Loading…
Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias
A routine diagnostic work-up does not identify structural abnormalities in a substantial proportion of patients with idiopathic ventricular arrhythmias (VAs). We investigated the added value of cardiac magnetic resonance (CMR) imaging in this group of patients. A single-centre prospective study was...
Saved in:
| Published in: | Diagnostics (Basel) 2021-06, Vol.11 (6), p.1109 |
|---|---|
| Main Authors: | , , , , , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c499t-ae621bcabc3da30cbb9226222621cfdfc6ffd3292ddfd25c327a36bd5ef3742d3 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c499t-ae621bcabc3da30cbb9226222621cfdfc6ffd3292ddfd25c327a36bd5ef3742d3 |
| container_end_page | |
| container_issue | 6 |
| container_start_page | 1109 |
| container_title | Diagnostics (Basel) |
| container_volume | 11 |
| creator | Nikolaidou, Chrysovalantou Kotanidis, Christos P Wijesurendra, Rohan Leal-Pelado, Joana Kouskouras, Konstantinos Vassilikos, Vassilios P Karvounis, Haralambos Ntusi, Ntobeko Antoniades, Charalambos Neubauer, Stefan Karamitsos, Theodoros D |
| description | A routine diagnostic work-up does not identify structural abnormalities in a substantial proportion of patients with idiopathic ventricular arrhythmias (VAs). We investigated the added value of cardiac magnetic resonance (CMR) imaging in this group of patients.
A single-centre prospective study was undertaken of 72 patients (mean age 46 ± 16 years; 53% females) with frequent premature ventricular contractions (PVCs ≥ 500/24 h) and/or non-sustained ventricular tachycardia (NSVT), an otherwise normal electrocardiogram, normal echocardiography and no coronary artery disease.
CMR provided an additional diagnostic yield in 54.2% of patients. The most prevalent diagnosis was previous myocarditis (23.6%) followed by possible PVC-related cardiomyopathy (20.8%), non-ischaemic cardiomyopathy (8.3%) and ischaemic heart disease (1.4%). The predictors of abnormal CMR findings were male gender, age and PVCs/NSVT non-outflow tract-related or with multiple morphologies. Patients with VAs had an impaired peak left ventricular (LV) global radial strain (GRS) compared with the controls (28.88% (IQR: 25.87% to 33.97%) vs. 36.65% (IQR: 33.19% to 40.2%),
< 0.001) and a global circumferential strain (GCS) (-17.66% (IQR: -19.62% to -16.23%) vs. -20.66% (IQR: -21.72% to -19.6%),
< 0.001).
CMR reveals abnormalities in a significant proportion of patients with frequent idiopathic VAs. Male gender, age and non-outflow tract PVC origin can be clinical indicators for CMR referral. |
| doi_str_mv | 10.3390/diagnostics11061109 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_ea06eaeead31421781449036dfd37ce1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_ea06eaeead31421781449036dfd37ce1</doaj_id><sourcerecordid>2544723742</sourcerecordid><originalsourceid>FETCH-LOGICAL-c499t-ae621bcabc3da30cbb9226222621cfdfc6ffd3292ddfd25c327a36bd5ef3742d3</originalsourceid><addsrcrecordid>eNptkl1rFDEUhgex2FL7CwQJeOPNar7m60Yoq9WFSotab8OZ5MxOltlkTTLK-uvNuLW00sAhOcl7HvIeTlG8YPSNEC19ayysnY_J6sgYrXK0T4oTTutyISVrnt47HxdnMW5oXi0TDS-fFcdC5lfGxUnxewkhszT5nHmYceQLRu_AaSTJk_eYUCeSBiQ3zmAY99atydepiylAQmIduYZk0aVIftk0kIuAP6ackpWxfgdpyMTvOQ9WTyMEch7CsE_D1kJ8Xhz1MEY8u91Pi5uLD9-WnxaXVx9Xy_PLhZZtmxaAFWedhk4LA4Lqrms5r_gcTPem11XfG8FbbkxveKkFr0FUnSmxF7XkRpwWqwPXeNioXbBbCHvlwaq_Fz6sFYTsfESFQCsERDCCSc7qhknZUlFlsqg1ssx6d2Dtpm6LRs_OYHwAffji7KDW_qdquBCN5Bnw-hYQfG5UTGpro8ZxBId-ioqXspGUyqbN0lf_STd-Ci63albJms_2skocVDr4GAP2d59hVM2joh4ZlVz18r6Pu5p_gyH-AGWiwHA</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2544723742</pqid></control><display><type>article</type><title>Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias</title><source>Publicly Available Content Database</source><source>PubMed Central</source><creator>Nikolaidou, Chrysovalantou ; Kotanidis, Christos P ; Wijesurendra, Rohan ; Leal-Pelado, Joana ; Kouskouras, Konstantinos ; Vassilikos, Vassilios P ; Karvounis, Haralambos ; Ntusi, Ntobeko ; Antoniades, Charalambos ; Neubauer, Stefan ; Karamitsos, Theodoros D</creator><creatorcontrib>Nikolaidou, Chrysovalantou ; Kotanidis, Christos P ; Wijesurendra, Rohan ; Leal-Pelado, Joana ; Kouskouras, Konstantinos ; Vassilikos, Vassilios P ; Karvounis, Haralambos ; Ntusi, Ntobeko ; Antoniades, Charalambos ; Neubauer, Stefan ; Karamitsos, Theodoros D</creatorcontrib><description>A routine diagnostic work-up does not identify structural abnormalities in a substantial proportion of patients with idiopathic ventricular arrhythmias (VAs). We investigated the added value of cardiac magnetic resonance (CMR) imaging in this group of patients.
A single-centre prospective study was undertaken of 72 patients (mean age 46 ± 16 years; 53% females) with frequent premature ventricular contractions (PVCs ≥ 500/24 h) and/or non-sustained ventricular tachycardia (NSVT), an otherwise normal electrocardiogram, normal echocardiography and no coronary artery disease.
CMR provided an additional diagnostic yield in 54.2% of patients. The most prevalent diagnosis was previous myocarditis (23.6%) followed by possible PVC-related cardiomyopathy (20.8%), non-ischaemic cardiomyopathy (8.3%) and ischaemic heart disease (1.4%). The predictors of abnormal CMR findings were male gender, age and PVCs/NSVT non-outflow tract-related or with multiple morphologies. Patients with VAs had an impaired peak left ventricular (LV) global radial strain (GRS) compared with the controls (28.88% (IQR: 25.87% to 33.97%) vs. 36.65% (IQR: 33.19% to 40.2%),
< 0.001) and a global circumferential strain (GCS) (-17.66% (IQR: -19.62% to -16.23%) vs. -20.66% (IQR: -21.72% to -19.6%),
< 0.001).
CMR reveals abnormalities in a significant proportion of patients with frequent idiopathic VAs. Male gender, age and non-outflow tract PVC origin can be clinical indicators for CMR referral.</description><identifier>ISSN: 2075-4418</identifier><identifier>EISSN: 2075-4418</identifier><identifier>DOI: 10.3390/diagnostics11061109</identifier><identifier>PMID: 34207123</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Cardiac arrhythmia ; cardiac magnetic resonance ; Cardiomyopathy ; Cardiovascular disease ; Coronary vessels ; Electrocardiography ; feature-tracking CMR ; Heart ; myocardial strain ; Myocarditis ; premature ventricular contractions ; Scanners ; ventricular arrhythmia</subject><ispartof>Diagnostics (Basel), 2021-06, Vol.11 (6), p.1109</ispartof><rights>2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 by the authors. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c499t-ae621bcabc3da30cbb9226222621cfdfc6ffd3292ddfd25c327a36bd5ef3742d3</citedby><cites>FETCH-LOGICAL-c499t-ae621bcabc3da30cbb9226222621cfdfc6ffd3292ddfd25c327a36bd5ef3742d3</cites><orcidid>0000-0003-0885-9170 ; 0000-0002-4658-5273</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2544723742/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2544723742?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34207123$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nikolaidou, Chrysovalantou</creatorcontrib><creatorcontrib>Kotanidis, Christos P</creatorcontrib><creatorcontrib>Wijesurendra, Rohan</creatorcontrib><creatorcontrib>Leal-Pelado, Joana</creatorcontrib><creatorcontrib>Kouskouras, Konstantinos</creatorcontrib><creatorcontrib>Vassilikos, Vassilios P</creatorcontrib><creatorcontrib>Karvounis, Haralambos</creatorcontrib><creatorcontrib>Ntusi, Ntobeko</creatorcontrib><creatorcontrib>Antoniades, Charalambos</creatorcontrib><creatorcontrib>Neubauer, Stefan</creatorcontrib><creatorcontrib>Karamitsos, Theodoros D</creatorcontrib><title>Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias</title><title>Diagnostics (Basel)</title><addtitle>Diagnostics (Basel)</addtitle><description>A routine diagnostic work-up does not identify structural abnormalities in a substantial proportion of patients with idiopathic ventricular arrhythmias (VAs). We investigated the added value of cardiac magnetic resonance (CMR) imaging in this group of patients.
A single-centre prospective study was undertaken of 72 patients (mean age 46 ± 16 years; 53% females) with frequent premature ventricular contractions (PVCs ≥ 500/24 h) and/or non-sustained ventricular tachycardia (NSVT), an otherwise normal electrocardiogram, normal echocardiography and no coronary artery disease.
CMR provided an additional diagnostic yield in 54.2% of patients. The most prevalent diagnosis was previous myocarditis (23.6%) followed by possible PVC-related cardiomyopathy (20.8%), non-ischaemic cardiomyopathy (8.3%) and ischaemic heart disease (1.4%). The predictors of abnormal CMR findings were male gender, age and PVCs/NSVT non-outflow tract-related or with multiple morphologies. Patients with VAs had an impaired peak left ventricular (LV) global radial strain (GRS) compared with the controls (28.88% (IQR: 25.87% to 33.97%) vs. 36.65% (IQR: 33.19% to 40.2%),
< 0.001) and a global circumferential strain (GCS) (-17.66% (IQR: -19.62% to -16.23%) vs. -20.66% (IQR: -21.72% to -19.6%),
< 0.001).
CMR reveals abnormalities in a significant proportion of patients with frequent idiopathic VAs. Male gender, age and non-outflow tract PVC origin can be clinical indicators for CMR referral.</description><subject>Cardiac arrhythmia</subject><subject>cardiac magnetic resonance</subject><subject>Cardiomyopathy</subject><subject>Cardiovascular disease</subject><subject>Coronary vessels</subject><subject>Electrocardiography</subject><subject>feature-tracking CMR</subject><subject>Heart</subject><subject>myocardial strain</subject><subject>Myocarditis</subject><subject>premature ventricular contractions</subject><subject>Scanners</subject><subject>ventricular arrhythmia</subject><issn>2075-4418</issn><issn>2075-4418</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptkl1rFDEUhgex2FL7CwQJeOPNar7m60Yoq9WFSotab8OZ5MxOltlkTTLK-uvNuLW00sAhOcl7HvIeTlG8YPSNEC19ayysnY_J6sgYrXK0T4oTTutyISVrnt47HxdnMW5oXi0TDS-fFcdC5lfGxUnxewkhszT5nHmYceQLRu_AaSTJk_eYUCeSBiQ3zmAY99atydepiylAQmIduYZk0aVIftk0kIuAP6ackpWxfgdpyMTvOQ9WTyMEch7CsE_D1kJ8Xhz1MEY8u91Pi5uLD9-WnxaXVx9Xy_PLhZZtmxaAFWedhk4LA4Lqrms5r_gcTPem11XfG8FbbkxveKkFr0FUnSmxF7XkRpwWqwPXeNioXbBbCHvlwaq_Fz6sFYTsfESFQCsERDCCSc7qhknZUlFlsqg1ssx6d2Dtpm6LRs_OYHwAffji7KDW_qdquBCN5Bnw-hYQfG5UTGpro8ZxBId-ioqXspGUyqbN0lf_STd-Ci63albJms_2skocVDr4GAP2d59hVM2joh4ZlVz18r6Pu5p_gyH-AGWiwHA</recordid><startdate>20210618</startdate><enddate>20210618</enddate><creator>Nikolaidou, Chrysovalantou</creator><creator>Kotanidis, Christos P</creator><creator>Wijesurendra, Rohan</creator><creator>Leal-Pelado, Joana</creator><creator>Kouskouras, Konstantinos</creator><creator>Vassilikos, Vassilios P</creator><creator>Karvounis, Haralambos</creator><creator>Ntusi, Ntobeko</creator><creator>Antoniades, Charalambos</creator><creator>Neubauer, Stefan</creator><creator>Karamitsos, Theodoros D</creator><general>MDPI AG</general><general>MDPI</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7XB</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-0885-9170</orcidid><orcidid>https://orcid.org/0000-0002-4658-5273</orcidid></search><sort><creationdate>20210618</creationdate><title>Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias</title><author>Nikolaidou, Chrysovalantou ; Kotanidis, Christos P ; Wijesurendra, Rohan ; Leal-Pelado, Joana ; Kouskouras, Konstantinos ; Vassilikos, Vassilios P ; Karvounis, Haralambos ; Ntusi, Ntobeko ; Antoniades, Charalambos ; Neubauer, Stefan ; Karamitsos, Theodoros D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c499t-ae621bcabc3da30cbb9226222621cfdfc6ffd3292ddfd25c327a36bd5ef3742d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Cardiac arrhythmia</topic><topic>cardiac magnetic resonance</topic><topic>Cardiomyopathy</topic><topic>Cardiovascular disease</topic><topic>Coronary vessels</topic><topic>Electrocardiography</topic><topic>feature-tracking CMR</topic><topic>Heart</topic><topic>myocardial strain</topic><topic>Myocarditis</topic><topic>premature ventricular contractions</topic><topic>Scanners</topic><topic>ventricular arrhythmia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nikolaidou, Chrysovalantou</creatorcontrib><creatorcontrib>Kotanidis, Christos P</creatorcontrib><creatorcontrib>Wijesurendra, Rohan</creatorcontrib><creatorcontrib>Leal-Pelado, Joana</creatorcontrib><creatorcontrib>Kouskouras, Konstantinos</creatorcontrib><creatorcontrib>Vassilikos, Vassilios P</creatorcontrib><creatorcontrib>Karvounis, Haralambos</creatorcontrib><creatorcontrib>Ntusi, Ntobeko</creatorcontrib><creatorcontrib>Antoniades, Charalambos</creatorcontrib><creatorcontrib>Neubauer, Stefan</creatorcontrib><creatorcontrib>Karamitsos, Theodoros D</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Publicly Available Content Database</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><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Diagnostics (Basel)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nikolaidou, Chrysovalantou</au><au>Kotanidis, Christos P</au><au>Wijesurendra, Rohan</au><au>Leal-Pelado, Joana</au><au>Kouskouras, Konstantinos</au><au>Vassilikos, Vassilios P</au><au>Karvounis, Haralambos</au><au>Ntusi, Ntobeko</au><au>Antoniades, Charalambos</au><au>Neubauer, Stefan</au><au>Karamitsos, Theodoros D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias</atitle><jtitle>Diagnostics (Basel)</jtitle><addtitle>Diagnostics (Basel)</addtitle><date>2021-06-18</date><risdate>2021</risdate><volume>11</volume><issue>6</issue><spage>1109</spage><pages>1109-</pages><issn>2075-4418</issn><eissn>2075-4418</eissn><abstract>A routine diagnostic work-up does not identify structural abnormalities in a substantial proportion of patients with idiopathic ventricular arrhythmias (VAs). We investigated the added value of cardiac magnetic resonance (CMR) imaging in this group of patients.
A single-centre prospective study was undertaken of 72 patients (mean age 46 ± 16 years; 53% females) with frequent premature ventricular contractions (PVCs ≥ 500/24 h) and/or non-sustained ventricular tachycardia (NSVT), an otherwise normal electrocardiogram, normal echocardiography and no coronary artery disease.
CMR provided an additional diagnostic yield in 54.2% of patients. The most prevalent diagnosis was previous myocarditis (23.6%) followed by possible PVC-related cardiomyopathy (20.8%), non-ischaemic cardiomyopathy (8.3%) and ischaemic heart disease (1.4%). The predictors of abnormal CMR findings were male gender, age and PVCs/NSVT non-outflow tract-related or with multiple morphologies. Patients with VAs had an impaired peak left ventricular (LV) global radial strain (GRS) compared with the controls (28.88% (IQR: 25.87% to 33.97%) vs. 36.65% (IQR: 33.19% to 40.2%),
< 0.001) and a global circumferential strain (GCS) (-17.66% (IQR: -19.62% to -16.23%) vs. -20.66% (IQR: -21.72% to -19.6%),
< 0.001).
CMR reveals abnormalities in a significant proportion of patients with frequent idiopathic VAs. Male gender, age and non-outflow tract PVC origin can be clinical indicators for CMR referral.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>34207123</pmid><doi>10.3390/diagnostics11061109</doi><orcidid>https://orcid.org/0000-0003-0885-9170</orcidid><orcidid>https://orcid.org/0000-0002-4658-5273</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2075-4418 |
| ispartof | Diagnostics (Basel), 2021-06, Vol.11 (6), p.1109 |
| issn | 2075-4418 2075-4418 |
| language | eng |
| recordid | cdi_doaj_primary_oai_doaj_org_article_ea06eaeead31421781449036dfd37ce1 |
| source | Publicly Available Content Database; PubMed Central |
| subjects | Cardiac arrhythmia cardiac magnetic resonance Cardiomyopathy Cardiovascular disease Coronary vessels Electrocardiography feature-tracking CMR Heart myocardial strain Myocarditis premature ventricular contractions Scanners ventricular arrhythmia |
| title | Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T18%3A25%3A35IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Cardiac%20Magnetic%20Resonance%20to%20Detect%20the%20Underlying%20Substrate%20in%20Patients%20with%20Frequent%20Idiopathic%20Ventricular%20Arrhythmias&rft.jtitle=Diagnostics%20(Basel)&rft.au=Nikolaidou,%20Chrysovalantou&rft.date=2021-06-18&rft.volume=11&rft.issue=6&rft.spage=1109&rft.pages=1109-&rft.issn=2075-4418&rft.eissn=2075-4418&rft_id=info:doi/10.3390/diagnostics11061109&rft_dat=%3Cproquest_doaj_%3E2544723742%3C/proquest_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c499t-ae621bcabc3da30cbb9226222621cfdfc6ffd3292ddfd25c327a36bd5ef3742d3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2544723742&rft_id=info:pmid/34207123&rfr_iscdi=true |