742.016
6.17240.252
5.809438.448
5.52336.523
5.276134.547
5.091332.536
4.965830.567
4.864728.677
4.799926.831
4.727725.107
4.661223.436
4.594421.839
4.548220.307
4.545118.861
4.554817.523
4.575616.243
4.601315.036
4.630113.914
4.660512.862
4.672411.919
4.680811.052
4.684910.319
4.68749.6469
4.70839.073
4.71298.57
4.75718.1397
4.76697.7773
4.79727.443
4.78577.1864
4.80896.9511
4.81136.7746
4.8366.6141
4.84146.4881
4.86696.3917
4.87316.3277
4.8996.2956
4.92496.2764
4.93536.2662
4.9236.2603
4.88366.257
4.85376.2552
4.83986.2542
4.87026.2341
4.8936.1908
4.96226.1196
5.01976.0771
5.10366.0544
5.11236.0609
5.13096.0381
5.17546.0348
5.22716.0101
5.30496.0045
5.33085.9789
5.39065.9922
5.42736.0093
5.46616.0153
5.50086.02
5.51546.0221
5.54486.0625
5.57326.1101
5.62386.1667
5.67876.2071
5.73886.2265
5.80096.2385
5.90346.2252
6.01456.225
6.17446.2223
6.36536.2217
6.65036.221
7.01896.2208
7.50126.2596
8.08166.2869
8.78246.3197
9.6056.3317
10.5546.3406
11.6316.3448
12.7596.3474
13.9426.3488
15.2056.3496
16.5736.35
18.0576.3503
19.6436.3504
21.3896.3505
23.2286.3896
25.0776.4365
26.9096.4928
28.7786.5329
30.696.5913
32.6386.6305
34.6016.65
36.5946.6422
38.5966.6641
40.6066.706
42.5816.7578
44.5496.7961
46.516.8532
48.4676.9308
50.4236.9968
52.267.0451
54.0157.068
55.6127.1408
57.1627.199
58.6117.2642
59.9737.3085
61.2197.3694
62.3457.4491
63.4067.5162
64.397.5651
65.3467.5883
66.2427.6223
67.127.6923
67.8857.7522
68.5857.8758
69.218.0102
69.7878.2766
70.348.5521
70.82
71.222
71.555
71.799
72.091
72.315
72.516
72.64
72.685
72.719
72.696
72.62
72.483
72.304
72.143
71.938
71.669
71.34
70.928
70.506
70.027
69.476
68.859
68.157
67.425
66.571
65.649
64.61
63.514
62.306
61.006
59.547
57.979
56.3
54.518
52.615
50.569
48.353
45.997
43.52
41.05
38.635
36.31
34.073
31.93
29.882
27.931
26.037
24.213
22.474
20.843
19.31
17.857
16.478
15.208
14.015
12.897
11.849
10.889
10.018
9.2221
8.4982
7.8427
7.2738
6.7555
6.3037
5.9339
5.6329
5.3815
5.1539
4.9604
4.798
4.6488
4.5669
4.5011
4.4716
4.4526
4.4428
4.4371
4.4145
4.4283
4.4461
4.472
4.4611
4.4446
4.4392
4.4738
4.4992
4.5307
4.5421
4.5702
4.5781
4.5853
4.5884
4.6099
4.6344
4.6631
4.6738
4.6816
4.6853
4.6877
4.6889
4.7091
4.7329
4.7808
4.8147
4.8505
4.8645
4.8354
4.8324
4.8259
4.8826
4.9318
5.0115
5.0959
5.1482
5.1951
5.2345
5.3103
5.3724
5.4196
5.4219
5.4122
5.3912
5.3851
5.3992
5.4203
5.4665
5.558
5.6832
5.8633
6.022
6.2851
6.6038
7.0522
7.5767
8.2205
9.001
9.8718
10.886
11.966
13.088
14.27
15.512
16.896
18.358
19.963
21.67
23.426
25.193
26.952
28.732
30.533
32.402
34.327
36.258
38.162
40.061
41.955
43.846
45.717
47.582
49.423
51.2
52.9
54.454
55.906
57.269
58.555
59.749
60.85
61.895
62.852
63.721
64.535
65.301
66.047
66.701
67.294
67.836
68.336
68.779
69.124
69.418
69.683
69.931
70.132
70.26
70.326
70.346
70.343
70.268
70.155
69.981
69.767
69.533
69.229
68.907
68.527
68.094
67.599
67.043
66.461
65.785
65.006
64.148
63.196
62.189
61.036
59.823
58.49
57.082
55.577
53.959
52.241
50.402
48.48
46.38
44.169
41.803
39.462
37.134
34.891
32.727
30.654
28.674
26.789
24.981
23.286
21.647
20.102
18.625
17.239
15.925
14.662
13.502
12.431
11.458
10.561
9.718
8.9794
8.2725
7.6514
7.0732
6.5795
6.1503
5.7899
5.4953
5.2471
5.0408
4.8523
4.6952
4.5675
4.4715
4.4072
4.3556
4.3325
4.3175
4.3099
4.3249
4.3459
4.3726
4.3822
4.409
4.4358
4.466
4.4774
4.4858
4.4702
4.4492
4.4224
4.4128
4.425
4.4451
4.4516
4.4373
4.4358
4.4522
4.4942
4.5059
4.5166
4.5406
4.5866
4.6397
4.6595
4.7132
4.7474
4.804
4.8222
4.8372
4.8438
4.8676
4.9128
4.9657
5.0439
5.1287
5.1808
5.1886
5.2006
5.2241
5.2703
5.3038
5.3588
5.3765
5.391
5.3779
5.3782
5.3952
5.4572
5.5902
5.7659
5.9839
6.258
6.6103
7.0676
7.6006
8.2674
9.0347
9.927
10.943
12.047
13.174
14.343
15.583
16.964
18.425
20.029
21.736
23.53
25.324
27.097
28.884
30.69
32.581
34.492
36.444
38.349
40.253
42.128
44.017
45.903
47.771
49.576
51.288
52.909
54.435
55.846
57.175
58.426
59.606
60.679
61.656
62.594
63.485
64.358
65.121
65.819
66.463
67.025
67.559
68.012
68.444
68.797
69.11
69.361
69.551
69.659
69.738
69.776
69.799
69.792
69.736
69.646
69.499
69.335
69.077
68.797
68.456
68.097
67.683
67.216
66.689
66.119
65.45
64.714
63.886
62.987
62.017
60.921
59.746
58.451
57.059
55.565
53.952
52.257
50.443
48.53
46.456
44.272
41.995
39.658
37.328
35.047
32.895
30.817
28.838
26.933
25.14
23.385
21.777
20.206
18.769
17.348
16.053
14.807
13.654
12.569
11.575
10.651
9.7984
9.033
8.3188
7.6909
7.1099
6.6143
6.145
5.7567
5.4095
5.1452
4.9056
4.7268
4.565
4.4382
4.361
4.3007
4.2732
4.2361
4.2427
4.2366
4.2562
4.2589
4.2634
4.2648
4.266
4.286
4.2903
4.2951
4.3165
4.3413
4.3505
4.3573
4.38
4.4055
4.4151
4.4221
4.4255
4.4275
4.4286
4.4292
4.4491
4.4141
4.4111
4.384
4.417
4.4573
4.511
4.5884
4.6341
4.7174
4.7627
4.8275
4.8495
4.8668
4.8747
4.8798
4.9019
4.9464
4.9987
5.0572
5.0989
5.1384
5.1742
5.2088
5.2424
5.2365
5.2616
5.285
5.3142
5.3638
5.4772
5.6856
5.9062
6.2068
6.565
7.0483
7.6072
8.304
9.102
9.9868
11.007
12.052
13.149
14.28
15.527
16.901
18.362
19.945
21.609
23.273
24.974
26.663
28.415
30.178
31.994
33.842
35.669
37.498
39.284
41.1
42.895
44.711
46.488
48.222
49.823
51.368
52.838
54.261
55.582
56.814
57.95
58.97
59.929
60.832
61.693
62.456
63.191
63.881
64.518
65.076
65.53
65.967
66.321
66.674
66.972
67.239
67.41
67.498
67.55
67.597
67.617
67.592
67.493
67.37
67.15
66.925
66.641
66.344
65.974
65.528
65.052
64.536
63.947
63.315
62.583
61.803
60.895
59.951
58.917
57.799
56.548
55.215
53.78
52.25
50.602
48.873
47.026
45.08
43.032
40.925
38.727
36.518
34.328
32.237
30.229
28.315
26.496
24.753
23.064
21.46
19.903
18.47
17.09
15.825
14.612
13.491
12.439
11.477
10.586
9.7658
9.0135
8.3279
7.6693
7.0879
6.5469
6.1272
5.7397
5.422
5.1443
4.8884
4.7036
4.5374
4.4281
4.3144
4.2307
4.1717
4.1041
4.0788
4.0407
4.0866
4.1077
4.1406
4.1514
4.1602
4.1641
4.1861
4.2109
4.2593
4.2739
4.3061
4.3154
4.3237
4.3077
4.3062
4.3222
4.3446
4.3523
4.3388
4.3376
4.3738
4.4003
4.4128
4.4011
4.3817
4.3755
4.4095
4.4736
4.5518
4.6193
4.6875
4.7342
4.7767
4.8141
4.8496
4.8642
4.8742
4.8791
4.8821
4.9032
4.908
4.9328
4.9387
4.9839
5.0331
5.0911
5.1321
5.1519
5.2031
5.2759
5.4179
5.5975
5.8181
6.113
6.4895
6.9754
7.5385
8.217
9.0122
9.932
10.959
12.031
13.115
14.269
15.498
16.854
18.269
19.819
21.467
23.161
24.865
26.541
28.271
30.027
31.857
33.687
35.552
37.385
39.218
41.025
42.828
44.643
46.422
48.156
49.777
51.327
52.781
54.163
55.453
56.652
57.735
58.758
59.726
60.652
61.499
62.264
62.997
63.687
64.342
64.924
65.445
65.88
66.228
66.501
66.723
66.959
67.168
67.355
67.453
67.491
67.459
67.363
67.259
67.141
66.96
66.744
66.469
66.195
65.831
65.431
64.946
64.397
63.82
63.223
62.539
61.795
60.982
60.124
59.145
58.035
56.856
55.558
54.164
52.669
51.075
49.403
47.617
45.753
43.754
41.692
39.513
37.337
35.137
33.032
30.979
29.034
27.18
25.424
23.726
22.097
20.553
19.079
17.674
16.356
15.128
13.974
12.893
11.86
10.909
10.024
9.247
8.5435
7.8958
7.2935
6.7506
6.2871
5.8905
5.5428
5.2181
4.9274
4.6871
4.4832
4.3358
4.207
4.1127
4.0485
4.0363
4.0406
4.039
4.02
3.9964
3.9879
3.9814
4.0175
4.0625
4.0982
4.1339
4.1677
4.2207
4.238
4.213
4.2115
4.2062
4.2244
4.2269
4.2506
4.2754
4.2851
4.292
4.3148
4.3403
4.3695
4.3804
4.3885
4.4118
4.4181
4.4435
4.4499
4.4953
4.5447
4.6027
4.6633
4.7065
4.7663
4.8065
4.846
4.8424
4.8496
4.8503
4.891
PRE
POST
PRE-stst
PRE-stst
POST-stst
LV volume (ml)
LV pressure (mmHg)
MAR14009
offsetBeatTimeVlvPressureECGcathPaoECGIIdVdPESPVR
-1.41510.48434311.5085.222770.1730.0237101.646.465Pes=-165.5+0.9902*Ves(r=0.9774,n=15)
1510.488343.811.6945.306670.0810.009571.4543.64beatVesPes
1510.492344.5811.8695.43769.794-0.012239.53642.43515254.587.617
1510.496345.4912.0395.568269.64-0.02863.975636.74616255.4288.624
1510.5346.1712.1865.621869.493-0.0304-28.98340.25117249.1783.099
1510.504346.6412.3475.618569.257-0.0047-58.21349.57918248.7180.446
1510.508346.7412.5455.618269.220.063-83.59452.14619250.0479.875
1510.512346.612.7535.609569.0670.1764-105.5569.17320246.7476.005
1510.516346.1213.035.646869.0690.3332-126.387.7421244.0474.939
1510.52345.5513.3815.76169.0580.5108-147.44129.0422239.8572.804
1510.524344.6413.8975.908468.880.6801-165.45160.5423235.570.506
1510.528343.6214.5396.044968.7840.8145-181.73209.2824239.5468.205
1510.532342.2815.3776.173668.5140.8923-191.17254.6325234.7168.157
1510.53634116.3956.286468.4020.9113-198.46307.6326233.8366.461
1510.54339.7917.6266.385368.3260.8789-202.12351.7127231.2364.714
1510.544338.7819.0326.443568.1510.8045-204.75385.7728233.2764.536
1510.548338.0320.5766.477368.160.7021-209.92430.729230.1662.539
1510.552337.2222.2986.495168.0290.5783-212.76466.03
1510.556336.4824.1626.509168.0430.4506-214.94516.26EDPVR
1510.56335.3426.2286.520468.020.33-209.09543.14beatVedPed
1510.564334.0628.46.528567.8230.2242-198.59573.211534311.508
1510.568332.5930.6936.528767.720.1389-184.18594.3616344.5910.38
1510.572331.1433.076.524867.4070.0704-169.95619.2617342.79.1618
1510.576329.9235.5476.516867.2450.0201-160.15643.1118336.658.176
1510.58328.9238.126.508367.131-0.0168-154.84662.6319337.897.6792
1510.584328.340.776.496566.939-0.045-154.27681.0720338.017.0868
1510.588327.9343.4956.483966.916-0.0648-155.56693.5421335.256.6454
1510.592327.4846.2696.474766.756-0.0808-153.78694.8522331.896.3038
1510.596327.0349.0486.466766.759-0.0904-152.19692.7223334.36.1119
1510.6326.651.8196.460266.786-0.0965-154.54687.6724334.435.833
1510.604326.354.576.453766.675-0.1006-163.29676.4725335.175.5448
1510.608326.0657.2766.447466.736-0.1017-175.71653.6926332.775.4122
1510.612325.7759.896.441266.589-0.1027-187.43622.4827329.895.3038
1510.616325.2662.386.43566.514-0.1016-197.6587.2728330.215.1742
1510.62324.4764.7296.429566.352-0.1002-205.14539.829330.044.9387
1510.624323.4766.8896.424766.07-0.1002-210.36508.62
1510.628322.5468.9236.420265.962-0.0999-216.9468.47dPdt
1510.632321.8670.7976.415365.728-0.1013-228.97444.44dPdtMax=-5135.9+16.975*Ved(r=0.9257,n=15)
1510.636321.4472.5756.410465.659-0.101-249.79402.31beatVeddPdtMax
1510.64320.9774.1846.404265.638-0.0998-273.66369.5415343694.85
1510.644320.0975.6626.398965.522-0.1004-295.09344.816344.59681.39
1510.648318.7577.0416.393565.553-0.1018-310.96318.6517342.7664.96
1510.652317.2978.3166.38965.439-0.1056-325.43308.4718336.65642.63
1510.656316.0479.556.383965.481-0.1071-340.08281.6719337.89617.78
1510.66314.7980.6766.379665.544-0.1067-355.28279.1620338.01589.99
1510.664313.5481.7936.376565.468-0.1075-370.2253.7721335.25574.23
1510.668312.3282.8086.37565.524-0.108-387.79243.3122331.89543.63
1510.672311.1283.7816.374165.422-0.1107-404.35221.4923334.3541.61
1510.676309.7484.6676.373665.471-0.1128-417.92200.3824334.43509.9
1510.68307.8685.4696.372765.5-0.1138-421.45186.9125335.17502.5
1510.684305.7586.2166.372465.34-0.1159-419.79165.3526332.77482.67
1510.688303.4486.8786.372865.255-0.115-411.97158.3427329.89487.94
1510.692301.1987.5116.37464.971-0.1162-401.97147.7528330.21462.13
1510.696299.0388.1026.376264.82-0.1153-390.45134.4629330.04466.22
1510.7297.2888.646.378764.694-0.1144-382.74129.68
1510.704295.5389.1596.382164.482-0.1155-374.03116.31
1510.708293.8389.6246.386364.473-0.117-364.62102.91
1510.712291.990.0366.392164.311-0.1214-349.5687.788
1510.716290.1990.3876.398464.316-0.1241-336.9272.319
1510.72288.590.6766.405764.363-0.126-325.4575.966
1510.724287.0990.986.413264.374-0.1293-320.2368.72
1510.728285.7491.2556.422364.619-0.1309-316.5572.884
1510.732284.5791.5466.431764.768-0.1338-315.3557.617
1510.736283.5691.7776.441565.121-0.1337-318.0350.514
1510.74282.6491.9796.451565.573-0.1338-323.7531.391
1510.744281.7192.1046.461566.007-0.1343-330.9916.382
1510.748280.6992.176.471666.692-0.1329-336.9819.32
1510.752279.6792.2476.481167.306-0.1323-345.116.907
1510.756278.7692.3156.489968.133-0.1304-354.8621.893
1510.76277.7292.4026.497969.065-0.1289-362.61-2.0046
1510.764276.4492.3946.504369.984-0.1288-365.31-5.7888
1510.768274.8692.3716.50971.115-0.1265-362.27-11.324
1510.772273.2392.3266.511272.17-0.1255-357.89-8.3065
1510.776271.7292.2936.511373.33-0.1209-353.67-18.574
1510.78270.192.2186.508874.535-0.1145-347.74-20.025
1510.784268.4492.1386.502875.632-0.1074-339.44-22.367
1510.788266.7192.0496.492676.913-0.0983-329.02-28.009
1510.792265.1591.9376.47978.112-0.0892-319.82-44.256
1510.796263.4591.766.46279.467-0.0753-307.01-63.28
1510.8261.8891.5076.441880.896-0.059-295.02-70.335
1510.804260.4791.2256.419882.214-0.0437-283.58-85.318
1510.808259.3390.8846.397383.682-0.0286-274.13-99.489
1510.812258.3490.4866.376284.981-0.0171-265.25-134.62
1510.816257.3689.9486.355986.335-0.0055-253.33-159.13
1510.82256.4489.3116.336787.5690.005-241.74-200.35
1510.824255.4488.516.31988.4770.0138-228.24-223.26
1510.828254.587.6176.302589.3350.023-216.85-265.39
1510.832253.5986.5556.287790.060.0291-207.12-293.04
1510.836252.6585.3836.273591.0990.0346-194.4-341.18
1510.84251.7984.0186.26192.3890.0379-179-375.87
1510.844250.9182.5156.249693.5970.0387-158.27-421.73
1510.848250.1180.8286.239394.8580.04-137.75-457.37
1510.852249.4478.9986.230795.8010.0394-117.75-498.09
1510.856248.8877.0066.223396.7310.04-100.8-532.89
1510.86248.6674.8756.217697.5540.0405-86.297-562.64
1510.864248.3972.6246.212698.1590.0398-71.473-609.73
1510.868248.1270.1856.207498.8150.0407-54.664-654.4
1510.872247.6367.5676.201199.2430.0398-35.281-726.46
1510.876246.9564.6626.195199.6950.0403-12.49-769.33
1510.88246.5961.5846.1908100.070.04077.9673-787.44
1510.884246.6358.4356.1894100.190.039923.093-760.57
1510.888247.255.3926.1882100.410.040831.655-734.41
1510.892247.6952.4556.1877100.360.039839.492-718.92
1510.896248.1949.5796.1874100.330.040347.419-705.7
1510.9248.3846.7566.1878100.220.040758.054-675.55
1510.904248.7644.0546.189199.940.039966.609-647.34
1510.908249.0441.4656.190699.8420.040876.956-621.02
1510.912249.5138.986.192499.5510.039886.112-605.24
1510.916249.8536.566.194399.3760.040397.589-591.93
1510.92250.234.1926.196299.1260.0407109.16-561.7
1510.924250.7431.9456.198898.6310.0384119.82-548.11
1510.928251.329.7536.20198.170.0375131.73-514.93
1510.932251.9727.6936.202597.4310.0345143.47-505.58
1510.936252.4625.6716.203996.820.0351155.99-472.66
1510.94253.0423.786.205196.2190.0361167.39-454.44
1510.944253.4921.9626.206895.4490.035181.78-429.56
1510.94825420.2446.20894.7840.0335196.98-401.41
1510.952254.6218.6386.209293.8910.0296212.71-371.27
1510.956255.4217.1536.209693.1110.029227.95-340.08
1510.96256.3115.7936.210692.2690.0285244.85-318.05
1510.964257.2414.5216.211591.2020.0264263.07-282.99
1510.968258.3813.3896.213190.1950.0234280.62-256.93
1510.972259.6512.3616.214288.9990.019298.71-230.05
1510.976260.9811.4416.215388.0120.0175318.31-209.7
1510.98262.0410.6026.216487.1260.0183343.1-185.61
1510.984263.069.85956.218786.1650.0181370.77-152.3
1510.988264.179.25036.221285.3660.0178398.47-131.06
1510.992265.448.72616.223384.4280.0152425.28-110.38
1510.996266.898.28456.224983.690.0151448.64-97.117
1511268.517.89616.226283.0430.0171468.49-85.445
1511.004270.387.55436.22882.3160.0174482.31-70.692
1511.008272.397.27156.229381.7880.0179491.46-60.524
1511.012274.537.02946.231181.1260.0156497.48-45.775
1511.016276.846.84636.231780.6540.0162499.3-35.908
1511.02279.36.70276.232880.1930.0178497.68-30.985
1511.024281.776.57876.233179.6160.0183493.16-18.261
1511.028284.336.50576.234779.1930.0187484.9-9.8493
1511.032286.886.46636.23578.6220.0184473.71-5.6221
1511.036289.466.44386.23678.170.0213459.746.6713
1511.04291.816.47056.236377.730.0262448.019.9756
1511.044293.976.51046.237177.1610.0298437.4422.861
1511.048295.866.60186.237476.7640.0344430.246.5672
1511.052297.516.62816.237676.2390.0365423.9310.768
1511.056299.156.67126.237775.9380.0398416.63.4671
1511.06300.766.68516.237775.7140.0424407.487.7299
1511.064302.416.7166.238475.3740.043396.19-2.6433
1511.068303.956.70546.239775.1440.0442384.661.0173
1511.072305.486.70956.241474.7570.0431371.534.5576
1511.076306.96.72776.243274.5360.0436358.795.9978
1511.08308.36.75176.243974.4140.0439344.132.1111
1511.084309.826.76016.243774.1890.0431326.781.6217
1511.088311.356.76666.24274.1590.0435307.0710.512
1511.092312.946.80876.239273.9910.0434286.1912.192
1511.096314.336.85746.236573.990.0464266.369.4237
1511.1315.656.89516.233673.9960.0504245.949.2061
1511.104316.746.9326.232473.8010.0528229.178.6088
1511.108317.736.96646.23173.7050.0546214.258.4457
1511.112318.67.00026.230573.4120.0535203.748.2937
1511.116319.337.03346.229573.2760.0546198.1513.113
1511.12320.017.08586.229873.1710.056197.0914.047
1511.124320.57.1426.230972.9660.0565204.1410.315
1511.128320.997.18336.232472.9240.0559213.059.7553
1511.132321.327.22236.234772.7570.053227.388.8968
1511.136321.777.25796.236772.7350.0499242.8123.262
1511.14322.167.35096.239472.7560.0472263.3121.08
1511.144322.457.43526.24172.580.0421287.2828.4
1511.148322.917.54886.242472.490.0376308.5129.427
1511.152323.467.66656.243672.2020.0299326.5631.097
1511.156324.347.79096.244272.0490.0235337.9431.636
1511.16325.487.91756.245171.9610.0178342.5327.195
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1511.168328.868.15146.246371.7360.0091338.2840.995
1511.172330.688.31546.246571.5350.0059334.4248.638
1511.176332.588.516.246171.4130.0052327.6147.224
1511.18334.488.69896.241871.270.0054317.0843.586
1511.184336.548.87326.231170.9630.0043300.2337.693
1511.188338.539.0246.205670.8340.0056278.7555.318
1511.192340.189.24536.15270.5910.0056256.6457.665
1511.196341.419.47596.025270.5170.0093238.3866.542
1511.2342.289.74215.788570.5120.014221.3954.138
1511.204342.839.95865.488970.3590.0161208.1258.316
1511.208343.5610.1925.300670.4060.0155188.7446.905
1611.212344.5910.385.195770.2280.0061161.9545.458
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1611.228348.2911.0075.623469.606-0.07918.75444.94
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1611.236348.4111.3545.620769.285-0.0295-42.14846.684
1611.24348.3611.5415.602469.240.0649-71.64166.564
1611.244348.1111.8075.611169.0770.2021-99.18791.009
1611.248347.9612.1715.698869.0940.37-128.92109.64
1611.252347.5712.615.842568.9870.5394-156.59142.67
1611.256346.9813.1815.992469.0270.6874-183.34182.3
1611.26345.9513.916.126769.0920.7894-204.17231.01
1611.264344.7514.8346.247668.9570.8331-221.34282.86
1611.268343.5215.9656.360268.9230.8241-233.3322.5
1611.272342.2117.2556.436268.6750.7691-241.85365.21
1611.276340.8218.7166.481268.540.6831-245.41391.45
1611.28339.5120.2826.506768.4240.5733-249.2434.54
1611.284338.322.026.522668.1990.4512-251.88472.81
1611.288337.0923.9116.536368.1690.3316-251.87518.38
1611.292335.8825.9856.545368.0210.2237-248.1540.04
1611.296334.5328.1456.549968.0050.1367-240.99563.25
1611.3332.9930.3986.548968.0110.0694-231.21581.98
1611.304331.4132.7266.544167.8130.0161-221.83605.02
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1611.316327.9240.2466.513167.244-0.0817-205.66665.16
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1611.324326.4845.6176.494566.919-0.11-198.71678.68
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1611.352321.5663.7326.449866.585-0.1095-220.77544.88
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1611.38315.9976.0696.413965.669-0.0932-326.84318.74
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1611.392312.3479.7176.402165.471-0.0928-370.21270.02
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1611.4309.3181.7726.396765.553-0.0952-391.81229.74
1611.404307.5982.6916.395165.472-0.0967-397.29211.92
1611.408305.8383.5396.394365.507-0.0962-398.87195.75
1611.412303.9684.3226.394565.361-0.0969-399.73184.07
1611.416301.9985.0586.39565.26-0.096-400.92168.74
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1611.424298.2186.3486.397964.877-0.096-407.24142.59
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1611.432294.6587.4286.402864.553-0.101-412.53117.51
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1611.448287.9189.1386.424764.352-0.1032-426.4485.384
1611.452286.7289.486.43264.236-0.1066-434.0881.932
1611.456285.2489.8076.440864.238-0.1076-436.7848.113
1611.46283.44906.450864.332-0.1061-432.2750.423
1611.464281.3690.2016.461964.332-0.1055-423.8134.355
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1611.476275.7590.6476.493865.275-0.1053-400.6525.171
1611.48273.9690.7486.503565.921-0.1039-391.4216.069
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1611.496266.8390.846.53569.094-0.0989-328.57-25.612
1611.5265.4690.7386.538470.097-0.092-312.24-30.926
1611.504264.3490.6146.540971.027-0.0858-298.13-30.84
1611.508263.1190.4916.539672.194-0.0783-281.91-31.883
1611.512261.9590.3636.536273.278-0.0721-266.92-27.1
