Longitudinal mechanics of the periinfarct zone and ventricular tachycardia inducibility in patients with chronic ischemic cardiomyopathy
Background Quantification of segmental left ventricular (LV) strain by speckle-tracking echocardiography can identify transmural infarcts in patients with chronic ischemic cardiomyopathy. The aim of the study was to explore the relationship between the LV longitudinal peak systolic strain (LPSS) of...
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| creator | Bertini, Matteo, MD Ng, Arnold C.T., MBBS Borleffs, C. Jan Willem, MD Delgado, Victoria, MD Wijnmaalen, Adrianus P., MD Nucifora, Gaetano, MD Ewe, See H., MD Shanks, Miriam, MD Thijssen, Joep, MD Zeppenfeld, Katja, MD, PhD Biffi, Mauro, MD Leung, Dominic Y., MBBS, PhD Schalij, Martin J., MD, PhD Bax, Jeroen J., MD, PhD |
| description | Background Quantification of segmental left ventricular (LV) strain by speckle-tracking echocardiography can identify transmural infarcts in patients with chronic ischemic cardiomyopathy. The aim of the study was to explore the relationship between the LV longitudinal peak systolic strain (LPSS) of the infarct, periinfarct, and remote zones and monomorphic ventricular tachycardia (VT) inducibility on electrophysiologic (EP) study. Methods A total of 134 patients with chronic ischemic cardiomyopathy scheduled for EP study were included. The protocol consisted of clinical, electrocardiographic, and echocardiographic evaluation, including LV longitudinal strain analysis using speckle-tracking echocardiography, immediately before EP study. An infarct segment was defined as a longitudinal strain value of greater than −5%, and a periinfarct segment was defined as immediately adjacent to an infarct segment. Results The infarct zone had the most impaired longitudinal strain (−0.5% ± 3.0%), whereas the periinfarct and remote zones had more preserved longitudinal strain (−10.8% ± 1.9% and −14.5% ± 3.0%, respectively; analysis of variance, P < .001). Seventy-two (54%) patients had inducible monomorphic VT on EP study. There was no significant difference in LV ejection fraction (31% ± 9% vs 32% ± 11%, P = .29) between inducible and noninducible patients. Longitudinal peak systolic strain of the periinfarct zone was more impaired in inducible patients (−9.8% ± 1.5% vs −11.0% ± 2.1%, P = .001), but no differences in LPSS of the infarct (−0.5% ± 3.2% vs −0.4% ± 2.7%, P = .75) and remote (−14.6% ± 2.8% vs −14.5% ± 3.4%, P = .92) zones were observed. Only LPSS of the periinfarct zone (OR 1.43, 95% CI 1.15-1.78, P = .001) was independently related to monomorphic VT inducibility on multiple logistic regression. Conclusions Longitudinal strain analysis may be a useful imaging tool to risk stratify ischemic patients for malignant ventricular arrhythmia. |
| doi_str_mv | 10.1016/j.ahj.2010.06.041 |
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Jan Willem, MD ; Delgado, Victoria, MD ; Wijnmaalen, Adrianus P., MD ; Nucifora, Gaetano, MD ; Ewe, See H., MD ; Shanks, Miriam, MD ; Thijssen, Joep, MD ; Zeppenfeld, Katja, MD, PhD ; Biffi, Mauro, MD ; Leung, Dominic Y., MBBS, PhD ; Schalij, Martin J., MD, PhD ; Bax, Jeroen J., MD, PhD</creator><creatorcontrib>Bertini, Matteo, MD ; Ng, Arnold C.T., MBBS ; Borleffs, C. Jan Willem, MD ; Delgado, Victoria, MD ; Wijnmaalen, Adrianus P., MD ; Nucifora, Gaetano, MD ; Ewe, See H., MD ; Shanks, Miriam, MD ; Thijssen, Joep, MD ; Zeppenfeld, Katja, MD, PhD ; Biffi, Mauro, MD ; Leung, Dominic Y., MBBS, PhD ; Schalij, Martin J., MD, PhD ; Bax, Jeroen J., MD, PhD</creatorcontrib><description>Background Quantification of segmental left ventricular (LV) strain by speckle-tracking echocardiography can identify transmural infarcts in patients with chronic ischemic cardiomyopathy. The aim of the study was to explore the relationship between the LV longitudinal peak systolic strain (LPSS) of the infarct, periinfarct, and remote zones and monomorphic ventricular tachycardia (VT) inducibility on electrophysiologic (EP) study. Methods A total of 134 patients with chronic ischemic cardiomyopathy scheduled for EP study were included. The protocol consisted of clinical, electrocardiographic, and echocardiographic evaluation, including LV longitudinal strain analysis using speckle-tracking echocardiography, immediately before EP study. An infarct segment was defined as a longitudinal strain value of greater than −5%, and a periinfarct segment was defined as immediately adjacent to an infarct segment. Results The infarct zone had the most impaired longitudinal strain (−0.5% ± 3.0%), whereas the periinfarct and remote zones had more preserved longitudinal strain (−10.8% ± 1.9% and −14.5% ± 3.0%, respectively; analysis of variance, P < .001). Seventy-two (54%) patients had inducible monomorphic VT on EP study. There was no significant difference in LV ejection fraction (31% ± 9% vs 32% ± 11%, P = .29) between inducible and noninducible patients. Longitudinal peak systolic strain of the periinfarct zone was more impaired in inducible patients (−9.8% ± 1.5% vs −11.0% ± 2.1%, P = .001), but no differences in LPSS of the infarct (−0.5% ± 3.2% vs −0.4% ± 2.7%, P = .75) and remote (−14.6% ± 2.8% vs −14.5% ± 3.4%, P = .92) zones were observed. Only LPSS of the periinfarct zone (OR 1.43, 95% CI 1.15-1.78, P = .001) was independently related to monomorphic VT inducibility on multiple logistic regression. Conclusions Longitudinal strain analysis may be a useful imaging tool to risk stratify ischemic patients for malignant ventricular arrhythmia.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2010.06.041</identifier><identifier>PMID: 20934568</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Aged ; Automation ; Biological and medical sciences ; Cardiac arrhythmia ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Cardiomyopathy ; Cardiovascular ; Cardiovascular disease ; Chronic Disease ; Disease Progression ; Echocardiography ; Electrocardiography ; Enzymes ; Female ; Follow-Up Studies ; Heart ; Heart attacks ; Heart Rate - physiology ; Humans ; Male ; Mechanical properties ; Medical sciences ; Myocardial Infarction - complications ; Myocardial Infarction - diagnosis ; Myocardial Infarction - physiopathology ; Myocarditis. Cardiomyopathies ; Prognosis ; Regression analysis ; Tachycardia, Ventricular - diagnosis ; Tachycardia, Ventricular - etiology ; Tachycardia, Ventricular - physiopathology ; Values</subject><ispartof>The American heart journal, 2010-10, Vol.160 (4), p.729-736</ispartof><rights>Mosby, Inc.</rights><rights>2010 Mosby, Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 Mosby, Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Oct 2010</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c465t-4c254b1d8efa9949953294b28238834a25d2cd71c9b7e0cbb3d7e4074d795c93</citedby><cites>FETCH-LOGICAL-c465t-4c254b1d8efa9949953294b28238834a25d2cd71c9b7e0cbb3d7e4074d795c93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002870310005570$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23393467$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20934568$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bertini, Matteo, MD</creatorcontrib><creatorcontrib>Ng, Arnold C.T., MBBS</creatorcontrib><creatorcontrib>Borleffs, C. Jan Willem, MD</creatorcontrib><creatorcontrib>Delgado, Victoria, MD</creatorcontrib><creatorcontrib>Wijnmaalen, Adrianus P., MD</creatorcontrib><creatorcontrib>Nucifora, Gaetano, MD</creatorcontrib><creatorcontrib>Ewe, See H., MD</creatorcontrib><creatorcontrib>Shanks, Miriam, MD</creatorcontrib><creatorcontrib>Thijssen, Joep, MD</creatorcontrib><creatorcontrib>Zeppenfeld, Katja, MD, PhD</creatorcontrib><creatorcontrib>Biffi, Mauro, MD</creatorcontrib><creatorcontrib>Leung, Dominic Y., MBBS, PhD</creatorcontrib><creatorcontrib>Schalij, Martin J., MD, PhD</creatorcontrib><creatorcontrib>Bax, Jeroen J., MD, PhD</creatorcontrib><title>Longitudinal mechanics of the periinfarct zone and ventricular tachycardia inducibility in patients with chronic ischemic cardiomyopathy</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background Quantification of segmental left ventricular (LV) strain by speckle-tracking echocardiography can identify transmural infarcts in patients with chronic ischemic cardiomyopathy. The aim of the study was to explore the relationship between the LV longitudinal peak systolic strain (LPSS) of the infarct, periinfarct, and remote zones and monomorphic ventricular tachycardia (VT) inducibility on electrophysiologic (EP) study. Methods A total of 134 patients with chronic ischemic cardiomyopathy scheduled for EP study were included. The protocol consisted of clinical, electrocardiographic, and echocardiographic evaluation, including LV longitudinal strain analysis using speckle-tracking echocardiography, immediately before EP study. An infarct segment was defined as a longitudinal strain value of greater than −5%, and a periinfarct segment was defined as immediately adjacent to an infarct segment. Results The infarct zone had the most impaired longitudinal strain (−0.5% ± 3.0%), whereas the periinfarct and remote zones had more preserved longitudinal strain (−10.8% ± 1.9% and −14.5% ± 3.0%, respectively; analysis of variance, P < .001). Seventy-two (54%) patients had inducible monomorphic VT on EP study. There was no significant difference in LV ejection fraction (31% ± 9% vs 32% ± 11%, P = .29) between inducible and noninducible patients. Longitudinal peak systolic strain of the periinfarct zone was more impaired in inducible patients (−9.8% ± 1.5% vs −11.0% ± 2.1%, P = .001), but no differences in LPSS of the infarct (−0.5% ± 3.2% vs −0.4% ± 2.7%, P = .75) and remote (−14.6% ± 2.8% vs −14.5% ± 3.4%, P = .92) zones were observed. Only LPSS of the periinfarct zone (OR 1.43, 95% CI 1.15-1.78, P = .001) was independently related to monomorphic VT inducibility on multiple logistic regression. Conclusions Longitudinal strain analysis may be a useful imaging tool to risk stratify ischemic patients for malignant ventricular arrhythmia.</description><subject>Aged</subject><subject>Automation</subject><subject>Biological and medical sciences</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. Vascular system</subject><subject>Cardiomyopathy</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Chronic Disease</subject><subject>Disease Progression</subject><subject>Echocardiography</subject><subject>Electrocardiography</subject><subject>Enzymes</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Heart Rate - physiology</subject><subject>Humans</subject><subject>Male</subject><subject>Mechanical properties</subject><subject>Medical sciences</subject><subject>Myocardial Infarction - complications</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Myocarditis. Cardiomyopathies</subject><subject>Prognosis</subject><subject>Regression analysis</subject><subject>Tachycardia, Ventricular - diagnosis</subject><subject>Tachycardia, Ventricular - etiology</subject><subject>Tachycardia, Ventricular - physiopathology</subject><subject>Values</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kt-K1DAUxoso7rj6AN5IQMSrjkmaJi2CIIv_YMAL9z6kJ6nN2DZjkq7UJ_CxPeOMLuyFVzkHft_h5PtOUTxldMsok6_2WzPst5xiT-WWCnav2DDaqlIqIe4XG0opLxtFq4viUUp7bCVv5MPigtO2ErVsNsWvXZi_-rxYP5uRTA4GM3tIJPQkD44cXPR-7k2ETH6G2REzW3Lj5hw9LKOJJBsYVjDRekP8bBfwnR99XrEhB5M9oon88HkgMMSAo4lPMLgJiz-qMK0BuWF9XDzozZjck_N7WVy_f3d99bHcff7w6ertrgQh61wK4LXomG1cb9pWtG1d8VZ0vOFV01TC8NpysIpB2ylHoesqq5ygSljV1tBWl8XL09hDDN8Xl7KecCE3jmZ2YUla1UpIyphA8vkdch-WiC4lzWoqpKC1aJBiJwpiSCm6Xh-in0xcNaP6GJLeawxJH0PSVGoMCTXPzpOXbnL2n-JvKgi8OAMmgRn7aGbw6ZarKgSlQu71iXNo2I13USdAx8FZHx1kbYP_7xpv7qhh9JiQGb-51aXb3-rENdVfjtd0PCaGRV1j8RuGNsXv</recordid><startdate>20101001</startdate><enddate>20101001</enddate><creator>Bertini, Matteo, MD</creator><creator>Ng, Arnold C.T., MBBS</creator><creator>Borleffs, C. Jan Willem, MD</creator><creator>Delgado, Victoria, MD</creator><creator>Wijnmaalen, Adrianus P., MD</creator><creator>Nucifora, Gaetano, MD</creator><creator>Ewe, See H., MD</creator><creator>Shanks, Miriam, MD</creator><creator>Thijssen, Joep, MD</creator><creator>Zeppenfeld, Katja, MD, PhD</creator><creator>Biffi, Mauro, MD</creator><creator>Leung, Dominic Y., MBBS, PhD</creator><creator>Schalij, Martin J., MD, PhD</creator><creator>Bax, Jeroen J., MD, PhD</creator><general>Mosby, Inc</general><general>Mosby</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20101001</creationdate><title>Longitudinal mechanics of the periinfarct zone and ventricular tachycardia inducibility in patients with chronic ischemic cardiomyopathy</title><author>Bertini, Matteo, MD ; Ng, Arnold C.T., MBBS ; Borleffs, C. Jan Willem, MD ; Delgado, Victoria, MD ; Wijnmaalen, Adrianus P., MD ; Nucifora, Gaetano, MD ; Ewe, See H., MD ; Shanks, Miriam, MD ; Thijssen, Joep, MD ; Zeppenfeld, Katja, MD, PhD ; Biffi, Mauro, MD ; Leung, Dominic Y., MBBS, PhD ; Schalij, Martin J., MD, PhD ; Bax, Jeroen J., MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c465t-4c254b1d8efa9949953294b28238834a25d2cd71c9b7e0cbb3d7e4074d795c93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Automation</topic><topic>Biological and medical sciences</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology. Vascular system</topic><topic>Cardiomyopathy</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Chronic Disease</topic><topic>Disease Progression</topic><topic>Echocardiography</topic><topic>Electrocardiography</topic><topic>Enzymes</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Heart Rate - physiology</topic><topic>Humans</topic><topic>Male</topic><topic>Mechanical properties</topic><topic>Medical sciences</topic><topic>Myocardial Infarction - complications</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Myocarditis. Cardiomyopathies</topic><topic>Prognosis</topic><topic>Regression analysis</topic><topic>Tachycardia, Ventricular - diagnosis</topic><topic>Tachycardia, Ventricular - etiology</topic><topic>Tachycardia, Ventricular - physiopathology</topic><topic>Values</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bertini, Matteo, MD</creatorcontrib><creatorcontrib>Ng, Arnold C.T., MBBS</creatorcontrib><creatorcontrib>Borleffs, C. 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Jan Willem, MD</au><au>Delgado, Victoria, MD</au><au>Wijnmaalen, Adrianus P., MD</au><au>Nucifora, Gaetano, MD</au><au>Ewe, See H., MD</au><au>Shanks, Miriam, MD</au><au>Thijssen, Joep, MD</au><au>Zeppenfeld, Katja, MD, PhD</au><au>Biffi, Mauro, MD</au><au>Leung, Dominic Y., MBBS, PhD</au><au>Schalij, Martin J., MD, PhD</au><au>Bax, Jeroen J., MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Longitudinal mechanics of the periinfarct zone and ventricular tachycardia inducibility in patients with chronic ischemic cardiomyopathy</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2010-10-01</date><risdate>2010</risdate><volume>160</volume><issue>4</issue><spage>729</spage><epage>736</epage><pages>729-736</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Background Quantification of segmental left ventricular (LV) strain by speckle-tracking echocardiography can identify transmural infarcts in patients with chronic ischemic cardiomyopathy. The aim of the study was to explore the relationship between the LV longitudinal peak systolic strain (LPSS) of the infarct, periinfarct, and remote zones and monomorphic ventricular tachycardia (VT) inducibility on electrophysiologic (EP) study. Methods A total of 134 patients with chronic ischemic cardiomyopathy scheduled for EP study were included. The protocol consisted of clinical, electrocardiographic, and echocardiographic evaluation, including LV longitudinal strain analysis using speckle-tracking echocardiography, immediately before EP study. An infarct segment was defined as a longitudinal strain value of greater than −5%, and a periinfarct segment was defined as immediately adjacent to an infarct segment. Results The infarct zone had the most impaired longitudinal strain (−0.5% ± 3.0%), whereas the periinfarct and remote zones had more preserved longitudinal strain (−10.8% ± 1.9% and −14.5% ± 3.0%, respectively; analysis of variance, P < .001). Seventy-two (54%) patients had inducible monomorphic VT on EP study. There was no significant difference in LV ejection fraction (31% ± 9% vs 32% ± 11%, P = .29) between inducible and noninducible patients. Longitudinal peak systolic strain of the periinfarct zone was more impaired in inducible patients (−9.8% ± 1.5% vs −11.0% ± 2.1%, P = .001), but no differences in LPSS of the infarct (−0.5% ± 3.2% vs −0.4% ± 2.7%, P = .75) and remote (−14.6% ± 2.8% vs −14.5% ± 3.4%, P = .92) zones were observed. Only LPSS of the periinfarct zone (OR 1.43, 95% CI 1.15-1.78, P = .001) was independently related to monomorphic VT inducibility on multiple logistic regression. Conclusions Longitudinal strain analysis may be a useful imaging tool to risk stratify ischemic patients for malignant ventricular arrhythmia.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>20934568</pmid><doi>10.1016/j.ahj.2010.06.041</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Automation Biological and medical sciences Cardiac arrhythmia Cardiac dysrhythmias Cardiology. Vascular system Cardiomyopathy Cardiovascular Cardiovascular disease Chronic Disease Disease Progression Echocardiography Electrocardiography Enzymes Female Follow-Up Studies Heart Heart attacks Heart Rate - physiology Humans Male Mechanical properties Medical sciences Myocardial Infarction - complications Myocardial Infarction - diagnosis Myocardial Infarction - physiopathology Myocarditis. Cardiomyopathies Prognosis Regression analysis Tachycardia, Ventricular - diagnosis Tachycardia, Ventricular - etiology Tachycardia, Ventricular - physiopathology Values |
| title | Longitudinal mechanics of the periinfarct zone and ventricular tachycardia inducibility in patients with chronic ischemic cardiomyopathy |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-28T16%3A07%3A10IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Longitudinal%20mechanics%20of%20the%20periinfarct%20zone%20and%20ventricular%20tachycardia%20inducibility%20in%20patients%20with%20chronic%20ischemic%20cardiomyopathy&rft.jtitle=The%20American%20heart%20journal&rft.au=Bertini,%20Matteo,%20MD&rft.date=2010-10-01&rft.volume=160&rft.issue=4&rft.spage=729&rft.epage=736&rft.pages=729-736&rft.issn=0002-8703&rft.eissn=1097-6744&rft.coden=AHJOA2&rft_id=info:doi/10.1016/j.ahj.2010.06.041&rft_dat=%3Cproquest_cross%3E757460114%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1504640548&rft_id=info:pmid/20934568&rft_els_id=1_s2_0_S0002870310005570&rfr_iscdi=true |