Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease
Recently, the therapeutic benefits of percutaneous coronary intervention (PCI) have been challenged in patients with stable coronary artery disease (SCD). The authors examined the impact of PCI on exercise responses in the coronary circulation, the microcirculation, and systemic hemodynamics in pati...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2018-08, Vol.72 (9), p.970-983 |
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| creator | Cook, Christopher M. Ahmad, Yousif Howard, James P. Shun-Shin, Matthew J. Sethi, Amarjit Clesham, Gerald J. Tang, Kare H. Nijjer, Sukhjinder S. Kelly, Paul A. Davies, John R. Malik, Iqbal S. Kaprielian, Raffi Mikhail, Ghada Petraco, Ricardo Al-Janabi, Firas Karamasis, Grigoris V. Mohdnazri, Shah Gamma, Reto Al-Lamee, Rasha Keeble, Thomas R. Mayet, Jamil Sen, Sayan Francis, Darrel P. Davies, Justin E. |
| description | Recently, the therapeutic benefits of percutaneous coronary intervention (PCI) have been challenged in patients with stable coronary artery disease (SCD).
The authors examined the impact of PCI on exercise responses in the coronary circulation, the microcirculation, and systemic hemodynamics in patients with SCD.
A total of 21 patients (mean age 60.3 ± 8.4 years) with SCD and single-vessel coronary stenosis underwent cardiac catheterization. Pre-PCI, patients exercised on a supine ergometer until rate-limiting angina or exhaustion. Simultaneous trans-stenotic coronary pressure-flow measurements were made throughout exercise. Post-PCI, this process was repeated. Physiological parameters, rate-limiting symptoms, and exercise performance were compared between pre-PCI and post-PCI exercise cycles.
PCI reduced ischemia as documented by fractional flow reserve value (pre-PCI 0.59 ± 0.18 to post-PCI 0.91 ± 0.07), instantaneous wave-free ratio value (pre-PCI 0.61 ± 0.27 to post-PCI 0.96 ± 0.05) and coronary flow reserve value (pre-PCI 1.7 ± 0.7 to post-PCI 3.1 ± 1.0; p < 0.001 for all). PCI increased peak-exercise average peak coronary flow velocity (p < 0.0001), coronary perfusion pressure (distal coronary pressure; p < 0.0001), systolic blood pressure (p = 0.01), accelerating wave energy (p < 0.001), and myocardial workload (rate-pressure product; p < 0.01). These changes observed immediately following PCI resulted from the abolition of stenosis resistance (p < 0.0001). PCI was also associated with an immediate improvement in exercise time (+67 s; 95% confidence interval: 31 to 102 s; p |
| doi_str_mv | 10.1016/j.jacc.2018.06.033 |
| format | Article |
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The authors examined the impact of PCI on exercise responses in the coronary circulation, the microcirculation, and systemic hemodynamics in patients with SCD.
A total of 21 patients (mean age 60.3 ± 8.4 years) with SCD and single-vessel coronary stenosis underwent cardiac catheterization. Pre-PCI, patients exercised on a supine ergometer until rate-limiting angina or exhaustion. Simultaneous trans-stenotic coronary pressure-flow measurements were made throughout exercise. Post-PCI, this process was repeated. Physiological parameters, rate-limiting symptoms, and exercise performance were compared between pre-PCI and post-PCI exercise cycles.
PCI reduced ischemia as documented by fractional flow reserve value (pre-PCI 0.59 ± 0.18 to post-PCI 0.91 ± 0.07), instantaneous wave-free ratio value (pre-PCI 0.61 ± 0.27 to post-PCI 0.96 ± 0.05) and coronary flow reserve value (pre-PCI 1.7 ± 0.7 to post-PCI 3.1 ± 1.0; p < 0.001 for all). PCI increased peak-exercise average peak coronary flow velocity (p < 0.0001), coronary perfusion pressure (distal coronary pressure; p < 0.0001), systolic blood pressure (p = 0.01), accelerating wave energy (p < 0.001), and myocardial workload (rate-pressure product; p < 0.01). These changes observed immediately following PCI resulted from the abolition of stenosis resistance (p < 0.0001). PCI was also associated with an immediate improvement in exercise time (+67 s; 95% confidence interval: 31 to 102 s; p < 0.0001) and a reduction in rate-limiting angina symptoms (81% reduction in rate-limiting angina symptoms post-PCI; p < 0.001).
In patients with SCD and severe single-vessel stenosis, objective physiological responses to exercise immediately normalize following PCI. This is seen in the coronary circulation, the microcirculation, and systemic hemodynamics.
[Display omitted]]]></description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2018.06.033</identifier><identifier>PMID: 30139442</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adenosine ; Aged ; Angina ; Angina pectoris ; Angioplasty ; Blood circulation ; Blood pressure ; Cardiology ; Cardiovascular disease ; Catheterization ; Catheters ; Clinical medicine ; Cohort Studies ; Confidence intervals ; Constraining ; Coronary artery ; Coronary artery disease ; Coronary Artery Disease - physiopathology ; Coronary Artery Disease - therapy ; Coronary circulation ; Coronary Circulation - physiology ; coronary physiology ; Coronary vessels ; Digital archives ; exercise ; Exercise - physiology ; Exercise Tolerance ; Exhaustion ; Female ; Flow velocity ; Hemodynamics ; Hemodynamics - physiology ; Humans ; Intubation ; Ischemia ; Laboratories ; Male ; Microcirculation - physiology ; Middle Aged ; Patients ; Percutaneous Coronary Intervention ; Perfusion ; Physiological responses ; Physiology ; Process parameters ; Reduction ; Signs and symptoms ; Software packages ; stable coronary disease ; Stenosis ; Variance analysis ; Wave energy ; Wave power ; Workload ; Workloads</subject><ispartof>Journal of the American College of Cardiology, 2018-08, Vol.72 (9), p.970-983</ispartof><rights>2018 The Authors</rights><rights>Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.</rights><rights>2018. The Authors</rights><rights>2018 The Authors 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-a9954953eff1aca351f7ee956813d260f0f9a04948553a3de103ed7bfb1d585b3</citedby><cites>FETCH-LOGICAL-c483t-a9954953eff1aca351f7ee956813d260f0f9a04948553a3de103ed7bfb1d585b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109718353579$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30139442$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cook, Christopher M.</creatorcontrib><creatorcontrib>Ahmad, Yousif</creatorcontrib><creatorcontrib>Howard, James P.</creatorcontrib><creatorcontrib>Shun-Shin, Matthew J.</creatorcontrib><creatorcontrib>Sethi, Amarjit</creatorcontrib><creatorcontrib>Clesham, Gerald J.</creatorcontrib><creatorcontrib>Tang, Kare H.</creatorcontrib><creatorcontrib>Nijjer, Sukhjinder S.</creatorcontrib><creatorcontrib>Kelly, Paul A.</creatorcontrib><creatorcontrib>Davies, John R.</creatorcontrib><creatorcontrib>Malik, Iqbal S.</creatorcontrib><creatorcontrib>Kaprielian, Raffi</creatorcontrib><creatorcontrib>Mikhail, Ghada</creatorcontrib><creatorcontrib>Petraco, Ricardo</creatorcontrib><creatorcontrib>Al-Janabi, Firas</creatorcontrib><creatorcontrib>Karamasis, Grigoris V.</creatorcontrib><creatorcontrib>Mohdnazri, Shah</creatorcontrib><creatorcontrib>Gamma, Reto</creatorcontrib><creatorcontrib>Al-Lamee, Rasha</creatorcontrib><creatorcontrib>Keeble, Thomas R.</creatorcontrib><creatorcontrib>Mayet, Jamil</creatorcontrib><creatorcontrib>Sen, Sayan</creatorcontrib><creatorcontrib>Francis, Darrel P.</creatorcontrib><creatorcontrib>Davies, Justin E.</creatorcontrib><title>Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description><![CDATA[Recently, the therapeutic benefits of percutaneous coronary intervention (PCI) have been challenged in patients with stable coronary artery disease (SCD).
The authors examined the impact of PCI on exercise responses in the coronary circulation, the microcirculation, and systemic hemodynamics in patients with SCD.
A total of 21 patients (mean age 60.3 ± 8.4 years) with SCD and single-vessel coronary stenosis underwent cardiac catheterization. Pre-PCI, patients exercised on a supine ergometer until rate-limiting angina or exhaustion. Simultaneous trans-stenotic coronary pressure-flow measurements were made throughout exercise. Post-PCI, this process was repeated. Physiological parameters, rate-limiting symptoms, and exercise performance were compared between pre-PCI and post-PCI exercise cycles.
PCI reduced ischemia as documented by fractional flow reserve value (pre-PCI 0.59 ± 0.18 to post-PCI 0.91 ± 0.07), instantaneous wave-free ratio value (pre-PCI 0.61 ± 0.27 to post-PCI 0.96 ± 0.05) and coronary flow reserve value (pre-PCI 1.7 ± 0.7 to post-PCI 3.1 ± 1.0; p < 0.001 for all). PCI increased peak-exercise average peak coronary flow velocity (p < 0.0001), coronary perfusion pressure (distal coronary pressure; p < 0.0001), systolic blood pressure (p = 0.01), accelerating wave energy (p < 0.001), and myocardial workload (rate-pressure product; p < 0.01). These changes observed immediately following PCI resulted from the abolition of stenosis resistance (p < 0.0001). PCI was also associated with an immediate improvement in exercise time (+67 s; 95% confidence interval: 31 to 102 s; p < 0.0001) and a reduction in rate-limiting angina symptoms (81% reduction in rate-limiting angina symptoms post-PCI; p < 0.001).
In patients with SCD and severe single-vessel stenosis, objective physiological responses to exercise immediately normalize following PCI. This is seen in the coronary circulation, the microcirculation, and systemic hemodynamics.
[Display omitted]]]></description><subject>Adenosine</subject><subject>Aged</subject><subject>Angina</subject><subject>Angina pectoris</subject><subject>Angioplasty</subject><subject>Blood circulation</subject><subject>Blood pressure</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Catheterization</subject><subject>Catheters</subject><subject>Clinical medicine</subject><subject>Cohort Studies</subject><subject>Confidence intervals</subject><subject>Constraining</subject><subject>Coronary artery</subject><subject>Coronary artery disease</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>Coronary Artery Disease - therapy</subject><subject>Coronary circulation</subject><subject>Coronary Circulation - physiology</subject><subject>coronary physiology</subject><subject>Coronary vessels</subject><subject>Digital archives</subject><subject>exercise</subject><subject>Exercise - physiology</subject><subject>Exercise Tolerance</subject><subject>Exhaustion</subject><subject>Female</subject><subject>Flow velocity</subject><subject>Hemodynamics</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Intubation</subject><subject>Ischemia</subject><subject>Laboratories</subject><subject>Male</subject><subject>Microcirculation - physiology</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Percutaneous Coronary Intervention</subject><subject>Perfusion</subject><subject>Physiological responses</subject><subject>Physiology</subject><subject>Process parameters</subject><subject>Reduction</subject><subject>Signs and symptoms</subject><subject>Software packages</subject><subject>stable coronary disease</subject><subject>Stenosis</subject><subject>Variance analysis</subject><subject>Wave energy</subject><subject>Wave power</subject><subject>Workload</subject><subject>Workloads</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kd-K1DAUxoMo7jj6Al5IwRtvWk96mrYBEWTcdRcWXPyDlyFNT90MbTMm7eDu08yzzJOZYdZFvRAC5yK_7-M752PsOYeMAy9fr7O1NibLgdcZlBkgPmALLkSdopDVQ7aACkXKQVYn7EkIawAoay4fsxMEjrIo8gUbLoaNNlPiuuSKvJknPZKbQ_KJtjqYudfe3urJujGJ7_RnRGyg_e6cBtfejHqwJiR2TK4iQ-MU9rtvdrre7z5PuukpWTnvRu1vkvdRpQM9ZY863Qd6djeX7OvZ6ZfVeXr58cPF6t1laooap1RLKQopkLqOa6NR8K4ikiKmxzYvoYNOaihkUQuBGlvigNRWTdfwVtSiwSV7e_TdzM1ArYnRvO7VxtshplFOW_X3z2iv1Xe3VaWoAUseDV7dGXj3Y6YwqcEGQ31_PI_KQSJCjvyAvvwHXbvZj3E9lfO65hXmkV2y_EgZ70Lw1N2H4aAObaq1OrSpDm0qKFVsM4pe_LnGveR3fRF4cwQoHnNryatgYg-GWuvJTKp19n_-vwDdF7Uy</recordid><startdate>20180828</startdate><enddate>20180828</enddate><creator>Cook, Christopher M.</creator><creator>Ahmad, Yousif</creator><creator>Howard, James P.</creator><creator>Shun-Shin, Matthew J.</creator><creator>Sethi, Amarjit</creator><creator>Clesham, Gerald J.</creator><creator>Tang, Kare H.</creator><creator>Nijjer, Sukhjinder S.</creator><creator>Kelly, Paul A.</creator><creator>Davies, John R.</creator><creator>Malik, Iqbal S.</creator><creator>Kaprielian, Raffi</creator><creator>Mikhail, Ghada</creator><creator>Petraco, Ricardo</creator><creator>Al-Janabi, Firas</creator><creator>Karamasis, Grigoris V.</creator><creator>Mohdnazri, Shah</creator><creator>Gamma, Reto</creator><creator>Al-Lamee, Rasha</creator><creator>Keeble, Thomas R.</creator><creator>Mayet, Jamil</creator><creator>Sen, Sayan</creator><creator>Francis, Darrel P.</creator><creator>Davies, Justin E.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><general>Elsevier Biomedical</general><scope>6I.</scope><scope>AAFTH</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>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180828</creationdate><title>Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease</title><author>Cook, Christopher M. ; Ahmad, Yousif ; Howard, James P. ; Shun-Shin, Matthew J. ; Sethi, Amarjit ; Clesham, Gerald J. ; Tang, Kare H. ; Nijjer, Sukhjinder S. ; Kelly, Paul A. ; Davies, John R. ; Malik, Iqbal S. ; Kaprielian, Raffi ; Mikhail, Ghada ; Petraco, Ricardo ; Al-Janabi, Firas ; Karamasis, Grigoris V. ; Mohdnazri, Shah ; Gamma, Reto ; Al-Lamee, Rasha ; Keeble, Thomas R. ; Mayet, Jamil ; Sen, Sayan ; Francis, Darrel P. ; Davies, Justin E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-a9954953eff1aca351f7ee956813d260f0f9a04948553a3de103ed7bfb1d585b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adenosine</topic><topic>Aged</topic><topic>Angina</topic><topic>Angina pectoris</topic><topic>Angioplasty</topic><topic>Blood circulation</topic><topic>Blood pressure</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Catheterization</topic><topic>Catheters</topic><topic>Clinical medicine</topic><topic>Cohort Studies</topic><topic>Confidence intervals</topic><topic>Constraining</topic><topic>Coronary artery</topic><topic>Coronary artery disease</topic><topic>Coronary Artery Disease - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cook, Christopher M.</au><au>Ahmad, Yousif</au><au>Howard, James P.</au><au>Shun-Shin, Matthew J.</au><au>Sethi, Amarjit</au><au>Clesham, Gerald J.</au><au>Tang, Kare H.</au><au>Nijjer, Sukhjinder S.</au><au>Kelly, Paul A.</au><au>Davies, John R.</au><au>Malik, Iqbal S.</au><au>Kaprielian, Raffi</au><au>Mikhail, Ghada</au><au>Petraco, Ricardo</au><au>Al-Janabi, Firas</au><au>Karamasis, Grigoris V.</au><au>Mohdnazri, Shah</au><au>Gamma, Reto</au><au>Al-Lamee, Rasha</au><au>Keeble, Thomas R.</au><au>Mayet, Jamil</au><au>Sen, Sayan</au><au>Francis, Darrel P.</au><au>Davies, Justin E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2018-08-28</date><risdate>2018</risdate><volume>72</volume><issue>9</issue><spage>970</spage><epage>983</epage><pages>970-983</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract><![CDATA[Recently, the therapeutic benefits of percutaneous coronary intervention (PCI) have been challenged in patients with stable coronary artery disease (SCD).
The authors examined the impact of PCI on exercise responses in the coronary circulation, the microcirculation, and systemic hemodynamics in patients with SCD.
A total of 21 patients (mean age 60.3 ± 8.4 years) with SCD and single-vessel coronary stenosis underwent cardiac catheterization. Pre-PCI, patients exercised on a supine ergometer until rate-limiting angina or exhaustion. Simultaneous trans-stenotic coronary pressure-flow measurements were made throughout exercise. Post-PCI, this process was repeated. Physiological parameters, rate-limiting symptoms, and exercise performance were compared between pre-PCI and post-PCI exercise cycles.
PCI reduced ischemia as documented by fractional flow reserve value (pre-PCI 0.59 ± 0.18 to post-PCI 0.91 ± 0.07), instantaneous wave-free ratio value (pre-PCI 0.61 ± 0.27 to post-PCI 0.96 ± 0.05) and coronary flow reserve value (pre-PCI 1.7 ± 0.7 to post-PCI 3.1 ± 1.0; p < 0.001 for all). PCI increased peak-exercise average peak coronary flow velocity (p < 0.0001), coronary perfusion pressure (distal coronary pressure; p < 0.0001), systolic blood pressure (p = 0.01), accelerating wave energy (p < 0.001), and myocardial workload (rate-pressure product; p < 0.01). These changes observed immediately following PCI resulted from the abolition of stenosis resistance (p < 0.0001). PCI was also associated with an immediate improvement in exercise time (+67 s; 95% confidence interval: 31 to 102 s; p < 0.0001) and a reduction in rate-limiting angina symptoms (81% reduction in rate-limiting angina symptoms post-PCI; p < 0.001).
In patients with SCD and severe single-vessel stenosis, objective physiological responses to exercise immediately normalize following PCI. This is seen in the coronary circulation, the microcirculation, and systemic hemodynamics.
[Display omitted]]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30139442</pmid><doi>10.1016/j.jacc.2018.06.033</doi><tpages>14</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0735-1097 |
| ispartof | Journal of the American College of Cardiology, 2018-08, Vol.72 (9), p.970-983 |
| issn | 0735-1097 1558-3597 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6580361 |
| source | MEDLINE; Elsevier ScienceDirect Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adenosine Aged Angina Angina pectoris Angioplasty Blood circulation Blood pressure Cardiology Cardiovascular disease Catheterization Catheters Clinical medicine Cohort Studies Confidence intervals Constraining Coronary artery Coronary artery disease Coronary Artery Disease - physiopathology Coronary Artery Disease - therapy Coronary circulation Coronary Circulation - physiology coronary physiology Coronary vessels Digital archives exercise Exercise - physiology Exercise Tolerance Exhaustion Female Flow velocity Hemodynamics Hemodynamics - physiology Humans Intubation Ischemia Laboratories Male Microcirculation - physiology Middle Aged Patients Percutaneous Coronary Intervention Perfusion Physiological responses Physiology Process parameters Reduction Signs and symptoms Software packages stable coronary disease Stenosis Variance analysis Wave energy Wave power Workload Workloads |
| title | Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T15%3A41%3A55IST&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=Impact%20of%20Percutaneous%20Revascularization%20on%20Exercise%C2%A0Hemodynamics%20in%20Patients%C2%A0With%C2%A0Stable%20Coronary%20Disease&rft.jtitle=Journal%20of%20the%20American%20College%20of%20Cardiology&rft.au=Cook,%20Christopher%20M.&rft.date=2018-08-28&rft.volume=72&rft.issue=9&rft.spage=970&rft.epage=983&rft.pages=970-983&rft.issn=0735-1097&rft.eissn=1558-3597&rft_id=info:doi/10.1016/j.jacc.2018.06.033&rft_dat=%3Cproquest_pubme%3E2093302311%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=2188173293&rft_id=info:pmid/30139442&rft_els_id=S0735109718353579&rfr_iscdi=true |