Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial
Aims On the basis of the current knowledge, cardiac resynchronization therapy (CRT) cannot be recommended as a first-line treatment for patients with severely symptomatic permanent atrial fibrillation undergoing atrioventricular (AV) junction ablation. We examined whether CRT was superior to convent...
Gespeichert in:
| Veröffentlicht in: | European heart journal 2011-10, Vol.32 (19), p.2420-2429 |
|---|---|
| Hauptverfasser: | , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 2429 |
|---|---|
| container_issue | 19 |
| container_start_page | 2420 |
| container_title | European heart journal |
| container_volume | 32 |
| creator | Brignole, Michele Botto, Gianluca Mont, Lluis Iacopino, Saverio De Marchi, Giuseppe Oddone, Daniele Luzi, Mario Tolosana, Jose M. Navazio, Alessandro Menozzi, Carlo |
| description | Aims
On the basis of the current knowledge, cardiac resynchronization therapy (CRT) cannot be recommended as a first-line treatment for patients with severely symptomatic permanent atrial fibrillation undergoing atrioventricular (AV) junction ablation. We examined whether CRT was superior to conventional right ventricular (RV) pacing in reducing heart failure (HF) events.
Methods and results
In this prospective, multi-centre study, we randomly assigned 186 patients, in whom AV junction ablation and CRT device implantation had been successfully performed, to receive optimized echo-guided CRT (97 patients) or RV apical pacing (89 patients). The data were analysed according to the intention-to-treat principle. During a median follow-up of 20 months (interquartile range 11-24), the primary composite endpoint of death from HF, hospitalization due to HF, or worsening HF occurred in 11 (11%) patients in the CRT group and 23 (26%) patients in the RV group [CRT vs. RV group: sub-hazard ratio (SHR) 0.37 ( 95% CI 0.18-0.73), P = 0.005]. In the CRT group, compared with the RV group, fewer patients had worsening HF [SHR 0.27 (95% CI 0.12-0.58), P = 0.001] and hospitalizations for HF [SHR 0.20 (95% CI 0.06-0.72), P = 0.013]. Total mortality was similar in both groups [hazard ratio (HR) 1.57 (95% CI 0.58-4.27), P = 0.372]. The beneficial effects of CRT were consistent in patients who had ejection fraction ≤35%, New York Heart Association Class ≥III and QRS width ≥120 and in those who did not. At multi-variable Cox regression, only CRT mode remained an independent predictor of absence of clinical failure during the follow-up [HR = 0.23 (95% CI 0.08-0.66), P = 0.007].
Conclusions
In patients undergoing 'Ablate and Pace' therapy for severely symptomatic permanent atrial fibrillation, CRT is superior to RV apical pacing in reducing the clinical manifestations of HF.
(ClinicalTrials.gov number: NCT00111527) |
| doi_str_mv | 10.1093/eurheartj/ehr162 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_896240976</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/eurheartj/ehr162</oup_id><sourcerecordid>896240976</sourcerecordid><originalsourceid>FETCH-LOGICAL-c364t-29be7db2875f07eaa5eb1ee061a84140e2bb31bfa88778e03ad2d66344026a1c3</originalsourceid><addsrcrecordid>eNqFkUFv1DAQhS0EotvCnRPyBXFAobbjOA43tIKCVKmXVuIWTZxJ16vEDuMEafsv-Mekm6UcOY00-t6b0XuMvZHioxRVfokz7RBo2l_ijqRRz9hGFkplldHFc7YRsioyY-yPM3ae0l4IYY00L9mZkkYYYfWG_d4CtR4cJ0yH4HYUg3-AycfApx0SjAfuAx-XDYYp8Tm0SPfRh3sOE_n4a9mSd3MPxPdzcEchNP3q0EXiI9IAYcGOAuh55xvy_Up84sAJQhsH_4AtPwKv2IsO-oSvT_OC3X39crv9ll3fXH3ffr7OXG70lKmqwbJtlC2LTpQIUGAjEYWRYLXUAlXT5LLpwNqytChyaFVrTK61UAakyy_Y-9V3pPhzxjTVg08Ol88CxjnVtjJKi6o0CylW0lFMibCrR_ID0KGWon7soX7qoV57WCRvT-ZzM2D7JPgb_AK8OwGQHPTdkoLz6R-nC1PkVbVwH1YuzuP_z_4Bsciomg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>896240976</pqid></control><display><type>article</type><title>Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Brignole, Michele ; Botto, Gianluca ; Mont, Lluis ; Iacopino, Saverio ; De Marchi, Giuseppe ; Oddone, Daniele ; Luzi, Mario ; Tolosana, Jose M. ; Navazio, Alessandro ; Menozzi, Carlo</creator><creatorcontrib>Brignole, Michele ; Botto, Gianluca ; Mont, Lluis ; Iacopino, Saverio ; De Marchi, Giuseppe ; Oddone, Daniele ; Luzi, Mario ; Tolosana, Jose M. ; Navazio, Alessandro ; Menozzi, Carlo</creatorcontrib><description>Aims
On the basis of the current knowledge, cardiac resynchronization therapy (CRT) cannot be recommended as a first-line treatment for patients with severely symptomatic permanent atrial fibrillation undergoing atrioventricular (AV) junction ablation. We examined whether CRT was superior to conventional right ventricular (RV) pacing in reducing heart failure (HF) events.
Methods and results
In this prospective, multi-centre study, we randomly assigned 186 patients, in whom AV junction ablation and CRT device implantation had been successfully performed, to receive optimized echo-guided CRT (97 patients) or RV apical pacing (89 patients). The data were analysed according to the intention-to-treat principle. During a median follow-up of 20 months (interquartile range 11-24), the primary composite endpoint of death from HF, hospitalization due to HF, or worsening HF occurred in 11 (11%) patients in the CRT group and 23 (26%) patients in the RV group [CRT vs. RV group: sub-hazard ratio (SHR) 0.37 ( 95% CI 0.18-0.73), P = 0.005]. In the CRT group, compared with the RV group, fewer patients had worsening HF [SHR 0.27 (95% CI 0.12-0.58), P = 0.001] and hospitalizations for HF [SHR 0.20 (95% CI 0.06-0.72), P = 0.013]. Total mortality was similar in both groups [hazard ratio (HR) 1.57 (95% CI 0.58-4.27), P = 0.372]. The beneficial effects of CRT were consistent in patients who had ejection fraction ≤35%, New York Heart Association Class ≥III and QRS width ≥120 and in those who did not. At multi-variable Cox regression, only CRT mode remained an independent predictor of absence of clinical failure during the follow-up [HR = 0.23 (95% CI 0.08-0.66), P = 0.007].
Conclusions
In patients undergoing 'Ablate and Pace' therapy for severely symptomatic permanent atrial fibrillation, CRT is superior to RV apical pacing in reducing the clinical manifestations of HF.
(ClinicalTrials.gov number: NCT00111527)</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehr162</identifier><identifier>PMID: 21606084</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Aged ; Aged, 80 and over ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - therapy ; Biological and medical sciences ; Cardiac dysrhythmias ; Cardiac Resynchronization Therapy - methods ; Cardiac Resynchronization Therapy Devices ; Cardiology. Vascular system ; Cardiovascular system ; Catheter Ablation - methods ; Combined Modality Therapy ; Echocardiography ; Female ; Heart ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Prospective Studies ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Risk Factors ; Stroke Volume ; Treatment Outcome ; Ultrasonic investigative techniques</subject><ispartof>European heart journal, 2011-10, Vol.32 (19), p.2420-2429</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011. For permissions please email: journals.permissions@oup.com 2011</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c364t-29be7db2875f07eaa5eb1ee061a84140e2bb31bfa88778e03ad2d66344026a1c3</citedby><cites>FETCH-LOGICAL-c364t-29be7db2875f07eaa5eb1ee061a84140e2bb31bfa88778e03ad2d66344026a1c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24565399$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21606084$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brignole, Michele</creatorcontrib><creatorcontrib>Botto, Gianluca</creatorcontrib><creatorcontrib>Mont, Lluis</creatorcontrib><creatorcontrib>Iacopino, Saverio</creatorcontrib><creatorcontrib>De Marchi, Giuseppe</creatorcontrib><creatorcontrib>Oddone, Daniele</creatorcontrib><creatorcontrib>Luzi, Mario</creatorcontrib><creatorcontrib>Tolosana, Jose M.</creatorcontrib><creatorcontrib>Navazio, Alessandro</creatorcontrib><creatorcontrib>Menozzi, Carlo</creatorcontrib><title>Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Aims
On the basis of the current knowledge, cardiac resynchronization therapy (CRT) cannot be recommended as a first-line treatment for patients with severely symptomatic permanent atrial fibrillation undergoing atrioventricular (AV) junction ablation. We examined whether CRT was superior to conventional right ventricular (RV) pacing in reducing heart failure (HF) events.
Methods and results
In this prospective, multi-centre study, we randomly assigned 186 patients, in whom AV junction ablation and CRT device implantation had been successfully performed, to receive optimized echo-guided CRT (97 patients) or RV apical pacing (89 patients). The data were analysed according to the intention-to-treat principle. During a median follow-up of 20 months (interquartile range 11-24), the primary composite endpoint of death from HF, hospitalization due to HF, or worsening HF occurred in 11 (11%) patients in the CRT group and 23 (26%) patients in the RV group [CRT vs. RV group: sub-hazard ratio (SHR) 0.37 ( 95% CI 0.18-0.73), P = 0.005]. In the CRT group, compared with the RV group, fewer patients had worsening HF [SHR 0.27 (95% CI 0.12-0.58), P = 0.001] and hospitalizations for HF [SHR 0.20 (95% CI 0.06-0.72), P = 0.013]. Total mortality was similar in both groups [hazard ratio (HR) 1.57 (95% CI 0.58-4.27), P = 0.372]. The beneficial effects of CRT were consistent in patients who had ejection fraction ≤35%, New York Heart Association Class ≥III and QRS width ≥120 and in those who did not. At multi-variable Cox regression, only CRT mode remained an independent predictor of absence of clinical failure during the follow-up [HR = 0.23 (95% CI 0.08-0.66), P = 0.007].
Conclusions
In patients undergoing 'Ablate and Pace' therapy for severely symptomatic permanent atrial fibrillation, CRT is superior to RV apical pacing in reducing the clinical manifestations of HF.
(ClinicalTrials.gov number: NCT00111527)</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiac Resynchronization Therapy - methods</subject><subject>Cardiac Resynchronization Therapy Devices</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular system</subject><subject>Catheter Ablation - methods</subject><subject>Combined Modality Therapy</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Heart</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Prospective Studies</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Risk Factors</subject><subject>Stroke Volume</subject><subject>Treatment Outcome</subject><subject>Ultrasonic investigative techniques</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUFv1DAQhS0EotvCnRPyBXFAobbjOA43tIKCVKmXVuIWTZxJ16vEDuMEafsv-Mekm6UcOY00-t6b0XuMvZHioxRVfokz7RBo2l_ijqRRz9hGFkplldHFc7YRsioyY-yPM3ae0l4IYY00L9mZkkYYYfWG_d4CtR4cJ0yH4HYUg3-AycfApx0SjAfuAx-XDYYp8Tm0SPfRh3sOE_n4a9mSd3MPxPdzcEchNP3q0EXiI9IAYcGOAuh55xvy_Up84sAJQhsH_4AtPwKv2IsO-oSvT_OC3X39crv9ll3fXH3ffr7OXG70lKmqwbJtlC2LTpQIUGAjEYWRYLXUAlXT5LLpwNqytChyaFVrTK61UAakyy_Y-9V3pPhzxjTVg08Ol88CxjnVtjJKi6o0CylW0lFMibCrR_ID0KGWon7soX7qoV57WCRvT-ZzM2D7JPgb_AK8OwGQHPTdkoLz6R-nC1PkVbVwH1YuzuP_z_4Bsciomg</recordid><startdate>20111001</startdate><enddate>20111001</enddate><creator>Brignole, Michele</creator><creator>Botto, Gianluca</creator><creator>Mont, Lluis</creator><creator>Iacopino, Saverio</creator><creator>De Marchi, Giuseppe</creator><creator>Oddone, Daniele</creator><creator>Luzi, Mario</creator><creator>Tolosana, Jose M.</creator><creator>Navazio, Alessandro</creator><creator>Menozzi, Carlo</creator><general>Oxford University Press</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>7X8</scope></search><sort><creationdate>20111001</creationdate><title>Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial</title><author>Brignole, Michele ; Botto, Gianluca ; Mont, Lluis ; Iacopino, Saverio ; De Marchi, Giuseppe ; Oddone, Daniele ; Luzi, Mario ; Tolosana, Jose M. ; Navazio, Alessandro ; Menozzi, Carlo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c364t-29be7db2875f07eaa5eb1ee061a84140e2bb31bfa88778e03ad2d66344026a1c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiac Resynchronization Therapy - methods</topic><topic>Cardiac Resynchronization Therapy Devices</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular system</topic><topic>Catheter Ablation - methods</topic><topic>Combined Modality Therapy</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Heart</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Prospective Studies</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Risk Factors</topic><topic>Stroke Volume</topic><topic>Treatment Outcome</topic><topic>Ultrasonic investigative techniques</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brignole, Michele</creatorcontrib><creatorcontrib>Botto, Gianluca</creatorcontrib><creatorcontrib>Mont, Lluis</creatorcontrib><creatorcontrib>Iacopino, Saverio</creatorcontrib><creatorcontrib>De Marchi, Giuseppe</creatorcontrib><creatorcontrib>Oddone, Daniele</creatorcontrib><creatorcontrib>Luzi, Mario</creatorcontrib><creatorcontrib>Tolosana, Jose M.</creatorcontrib><creatorcontrib>Navazio, Alessandro</creatorcontrib><creatorcontrib>Menozzi, Carlo</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brignole, Michele</au><au>Botto, Gianluca</au><au>Mont, Lluis</au><au>Iacopino, Saverio</au><au>De Marchi, Giuseppe</au><au>Oddone, Daniele</au><au>Luzi, Mario</au><au>Tolosana, Jose M.</au><au>Navazio, Alessandro</au><au>Menozzi, Carlo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2011-10-01</date><risdate>2011</risdate><volume>32</volume><issue>19</issue><spage>2420</spage><epage>2429</epage><pages>2420-2429</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Aims
On the basis of the current knowledge, cardiac resynchronization therapy (CRT) cannot be recommended as a first-line treatment for patients with severely symptomatic permanent atrial fibrillation undergoing atrioventricular (AV) junction ablation. We examined whether CRT was superior to conventional right ventricular (RV) pacing in reducing heart failure (HF) events.
Methods and results
In this prospective, multi-centre study, we randomly assigned 186 patients, in whom AV junction ablation and CRT device implantation had been successfully performed, to receive optimized echo-guided CRT (97 patients) or RV apical pacing (89 patients). The data were analysed according to the intention-to-treat principle. During a median follow-up of 20 months (interquartile range 11-24), the primary composite endpoint of death from HF, hospitalization due to HF, or worsening HF occurred in 11 (11%) patients in the CRT group and 23 (26%) patients in the RV group [CRT vs. RV group: sub-hazard ratio (SHR) 0.37 ( 95% CI 0.18-0.73), P = 0.005]. In the CRT group, compared with the RV group, fewer patients had worsening HF [SHR 0.27 (95% CI 0.12-0.58), P = 0.001] and hospitalizations for HF [SHR 0.20 (95% CI 0.06-0.72), P = 0.013]. Total mortality was similar in both groups [hazard ratio (HR) 1.57 (95% CI 0.58-4.27), P = 0.372]. The beneficial effects of CRT were consistent in patients who had ejection fraction ≤35%, New York Heart Association Class ≥III and QRS width ≥120 and in those who did not. At multi-variable Cox regression, only CRT mode remained an independent predictor of absence of clinical failure during the follow-up [HR = 0.23 (95% CI 0.08-0.66), P = 0.007].
Conclusions
In patients undergoing 'Ablate and Pace' therapy for severely symptomatic permanent atrial fibrillation, CRT is superior to RV apical pacing in reducing the clinical manifestations of HF.
(ClinicalTrials.gov number: NCT00111527)</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>21606084</pmid><doi>10.1093/eurheartj/ehr162</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0195-668X |
| ispartof | European heart journal, 2011-10, Vol.32 (19), p.2420-2429 |
| issn | 0195-668X 1522-9645 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_896240976 |
| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Atrial Fibrillation - physiopathology Atrial Fibrillation - therapy Biological and medical sciences Cardiac dysrhythmias Cardiac Resynchronization Therapy - methods Cardiac Resynchronization Therapy Devices Cardiology. Vascular system Cardiovascular system Catheter Ablation - methods Combined Modality Therapy Echocardiography Female Heart Heart failure, cardiogenic pulmonary edema, cardiac enlargement Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Prospective Studies Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Risk Factors Stroke Volume Treatment Outcome Ultrasonic investigative techniques |
| title | Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T13%3A36%3A25IST&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=Cardiac%20resynchronization%20therapy%20in%20patients%20undergoing%20atrioventricular%20junction%20ablation%20for%20permanent%20atrial%20fibrillation:%20a%20randomized%20trial&rft.jtitle=European%20heart%20journal&rft.au=Brignole,%20Michele&rft.date=2011-10-01&rft.volume=32&rft.issue=19&rft.spage=2420&rft.epage=2429&rft.pages=2420-2429&rft.issn=0195-668X&rft.eissn=1522-9645&rft_id=info:doi/10.1093/eurheartj/ehr162&rft_dat=%3Cproquest_cross%3E896240976%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=896240976&rft_id=info:pmid/21606084&rft_oup_id=10.1093/eurheartj/ehr162&rfr_iscdi=true |