Serum Lp(a) lipoprotein concentration and outcome of thrombolytic treatment for myocardial infarction

BACKGROUND--Lp(a) lipoprotein has structural homology with plasminogen and has been shown to inhibit plasminogen activation in vitro. OBJECTIVE--To determine whether the serum concentration of Lp(a) lipoprotein present when streptokinase was given in acute myocardial infarction influenced the outcom...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:British Heart Journal 1994-04, Vol.71 (4), p.316-321
Hauptverfasser: MBewu, A. D., Durrington, P. N., Mackness, M. I., Hunt, L., Turkie, W. H., Creamer, J. E.
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 321
container_issue 4
container_start_page 316
container_title British Heart Journal
container_volume 71
creator MBewu, A. D.
Durrington, P. N.
Mackness, M. I.
Hunt, L.
Turkie, W. H.
Creamer, J. E.
description BACKGROUND--Lp(a) lipoprotein has structural homology with plasminogen and has been shown to inhibit plasminogen activation in vitro. OBJECTIVE--To determine whether the serum concentration of Lp(a) lipoprotein present when streptokinase was given in acute myocardial infarction influenced the outcome as judged by electrocardiographic methods. PATIENTS AND DESIGN--Serum Lp(a) lipoprotein concentration was measured in 135 consecutive patients admitted with a diagnosis of acute myocardial infarction who received streptokinase treatment. Recovery from myocardial injury was assessed by the reduction in the sum of ST segment elevation measured from the J point (STJ) in the electrocardiogram immediately before streptokinase was given compared with that three hours later. RESULTS--The serum Lp(a) lipoprotein concentrations were measured within 12 hours of the onset of symptoms of myocardial infarction and were higher than in healthy reference populations. Recovery from myocardial infarction could be assessed from the STJ in 116 patients (86% of the series). Those in whom it could not had bundle branch block, left ventricular hypertrophy, did not survive three hours, or had started intravenous nitrate treatment or some other clinical procedure before or at the time the second electrocardiogram was to be recorded. Patients with reductions in STJ after streptokinase that were > 4 mm (the median decrease) had mean (range) serum Lp(a) lipoprotein concentrations of 41.0 (0.8-220) mg/dl and those with a smaller reduction in STJ had concentrations of 29.1 (1.7-151) mg/dl. The difference was not statistically significant. CONCLUSION--In this study Lp(a) lipoprotein concentration did not significantly influence the outcome of thrombolytic treatment with streptokinase.
doi_str_mv 10.1136/hrt.71.4.316
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_483679</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>76524502</sourcerecordid><originalsourceid>FETCH-LOGICAL-b571t-51025057ff1228677ae52e69236da985cf95ccdbafb7b710cba11429fe0e300b3</originalsourceid><addsrcrecordid>eNp90c2L1DAYBvAgyjq7evMqBJRVwY5J2nz04EEGv2DQg-sHXkKaJk7GNqlJKs5_b5YOg3rwFMLze8MbHgDuYbTGuGbPdjGvOV436xqzG2CFGyYqgvCXm2CFEOIV4qy9Dc5T2pdr0wp2Bs4EboUQaAXMBxPnEW6nx-oJHNwUphiycR7q4LXxOarsgofK9zDMWYfRwGBh3sUwdmE4ZKdhjkblsVhoQ4TjIWgVe6cG6LxVUV_P3wG3rBqSuXs8L8DHVy-vNm-q7fvXbzcvtlVHOc4VxYhQRLm1mBDBOFeGEsNaUrNetYJq21Kt-07ZjnccI90pjBvSWoNMjVBXX4Dny7vT3I2mXz4wyCm6UcWDDMrJvxPvdvJb-CkbUTPelvnL43wMP2aTshxd0mYYlDdhTpIzShqKSIEP_oH7MEdf_iYx5wgxxkld1NNF6RhSisaeNsFIXncnS3eSY9nI0l3h9__c_oSPZZX84TFXSavBRuW1SyfWYMSQoIVVC3Mpm1-nWMXvkvGaU_nu00Z-3l41NRJEfi3-0eK7cf__BX8DuBG_5Q</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1770066723</pqid></control><display><type>article</type><title>Serum Lp(a) lipoprotein concentration and outcome of thrombolytic treatment for myocardial infarction</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>MBewu, A. D. ; Durrington, P. N. ; Mackness, M. I. ; Hunt, L. ; Turkie, W. H. ; Creamer, J. E.</creator><creatorcontrib>MBewu, A. D. ; Durrington, P. N. ; Mackness, M. I. ; Hunt, L. ; Turkie, W. H. ; Creamer, J. E.</creatorcontrib><description>BACKGROUND--Lp(a) lipoprotein has structural homology with plasminogen and has been shown to inhibit plasminogen activation in vitro. OBJECTIVE--To determine whether the serum concentration of Lp(a) lipoprotein present when streptokinase was given in acute myocardial infarction influenced the outcome as judged by electrocardiographic methods. PATIENTS AND DESIGN--Serum Lp(a) lipoprotein concentration was measured in 135 consecutive patients admitted with a diagnosis of acute myocardial infarction who received streptokinase treatment. Recovery from myocardial injury was assessed by the reduction in the sum of ST segment elevation measured from the J point (STJ) in the electrocardiogram immediately before streptokinase was given compared with that three hours later. RESULTS--The serum Lp(a) lipoprotein concentrations were measured within 12 hours of the onset of symptoms of myocardial infarction and were higher than in healthy reference populations. Recovery from myocardial infarction could be assessed from the STJ in 116 patients (86% of the series). Those in whom it could not had bundle branch block, left ventricular hypertrophy, did not survive three hours, or had started intravenous nitrate treatment or some other clinical procedure before or at the time the second electrocardiogram was to be recorded. Patients with reductions in STJ after streptokinase that were &gt; 4 mm (the median decrease) had mean (range) serum Lp(a) lipoprotein concentrations of 41.0 (0.8-220) mg/dl and those with a smaller reduction in STJ had concentrations of 29.1 (1.7-151) mg/dl. The difference was not statistically significant. CONCLUSION--In this study Lp(a) lipoprotein concentration did not significantly influence the outcome of thrombolytic treatment with streptokinase.</description><identifier>ISSN: 0007-0769</identifier><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>EISSN: 2053-5864</identifier><identifier>DOI: 10.1136/hrt.71.4.316</identifier><identifier>PMID: 8198880</identifier><identifier>CODEN: BHJUAV</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Blood. Blood coagulation. Reticuloendothelial system ; Coronary Angiography ; Electrocardiography ; Female ; Fibrinogen - analysis ; Heart - physiopathology ; Humans ; Lipoprotein(a) - blood ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - blood ; Myocardial Infarction - diagnostic imaging ; Myocardial Infarction - drug therapy ; Myocardial Infarction - physiopathology ; Pharmacology. Drug treatments ; Streptokinase - therapeutic use ; Thrombolytic Therapy ; Time Factors ; Treatment Outcome</subject><ispartof>British Heart Journal, 1994-04, Vol.71 (4), p.316-321</ispartof><rights>1994 INIST-CNRS</rights><rights>Copyright BMJ Publishing Group LTD Apr 1994</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b571t-51025057ff1228677ae52e69236da985cf95ccdbafb7b710cba11429fe0e300b3</citedby><cites>FETCH-LOGICAL-b571t-51025057ff1228677ae52e69236da985cf95ccdbafb7b710cba11429fe0e300b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC483679/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC483679/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=4106085$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8198880$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MBewu, A. D.</creatorcontrib><creatorcontrib>Durrington, P. N.</creatorcontrib><creatorcontrib>Mackness, M. I.</creatorcontrib><creatorcontrib>Hunt, L.</creatorcontrib><creatorcontrib>Turkie, W. H.</creatorcontrib><creatorcontrib>Creamer, J. E.</creatorcontrib><title>Serum Lp(a) lipoprotein concentration and outcome of thrombolytic treatment for myocardial infarction</title><title>British Heart Journal</title><addtitle>Br Heart J</addtitle><description>BACKGROUND--Lp(a) lipoprotein has structural homology with plasminogen and has been shown to inhibit plasminogen activation in vitro. OBJECTIVE--To determine whether the serum concentration of Lp(a) lipoprotein present when streptokinase was given in acute myocardial infarction influenced the outcome as judged by electrocardiographic methods. PATIENTS AND DESIGN--Serum Lp(a) lipoprotein concentration was measured in 135 consecutive patients admitted with a diagnosis of acute myocardial infarction who received streptokinase treatment. Recovery from myocardial injury was assessed by the reduction in the sum of ST segment elevation measured from the J point (STJ) in the electrocardiogram immediately before streptokinase was given compared with that three hours later. RESULTS--The serum Lp(a) lipoprotein concentrations were measured within 12 hours of the onset of symptoms of myocardial infarction and were higher than in healthy reference populations. Recovery from myocardial infarction could be assessed from the STJ in 116 patients (86% of the series). Those in whom it could not had bundle branch block, left ventricular hypertrophy, did not survive three hours, or had started intravenous nitrate treatment or some other clinical procedure before or at the time the second electrocardiogram was to be recorded. Patients with reductions in STJ after streptokinase that were &gt; 4 mm (the median decrease) had mean (range) serum Lp(a) lipoprotein concentrations of 41.0 (0.8-220) mg/dl and those with a smaller reduction in STJ had concentrations of 29.1 (1.7-151) mg/dl. The difference was not statistically significant. CONCLUSION--In this study Lp(a) lipoprotein concentration did not significantly influence the outcome of thrombolytic treatment with streptokinase.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Blood. Blood coagulation. Reticuloendothelial system</subject><subject>Coronary Angiography</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Fibrinogen - analysis</subject><subject>Heart - physiopathology</subject><subject>Humans</subject><subject>Lipoprotein(a) - blood</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - blood</subject><subject>Myocardial Infarction - diagnostic imaging</subject><subject>Myocardial Infarction - drug therapy</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Pharmacology. Drug treatments</subject><subject>Streptokinase - therapeutic use</subject><subject>Thrombolytic Therapy</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0007-0769</issn><issn>1355-6037</issn><issn>1468-201X</issn><issn>2053-5864</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1994</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp90c2L1DAYBvAgyjq7evMqBJRVwY5J2nz04EEGv2DQg-sHXkKaJk7GNqlJKs5_b5YOg3rwFMLze8MbHgDuYbTGuGbPdjGvOV436xqzG2CFGyYqgvCXm2CFEOIV4qy9Dc5T2pdr0wp2Bs4EboUQaAXMBxPnEW6nx-oJHNwUphiycR7q4LXxOarsgofK9zDMWYfRwGBh3sUwdmE4ZKdhjkblsVhoQ4TjIWgVe6cG6LxVUV_P3wG3rBqSuXs8L8DHVy-vNm-q7fvXbzcvtlVHOc4VxYhQRLm1mBDBOFeGEsNaUrNetYJq21Kt-07ZjnccI90pjBvSWoNMjVBXX4Dny7vT3I2mXz4wyCm6UcWDDMrJvxPvdvJb-CkbUTPelvnL43wMP2aTshxd0mYYlDdhTpIzShqKSIEP_oH7MEdf_iYx5wgxxkld1NNF6RhSisaeNsFIXncnS3eSY9nI0l3h9__c_oSPZZX84TFXSavBRuW1SyfWYMSQoIVVC3Mpm1-nWMXvkvGaU_nu00Z-3l41NRJEfi3-0eK7cf__BX8DuBG_5Q</recordid><startdate>19940401</startdate><enddate>19940401</enddate><creator>MBewu, A. D.</creator><creator>Durrington, P. N.</creator><creator>Mackness, M. I.</creator><creator>Hunt, L.</creator><creator>Turkie, W. H.</creator><creator>Creamer, J. E.</creator><general>BMJ Publishing Group Ltd and British Cardiovascular Society</general><general>BMJ</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><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>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>19940401</creationdate><title>Serum Lp(a) lipoprotein concentration and outcome of thrombolytic treatment for myocardial infarction</title><author>MBewu, A. D. ; Durrington, P. N. ; Mackness, M. I. ; Hunt, L. ; Turkie, W. H. ; Creamer, J. E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b571t-51025057ff1228677ae52e69236da985cf95ccdbafb7b710cba11429fe0e300b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1994</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Blood. Blood coagulation. Reticuloendothelial system</topic><topic>Coronary Angiography</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Fibrinogen - analysis</topic><topic>Heart - physiopathology</topic><topic>Humans</topic><topic>Lipoprotein(a) - blood</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - blood</topic><topic>Myocardial Infarction - diagnostic imaging</topic><topic>Myocardial Infarction - drug therapy</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Pharmacology. Drug treatments</topic><topic>Streptokinase - therapeutic use</topic><topic>Thrombolytic Therapy</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MBewu, A. D.</creatorcontrib><creatorcontrib>Durrington, P. N.</creatorcontrib><creatorcontrib>Mackness, M. I.</creatorcontrib><creatorcontrib>Hunt, L.</creatorcontrib><creatorcontrib>Turkie, W. H.</creatorcontrib><creatorcontrib>Creamer, J. E.</creatorcontrib><collection>Istex</collection><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>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health &amp; Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health &amp; Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British Heart Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MBewu, A. D.</au><au>Durrington, P. N.</au><au>Mackness, M. I.</au><au>Hunt, L.</au><au>Turkie, W. H.</au><au>Creamer, J. E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Serum Lp(a) lipoprotein concentration and outcome of thrombolytic treatment for myocardial infarction</atitle><jtitle>British Heart Journal</jtitle><addtitle>Br Heart J</addtitle><date>1994-04-01</date><risdate>1994</risdate><volume>71</volume><issue>4</issue><spage>316</spage><epage>321</epage><pages>316-321</pages><issn>0007-0769</issn><issn>1355-6037</issn><eissn>1468-201X</eissn><eissn>2053-5864</eissn><coden>BHJUAV</coden><abstract>BACKGROUND--Lp(a) lipoprotein has structural homology with plasminogen and has been shown to inhibit plasminogen activation in vitro. OBJECTIVE--To determine whether the serum concentration of Lp(a) lipoprotein present when streptokinase was given in acute myocardial infarction influenced the outcome as judged by electrocardiographic methods. PATIENTS AND DESIGN--Serum Lp(a) lipoprotein concentration was measured in 135 consecutive patients admitted with a diagnosis of acute myocardial infarction who received streptokinase treatment. Recovery from myocardial injury was assessed by the reduction in the sum of ST segment elevation measured from the J point (STJ) in the electrocardiogram immediately before streptokinase was given compared with that three hours later. RESULTS--The serum Lp(a) lipoprotein concentrations were measured within 12 hours of the onset of symptoms of myocardial infarction and were higher than in healthy reference populations. Recovery from myocardial infarction could be assessed from the STJ in 116 patients (86% of the series). Those in whom it could not had bundle branch block, left ventricular hypertrophy, did not survive three hours, or had started intravenous nitrate treatment or some other clinical procedure before or at the time the second electrocardiogram was to be recorded. Patients with reductions in STJ after streptokinase that were &gt; 4 mm (the median decrease) had mean (range) serum Lp(a) lipoprotein concentrations of 41.0 (0.8-220) mg/dl and those with a smaller reduction in STJ had concentrations of 29.1 (1.7-151) mg/dl. The difference was not statistically significant. CONCLUSION--In this study Lp(a) lipoprotein concentration did not significantly influence the outcome of thrombolytic treatment with streptokinase.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Cardiovascular Society</pub><pmid>8198880</pmid><doi>10.1136/hrt.71.4.316</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0007-0769
ispartof British Heart Journal, 1994-04, Vol.71 (4), p.316-321
issn 0007-0769
1355-6037
1468-201X
2053-5864
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_483679
source MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central
subjects Adult
Aged
Aged, 80 and over
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Coronary Angiography
Electrocardiography
Female
Fibrinogen - analysis
Heart - physiopathology
Humans
Lipoprotein(a) - blood
Male
Medical sciences
Middle Aged
Myocardial Infarction - blood
Myocardial Infarction - diagnostic imaging
Myocardial Infarction - drug therapy
Myocardial Infarction - physiopathology
Pharmacology. Drug treatments
Streptokinase - therapeutic use
Thrombolytic Therapy
Time Factors
Treatment Outcome
title Serum Lp(a) lipoprotein concentration and outcome of thrombolytic treatment for myocardial infarction
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-19T00%3A44%3A06IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Serum%20Lp(a)%20lipoprotein%20concentration%20and%20outcome%20of%20thrombolytic%20treatment%20for%20myocardial%20infarction&rft.jtitle=British%20Heart%20Journal&rft.au=MBewu,%20A.%20D.&rft.date=1994-04-01&rft.volume=71&rft.issue=4&rft.spage=316&rft.epage=321&rft.pages=316-321&rft.issn=0007-0769&rft.eissn=1468-201X&rft.coden=BHJUAV&rft_id=info:doi/10.1136/hrt.71.4.316&rft_dat=%3Cproquest_pubme%3E76524502%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1770066723&rft_id=info:pmid/8198880&rfr_iscdi=true