Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology.
暂无分享,去创建一个
J. Lumens | A. Torbicki | J. Newman | N. Voelkel | R. Naeije | P. Hassoun | F. Haddad | R. Oudiz | K. Chin | S. Kawut | A. Vonk-Noordegraaf | P. Forfia | S. Provencher
[1] M. Humbert,et al. Non-invasive indices of right ventricular function are markers of ventricular-arterial coupling rather than ventricular contractility: insights from a porcine model of chronic pressure overload. , 2013, European heart journal cardiovascular Imaging.
[2] W. Paulus,et al. Right Ventricular Diastolic Impairment in Patients With Pulmonary Arterial Hypertension , 2013, Circulation.
[3] M. Drazner,et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. , 2013, Journal of the American College of Cardiology.
[4] E. Fadel,et al. Experimental Models of Right Heart Failure: A Window for Translational Research in Pulmonary Hypertension , 2013, Seminars in Respiratory and Critical Care Medicine.
[5] M. Ishihara,et al. Right ventricular electrical remodeling and arrhythmogenic substrate in rat pulmonary hypertension. , 2013, American journal of respiratory cell and molecular biology.
[6] Ami A. Shah,et al. Right Ventricular Dysfunction in Systemic Sclerosis–Associated Pulmonary Arterial Hypertension , 2013, Circulation. Heart failure.
[7] S. Xavier,et al. Pulmonary Arterial Hypertension: Use of Delayed Contrast-Enhanced Cardiovascular Magnetic Resonance in Risk Assessment , 2013, Arquivos brasileiros de cardiologia.
[8] M. Humbert,et al. Pulmonary arterial hypertension , 2013, Orphanet Journal of Rare Diseases.
[9] M. Arzt,et al. Impact of right ventricular reserve on exercise capacity and survival in patients with pulmonary hypertension , 2013, European journal of heart failure.
[10] C. Ayers,et al. Association of cardiac troponin I with disease severity and outcomes in patients with pulmonary hypertension. , 2013, The American journal of cardiology.
[11] H. Ghofrani,et al. Imatinib Mesylate as Add-on Therapy for Pulmonary Arterial Hypertension: Results of the Randomized IMPRES Study , 2013, Circulation.
[12] N. Westerhof,et al. Right ventricular oxygen supply parameters are decreased in human and experimental pulmonary hypertension. , 2013, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.
[13] J. Marcus,et al. Early-diastolic left ventricular lengthening implies pulmonary hypertension-induced right ventricular decompensation. , 2012, Cardiovascular research.
[14] Tammo Delhaas,et al. Cardiovascular modeling in pulmonary arterial hypertension: focus on mechanisms and treatment of right heart failure using the CircAdapt model. , 2012, The American journal of cardiology.
[15] Jeroen J. Bax,et al. Prognostic Value of Right Ventricular Longitudinal Peak Systolic Strain in Patients With Pulmonary Hypertension , 2012, Circulation. Cardiovascular imaging.
[16] N. Voelkel,et al. Pathobiology of pulmonary arterial hypertension and right ventricular failure , 2012, European Respiratory Journal.
[17] H. Tan,et al. Electrophysiologic remodeling of the left ventricle in pressure overload-induced right ventricular failure. , 2012, Journal of the American College of Cardiology.
[18] Jeroen J. Bax,et al. Right ventricular longitudinal peak systolic strain measurements from the subcostal view in patients with suspected pulmonary hypertension: a feasibility study. , 2012, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.
[19] D. Bernstein,et al. Dynamic microRNA expression during the transition from right ventricular hypertrophy to failure. , 2012, Physiological genomics.
[20] L. Dell’Italia. Anatomy and physiology of the right ventricle. , 2012, Cardiology clinics.
[21] N. Westerhof,et al. Progressive changes in right ventricular geometric shortening and long-term survival in pulmonary arterial hypertension. , 2012, Chest.
[22] M. Gomberg-Maitland,et al. Validation of the pulmonary hypertension connection equation for survival prediction in pulmonary arterial hypertension. , 2012, Chest.
[23] R. Naeije,et al. Pulmonary vascular responses to exercise: a haemodynamic observation , 2012, European Respiratory Journal.
[24] R. Tuder,et al. Targeting energetic metabolism: a new frontier in the pathogenesis and treatment of pulmonary hypertension. , 2012, American journal of respiratory and critical care medicine.
[25] Theo Arts,et al. Control of Whole Heart Geometry by Intramyocardial Mechano-Feedback: A Model Study , 2012, PLoS Comput. Biol..
[26] James O. Mudd,et al. Pulmonary Capillary Wedge Pressure Augments Right Ventricular Pulsatile Loading , 2012, Circulation.
[27] Nico Westerhof,et al. Pulmonary endarterectomy normalizes interventricular dyssynchrony and right ventricular systolic wall stress , 2012, Journal of Cardiovascular Magnetic Resonance.
[28] W. Paulus,et al. Bisoprolol Delays Progression Towards Right Heart Failure in Experimental Pulmonary Hypertension , 2012, Circulation. Heart failure.
[29] Nico Westerhof,et al. Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. , 2011, Journal of the American College of Cardiology.
[30] A. Noordegraaf,et al. The role of the right ventricle in pulmonary arterial hypertension , 2011, European Respiratory Review.
[31] A. Denault,et al. Characteristics and Outcome After Hospitalization for Acute Right Heart Failure in Patients With Pulmonary Arterial Hypertension , 2011, Circulation. Heart failure.
[32] G. Lip,et al. The role of monocytes and inflammation in the pathophysiology of heart failure , 2011, European journal of heart failure.
[33] A. Berghold,et al. Pulmonary vascular resistances during exercise in normal subjects: a systematic review , 2011, European Respiratory Journal.
[34] S. Hazen,et al. Sensitive cardiac troponin I predicts poor outcomes in pulmonary arterial hypertension , 2011, European Respiratory Journal.
[35] M. Humbert,et al. The association between resting and mild-to-moderate exercise pulmonary artery pressure , 2011, European Respiratory Journal.
[36] W. Winkelmayer,et al. Incidence, correlates, and consequences of acute kidney injury in patients with pulmonary arterial hypertension hospitalized with acute right-side heart failure. , 2011, Journal of cardiac failure.
[37] P. Fawcett,et al. Molecular signature of a right heart failure program in chronic severe pulmonary hypertension. , 2011, American journal of respiratory cell and molecular biology.
[38] R. Kronmal,et al. Sex and Race Differences in Right Ventricular Structure and Function: The Multi-Ethnic Study of Atherosclerosis–Right Ventricle Study , 2011, Circulation.
[39] P. Pellikka,et al. Right ventricular strain for prediction of survival in patients with pulmonary arterial hypertension. , 2011, Chest.
[40] Anton Vonk-Noordegraaf,et al. Early onset of retrograde flow in the main pulmonary artery is a characteristic of pulmonary arterial hypertension , 2011, Journal of magnetic resonance imaging : JMRI.
[41] G. Lewis,et al. Pulmonary Vascular Response Patterns During Exercise in Left Ventricular Systolic Dysfunction Predict Exercise Capacity and Outcomes , 2011, Circulation. Heart failure.
[42] J. Bronzwaer,et al. Clinically significant change in stroke volume in pulmonary hypertension. , 2011, Chest.
[43] G. Di Salvo,et al. Range in pulmonary artery systolic pressure among highly trained athletes. , 2011, Chest.
[44] I. Belenkie,et al. Volume loading reduces pulmonary vascular resistance in ventilated animals with acute lung injury: evaluation of RV afterload. , 2011, American journal of physiology. Regulatory, integrative and comparative physiology.
[45] S. Ghio,et al. Clinical and prognostic relevance of echocardiographic evaluation of right ventricular geometry in patients with idiopathic pulmonary arterial hypertension. , 2011, The American journal of cardiology.
[46] A. Zaiman,et al. Outcomes of hospitalisation for right heart failure in pulmonary arterial hypertension , 2011, European Respiratory Journal.
[47] Dave P. Miller,et al. Characterization of connective tissue disease-associated pulmonary arterial hypertension from REVEAL: identifying systemic sclerosis as a unique phenotype. , 2010, Chest.
[48] N. Westerhof,et al. Right ventricular oscillatory power is a constant fraction of total power irrespective of pulmonary artery pressure. , 2010, American journal of respiratory and critical care medicine.
[49] H. Ghofrani,et al. Imatinib in pulmonary arterial hypertension patients with inadequate response to established therapy. , 2010, American journal of respiratory and critical care medicine.
[50] S. Anker,et al. Inflammation in right ventricular dysfunction due to thromboembolic pulmonary hypertension. , 2010, International journal of cardiology.
[51] S. Ghio,et al. Inappropriate exercise-induced increase in pulmonary artery pressure in patients with systemic sclerosis , 2010, Heart.
[52] A. Chapelier,et al. Long-term outcome of double-lung and heart-lung transplantation for pulmonary hypertension: a comparative retrospective study of 219 patients. , 2010, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.
[53] N. Westerhof,et al. The arterial load in pulmonary hypertension , 2010, European Respiratory Review.
[54] N. Voelkel,et al. Adrenergic receptor blockade reverses right heart remodeling and dysfunction in pulmonary hypertensive rats. , 2010, American journal of respiratory and critical care medicine.
[55] G. Lopaschuk,et al. Fatty Acid Oxidation and Malonyl-CoA Decarboxylase in the Vascular Remodeling of Pulmonary Hypertension , 2010, Science Translational Medicine.
[56] H. Katus,et al. High-sensitive troponin T: a novel biomarker for prognosis and disease severity in patients with pulmonary arterial hypertension. , 2010, Clinical science.
[57] Horst Olschewski,et al. Assessment of pulmonary arterial pressure during exercise in collagen vascular disease: echocardiography vs right-sided heart catheterization. , 2010, Chest.
[58] A. Zaiman,et al. Hemodynamic predictors of survival in scleroderma-related pulmonary arterial hypertension. , 2010, American journal of respiratory and critical care medicine.
[59] Christopher S Coffey,et al. Predicting Survival in Pulmonary Arterial Hypertension: Insights From the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) , 2010, Circulation.
[60] M. Humbert,et al. Survival in Patients With Idiopathic, Familial, and Anorexigen-Associated Pulmonary Arterial Hypertension in the Modern Management Era , 2010, Circulation.
[61] S. Ghio,et al. Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. , 2010, International journal of cardiology.
[62] J. E. Hansen,et al. Usefulness of right-to-left shunting and poor exercise gas exchange for predicting prognosis in patients with pulmonary arterial hypertension. , 2010, The American journal of cardiology.
[63] W. Paulus,et al. Perspectives on novel therapeutic strategies for right heart failure in pulmonary arterial hypertension: lessons from the left heart , 2010, European Respiratory Review.
[64] J. Kline,et al. Right ventricular heart failure from pulmonary embolism: key distinctions from chronic pulmonary hypertension. , 2010, Journal of cardiac failure.
[65] E. Ashley,et al. New insights for the diagnosis and management of right ventricular failure, from molecular imaging to targeted right ventricular therapy , 2010, Current opinion in cardiology.
[66] Sanjiv J. Shah,et al. Survival in pulmonary arterial hypertension: a reappraisal of the NIH risk stratification equation , 2009, European Respiratory Journal.
[67] B. Westerhof,et al. RC time constant of single lung equals that of both lungs together: a study in chronic thromboembolic pulmonary hypertension. , 2009, American journal of physiology. Heart and circulatory physiology.
[68] C. Long,et al. Chronic Pulmonary Artery Pressure Elevation Is Insufficient to Explain Right Heart Failure , 2009, Circulation.
[69] N. Chesler,et al. How to measure peripheral pulmonary vascular mechanics , 2009, 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.
[70] N. Chesler,et al. How to measure pulmonary vascular and right ventricular function , 2009, 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.
[71] M. Humbert,et al. Prognostic factors of acute heart failure in patients with pulmonary arterial hypertension , 2009, European Respiratory Journal.
[72] W. Paulus,et al. Right ventricular pacing improves right heart function in experimental pulmonary arterial hypertension: a study in the isolated heart. , 2009, American journal of physiology. Heart and circulatory physiology.
[73] W. Graninger,et al. Borderline pulmonary arterial pressure is associated with decreased exercise capacity in scleroderma. , 2009, American journal of respiratory and critical care medicine.
[74] N. Chesler,et al. Exercise stress echocardiography for the study of the pulmonary circulation , 2009, European Respiratory Journal.
[75] P. Hassoun,et al. Comprehensive invasive and noninvasive approach to the right ventricle-pulmonary circulation unit: state of the art and clinical and research implications. , 2009, Circulation.
[76] J. Wild,et al. Ventricular mass index correlates with pulmonary artery pressure and predicts survival in suspected systemic sclerosis-associated pulmonary arterial hypertension. , 2009, Rheumatology.
[77] Gloria Tamborini,et al. Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic study. , 2009, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.
[78] E. Michelakis,et al. Mitochondrial NOS is upregulated in the hypoxic heart: implications for the function of the hypertrophied right ventricle. , 2009, American journal of physiology. Heart and circulatory physiology.
[79] Kohtaro Abe,et al. The right ventricle under pressure: cellular and molecular mechanisms of right-heart failure in pulmonary hypertension. , 2009, Chest.
[80] P. Postmus,et al. Exercise testing to estimate survival in pulmonary hypertension. , 2008, Medicine and science in sports and exercise.
[81] M. Wilkins,et al. Emerging concepts and translational priorities in pulmonary arterial hypertension. , 2008, Circulation.
[82] D. Bernstein,et al. Molecular and physiological characterization of RV remodeling in a murine model of pulmonary stenosis. , 2008, American journal of physiology. Heart and circulatory physiology.
[83] M. Humbert,et al. Changes in exercise haemodynamics during treatment in pulmonary arterial hypertension , 2008, European Respiratory Journal.
[84] A. Torbicki,et al. Characteristics and prognosis of patients with decompensated right ventricular failure during the course of pulmonary hypertension. , 2008, Kardiologia polska.
[85] Nico Westerhof,et al. Pulmonary vascular resistance and compliance stay inversely related during treatment of pulmonary hypertension. , 2008, European heart journal.
[86] J. Dyck,et al. A dynamic and chamber-specific mitochondrial remodeling in right ventricular hypertrophy can be therapeutically targeted. , 2008, The Journal of thoracic and cardiovascular surgery.
[87] P. Hassoun,et al. Hyponatremia predicts right heart failure and poor survival in pulmonary arterial hypertension. , 2008, American journal of respiratory and critical care medicine.
[88] P. Beerbaum,et al. Imaging the right ventricle , 2008, Heart.
[89] Sanjiv J. Shah,et al. Association of Serum Creatinine With Abnormal Hemodynamics and Mortality in Pulmonary Arterial Hypertension , 2008, Circulation.
[90] S. Hunt,et al. Right Ventricular Function in Cardiovascular Disease, Part II: Pathophysiology, Clinical Importance, and Management of Right Ventricular Failure , 2008, Circulation.
[91] S. Hunt,et al. Right Ventricular Function in Cardiovascular Disease, Part I: Anatomy, Physiology, Aging, and Functional Assessment of the Right Ventricle , 2008, Circulation.
[92] J. Zwanenburg,et al. Interventricular mechanical asynchrony in pulmonary arterial hypertension: left-to-right delay in peak shortening is related to right ventricular overload and left ventricular underfilling. , 2008, Journal of the American College of Cardiology.
[93] M. Maitland,et al. Mitochondrial metabolism, redox signaling, and fusion: a mitochondria-ROS-HIF-1alpha-Kv1.5 O2-sensing pathway at the intersection of pulmonary hypertension and cancer. , 2008, American journal of physiology. Heart and circulatory physiology.
[94] Nico Westerhof,et al. Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension. , 2007, Chest.
[95] P. V. van Riel,et al. Right ventricle Tei-index: a tool to increase the accuracy of non-invasive detection of pulmonary arterial hypertension in connective tissue diseases. , 2007, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.
[96] V. Fuster,et al. Prevalence and correlates of septal delayed contrast enhancement in patients with pulmonary hypertension. , 2007, The American journal of cardiology.
[97] P. Light,et al. Phosphodiesterase Type 5 Is Highly Expressed in the Hypertrophied Human Right Ventricle, and Acute Inhibition of Phosphodiesterase Type 5 Improves Contractility , 2007, Circulation.
[98] J. Bronzwaer,et al. Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension. , 2007, European heart journal.
[99] R. Naeije,et al. How prostacyclin improves cardiac output in right heart failure in conjunction with pulmonary hypertension. , 2007, American journal of respiratory and critical care medicine.
[100] H. Niessen,et al. Extent of MRI delayed enhancement of myocardial mass is related to right ventricular dysfunction in pulmonary artery hypertension. , 2007, AJR. American journal of roentgenology.
[101] Bernard Lambermont,et al. The role of right ventricular-pulmonary arterial coupling to differentiate between effects of inotropic agents in experimental right heart failure. , 2006, Critical care medicine.
[102] T. Abraham,et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. , 2006, American journal of respiratory and critical care medicine.
[103] M. Gladwin,et al. Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. , 2006, Circulation.
[104] J. Kline,et al. Cardiac inflammation contributes to right ventricular dysfunction following experimental pulmonary embolism in rats. , 2006, Journal of molecular and cellular cardiology.
[105] R. Naeije,et al. Effects of levosimendan versus dobutamine on pressure load-induced right ventricular failure. , 2006, Critical care medicine.
[106] A. Torbicki,et al. Serum N-terminal brain natriuretic peptide as a prognostic parameter in patients with pulmonary hypertension. , 2006, Chest.
[107] Paul Sorajja,et al. Relationship of pulmonary arterial capacitance and mortality in idiopathic pulmonary arterial hypertension. , 2006, Journal of the American College of Cardiology.
[108] H. Farber,et al. Pulmonary hemodynamic responses to brain natriuretic peptide and sildenafil in patients with pulmonary arterial hypertension. , 2006, Chest.
[109] J. Marcus,et al. Interventricular mechanical asynchrony due to right ventricular pressure overload in pulmonary hypertension plays an important role in impaired left ventricular filling. , 2005, Chest.
[110] M. Buckingham,et al. Building the mammalian heart from two sources of myocardial cells , 2005, Nature Reviews Genetics.
[111] Paolo Pelosi,et al. Clinical review: Positive end-expiratory pressure and cardiac output , 2005, Critical care.
[112] A. Beek,et al. Delayed contrast-enhanced magnetic resonance imaging in pulmonary arterial hypertension. , 2005, Circulation.
[113] K. Chatterjee,et al. Effects of intravenous nesiritide on pulmonary vascular hemodynamics in pulmonary hypertension. , 2005, Journal of cardiac failure.
[114] J. Linehan,et al. Distensibility of the normal human lung circulation during exercise. , 2005, American journal of physiology. Lung cellular and molecular physiology.
[115] K. Chin,et al. The right ventricle in pulmonary hypertension , 2005, Coronary artery disease.
[116] Titus Kuehne,et al. Magnetic Resonance Imaging Analysis of Right Ventricular Pressure-Volume Loops: In Vivo Validation and Clinical Application in Patients With Pulmonary Hypertension , 2004, Circulation.
[117] P. Jaksch,et al. Reverse cardiac remodelling in patients with primary pulmonary hypertension after isolated lung transplantation. , 2004, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.
[118] R. Naeije,et al. Effects of norepinephrine and dobutamine on pressure load-induced right ventricular failure* , 2004, Critical care medicine.
[119] A. Torbicki,et al. Detectable Serum Cardiac Troponin T as a Marker of Poor Prognosis Among Patients With Chronic Precapillary Pulmonary Hypertension , 2003, Circulation.
[120] Jeffrey A Feinstein,et al. Electrical Resynchronization: A Novel Therapy for the Failing Right Ventricle , 2003, Circulation.
[121] G. Koch,et al. Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. , 2002, Journal of the American College of Cardiology.
[122] M. Rubenfire,et al. Outcome after cardiopulmonary resuscitation in patients with pulmonary arterial hypertension. , 2002, American journal of respiratory and critical care medicine.
[123] J. Orens,et al. Lung transplantation for primary and secondary pulmonary hypertension. , 2001, The Annals of thoracic surgery.
[124] J M Norton,et al. Toward consistent definitions for preload and afterload. , 2001, Advances in physiology education.
[125] I. Belenkie,et al. Ventricular interaction: from bench to bedside , 2001, Annals of medicine.
[126] K. Kangawa,et al. Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension. , 2000, Circulation.
[127] M. Fujita,et al. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. , 2000, American journal of respiratory and critical care medicine.
[128] S. Rich,et al. The short-term effects of digoxin in patients with right ventricular dysfunction from pulmonary hypertension. , 1998, Chest.
[129] J B Seward,et al. Value of a Doppler-derived index combining systolic and diastolic time intervals in predicting outcome in primary pulmonary hypertension. , 1998, The American journal of cardiology.
[130] B. Groves,et al. Changes in gene expression in the intact human heart. Downregulation of alpha-myosin heavy chain in hypertrophied, failing ventricular myocardium. , 1997, The Journal of clinical investigation.
[131] C. Lorenz,et al. MRI complements standard assessment of right ventricular function after lung transplantation. , 1995, The Annals of thoracic surgery.
[132] S. Rich,et al. Understanding right and left ventricular systolic function and interactions at rest and with exercise in primary pulmonary hypertension. , 1995, The American journal of cardiology.
[133] J. Sandoval,et al. Survival in primary pulmonary hypertension. Validation of a prognostic equation. , 1994, Circulation.
[134] H. Valantine,et al. Recovery of the right ventricle after single-lung transplantation in pulmonary hypertension. , 1994, The American journal of cardiology.
[135] E H Bergofsky,et al. Survival in Patients with Primary Pulmonary Hypertension: Results from a National Prospective Registry , 1991 .
[136] R. Walsh,et al. Application of a time varying elastance model to right ventricular performance in man. , 1988, Cardiovascular research.
[137] N. Fowler. The normal pulmonary arterial pressure-flow relationships during exercise. , 1969, The American journal of medicine.
[138] R. Riley,et al. Studies of the pulmonary circulation at rest and during exercise in normal individuals and in patients with chronic pulmonary disease. , 1948, The American journal of physiology.
[139] S. Solomon,et al. GUIDELINES AND STANDARDS , 2010 .
[140] David A Bluemke,et al. Myocardial delayed enhancement in pulmonary hypertension: pulmonary hemodynamics, right ventricular function, and remodeling. , 2011, AJR. American journal of roentgenology.
[141] M. Hoeper,et al. Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmonary hypertension. , 2007, American heart journal.
[142] M. Humbert,et al. Deleterious effects of beta-blockers on exercise capacity and hemodynamics in patients with portopulmonary hypertension. , 2006, Gastroenterology.
[143] P. McGuire,et al. Cardiac chamber-specific alterations of ANP and BNP expression with advancing age and with systemic hypertension , 2004, Molecular and Cellular Biochemistry.
[144] J. H. Dripps,et al. Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society , 1989 .