Loading…
A prospective study in search of an optimal B-natriuretic peptide level to screen patients for cardiac dysfunction
Although echocardiography is the gold standard test for suspected left ventricular dysfunction, its cost and availability limits its use as a routine screening tool. The high negative predictive value of B-natriuretic peptide (BNP) in dyspneic patients suggests its possible utility in screening pati...
Saved in:
| Published in: | The American heart journal 2004-09, Vol.148 (3), p.518-523 |
|---|---|
| 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-c502t-c49b0e31f613d5eb37bf50e680dc49e1702cef2f62bb987d483fab7a5b97682b3 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c502t-c49b0e31f613d5eb37bf50e680dc49e1702cef2f62bb987d483fab7a5b97682b3 |
| container_end_page | 523 |
| container_issue | 3 |
| container_start_page | 518 |
| container_title | The American heart journal |
| container_volume | 148 |
| creator | Atisha, Dunya Bhalla, Meenakshi A. Morrison, L.Katherine Felicio, Leda Clopton, Paul Gardetto, Nancy Kazanegra, Radmila Chiu, Albert Maisel, Alan S. |
| description | Although echocardiography is the gold standard test for suspected left ventricular dysfunction, its cost and availability limits its use as a routine screening tool. The high negative predictive value of B-natriuretic peptide (BNP) in dyspneic patients suggests its possible utility in screening patients prior to echocardiography. Determining an appropriate BNP level below which the need for echocardiography is precluded would be valuable. We hypothesized that a fixed plasma BNP level of 20 pg/mL and simple clinical parameters are an effective pre-echocardiographic screening tool for left ventricular dysfunction.
Two hundred and two patients at a Veterans Administration facility with symptoms suggestive of heart disease (male to female ratio 193:9, mean age 65 years) were screened prior to echocardiography. Patients with known cardiac dysfunction were excluded.
BNP levels of ≥20 pg/mL were 79% sensitive and 44% specific in screening for any abnormality of ventricular function. The negative predictive value was 69%. When broken down into categories of dysfunction, the cutoff point of 20 pg/mL had a better negative predictive value for those with systolic dysfunction (96%) or systolic plus diastolic dysfunction (100%) if patients with diastolic dysfunction were excluded. The majority of patients with falsely low BNP levels ( |
| doi_str_mv | 10.1016/j.ahj.2004.03.014 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_66903694</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002870304001401</els_id><sourcerecordid>3237561681</sourcerecordid><originalsourceid>FETCH-LOGICAL-c502t-c49b0e31f613d5eb37bf50e680dc49e1702cef2f62bb987d483fab7a5b97682b3</originalsourceid><addsrcrecordid>eNp9kUGL1DAUx4Mo7rj6AbxIQPTW-pKmaYun3cVdhQUveg5p8sKmdNKapAPz7c0wAwsePIUkv_fy8v8R8p5BzYDJL1Otn6aaA4gamhqYeEF2DIaukp0QL8kOAHjVd9BckTcpTWUreS9fkyvWNv3ABd-ReEPXuKQVTfYHpClv9kh9oAl1NE90cVQHuqzZ7_VMb6ugc_RbxOwNXbEcW6QzHnCmeaHJRMRAV509hpyoWyI1OlqvDbXH5LZQHlnCW_LK6Tnhu8t6TX7ff_t19716_Pnw4-7msTIt8FwZMYyADXOSNbbFselG1wLKHmy5QtYBN-i4k3wch76zom-cHjvdjkMnez421-TzuW_54J8NU1Z7nwzOsw64bElJOUAjB1HAj_-A07LFUGZTrAUh2oEDLxQ7U6bklSI6tcaSSjwqBuqkQ02q6FAnHQoaVXSUmg-Xztu4R_tcccm_AJ8ugE5Gzy7qYHx65iSTUrQn7uuZwxLYwWNUyZSQDVofizplF_-fMf4C9H6oew</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1504459202</pqid></control><display><type>article</type><title>A prospective study in search of an optimal B-natriuretic peptide level to screen patients for cardiac dysfunction</title><source>Elsevier</source><creator>Atisha, Dunya ; Bhalla, Meenakshi A. ; Morrison, L.Katherine ; Felicio, Leda ; Clopton, Paul ; Gardetto, Nancy ; Kazanegra, Radmila ; Chiu, Albert ; Maisel, Alan S.</creator><creatorcontrib>Atisha, Dunya ; Bhalla, Meenakshi A. ; Morrison, L.Katherine ; Felicio, Leda ; Clopton, Paul ; Gardetto, Nancy ; Kazanegra, Radmila ; Chiu, Albert ; Maisel, Alan S.</creatorcontrib><description>Although echocardiography is the gold standard test for suspected left ventricular dysfunction, its cost and availability limits its use as a routine screening tool. The high negative predictive value of B-natriuretic peptide (BNP) in dyspneic patients suggests its possible utility in screening patients prior to echocardiography. Determining an appropriate BNP level below which the need for echocardiography is precluded would be valuable. We hypothesized that a fixed plasma BNP level of 20 pg/mL and simple clinical parameters are an effective pre-echocardiographic screening tool for left ventricular dysfunction.
Two hundred and two patients at a Veterans Administration facility with symptoms suggestive of heart disease (male to female ratio 193:9, mean age 65 years) were screened prior to echocardiography. Patients with known cardiac dysfunction were excluded.
BNP levels of ≥20 pg/mL were 79% sensitive and 44% specific in screening for any abnormality of ventricular function. The negative predictive value was 69%. When broken down into categories of dysfunction, the cutoff point of 20 pg/mL had a better negative predictive value for those with systolic dysfunction (96%) or systolic plus diastolic dysfunction (100%) if patients with diastolic dysfunction were excluded. The majority of patients with falsely low BNP levels (<20 pg/mL with positive echocardiographic findings) had mild diastolic dysfunction, with 3 patients exhibiting mild systolic dysfunction.
BNP may be a useful screening tool for left ventricular dysfunction in patients with history suggestive of heart disease and be used to assist in forming a pretest probability, which in turn could greatly assist in appropriateness of patient referral and in optimization of drug therapy.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2004.03.014</identifier><identifier>PMID: 15389242</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Cardiovascular disease ; Echocardiography ; Echocardiography, Doppler, Color ; Female ; Heart ; Heart attacks ; Heart Diseases - physiopathology ; Humans ; Male ; Medical prognosis ; Medical sciences ; Middle Aged ; Natriuretic Peptide, Brain - blood ; Patients ; Predictive Value of Tests ; Prospective Studies ; Sensitivity and Specificity ; Stroke Volume ; Ultrasonic imaging ; Ventricular Dysfunction, Left - blood ; Ventricular Dysfunction, Left - diagnosis ; Ventricular Dysfunction, Left - diagnostic imaging</subject><ispartof>The American heart journal, 2004-09, Vol.148 (3), p.518-523</ispartof><rights>2004 Elsevier Inc.</rights><rights>2004 INIST-CNRS</rights><rights>Copyright Elsevier Limited Sep 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c502t-c49b0e31f613d5eb37bf50e680dc49e1702cef2f62bb987d483fab7a5b97682b3</citedby><cites>FETCH-LOGICAL-c502t-c49b0e31f613d5eb37bf50e680dc49e1702cef2f62bb987d483fab7a5b97682b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16166452$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15389242$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Atisha, Dunya</creatorcontrib><creatorcontrib>Bhalla, Meenakshi A.</creatorcontrib><creatorcontrib>Morrison, L.Katherine</creatorcontrib><creatorcontrib>Felicio, Leda</creatorcontrib><creatorcontrib>Clopton, Paul</creatorcontrib><creatorcontrib>Gardetto, Nancy</creatorcontrib><creatorcontrib>Kazanegra, Radmila</creatorcontrib><creatorcontrib>Chiu, Albert</creatorcontrib><creatorcontrib>Maisel, Alan S.</creatorcontrib><title>A prospective study in search of an optimal B-natriuretic peptide level to screen patients for cardiac dysfunction</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Although echocardiography is the gold standard test for suspected left ventricular dysfunction, its cost and availability limits its use as a routine screening tool. The high negative predictive value of B-natriuretic peptide (BNP) in dyspneic patients suggests its possible utility in screening patients prior to echocardiography. Determining an appropriate BNP level below which the need for echocardiography is precluded would be valuable. We hypothesized that a fixed plasma BNP level of 20 pg/mL and simple clinical parameters are an effective pre-echocardiographic screening tool for left ventricular dysfunction.
Two hundred and two patients at a Veterans Administration facility with symptoms suggestive of heart disease (male to female ratio 193:9, mean age 65 years) were screened prior to echocardiography. Patients with known cardiac dysfunction were excluded.
BNP levels of ≥20 pg/mL were 79% sensitive and 44% specific in screening for any abnormality of ventricular function. The negative predictive value was 69%. When broken down into categories of dysfunction, the cutoff point of 20 pg/mL had a better negative predictive value for those with systolic dysfunction (96%) or systolic plus diastolic dysfunction (100%) if patients with diastolic dysfunction were excluded. The majority of patients with falsely low BNP levels (<20 pg/mL with positive echocardiographic findings) had mild diastolic dysfunction, with 3 patients exhibiting mild systolic dysfunction.
BNP may be a useful screening tool for left ventricular dysfunction in patients with history suggestive of heart disease and be used to assist in forming a pretest probability, which in turn could greatly assist in appropriateness of patient referral and in optimization of drug therapy.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular disease</subject><subject>Echocardiography</subject><subject>Echocardiography, Doppler, Color</subject><subject>Female</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Heart Diseases - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Patients</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Stroke Volume</subject><subject>Ultrasonic imaging</subject><subject>Ventricular Dysfunction, Left - blood</subject><subject>Ventricular Dysfunction, Left - diagnosis</subject><subject>Ventricular Dysfunction, Left - diagnostic imaging</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><recordid>eNp9kUGL1DAUx4Mo7rj6AbxIQPTW-pKmaYun3cVdhQUveg5p8sKmdNKapAPz7c0wAwsePIUkv_fy8v8R8p5BzYDJL1Otn6aaA4gamhqYeEF2DIaukp0QL8kOAHjVd9BckTcpTWUreS9fkyvWNv3ABd-ReEPXuKQVTfYHpClv9kh9oAl1NE90cVQHuqzZ7_VMb6ugc_RbxOwNXbEcW6QzHnCmeaHJRMRAV509hpyoWyI1OlqvDbXH5LZQHlnCW_LK6Tnhu8t6TX7ff_t19716_Pnw4-7msTIt8FwZMYyADXOSNbbFselG1wLKHmy5QtYBN-i4k3wch76zom-cHjvdjkMnez421-TzuW_54J8NU1Z7nwzOsw64bElJOUAjB1HAj_-A07LFUGZTrAUh2oEDLxQ7U6bklSI6tcaSSjwqBuqkQ02q6FAnHQoaVXSUmg-Xztu4R_tcccm_AJ8ugE5Gzy7qYHx65iSTUrQn7uuZwxLYwWNUyZSQDVofizplF_-fMf4C9H6oew</recordid><startdate>20040901</startdate><enddate>20040901</enddate><creator>Atisha, Dunya</creator><creator>Bhalla, Meenakshi A.</creator><creator>Morrison, L.Katherine</creator><creator>Felicio, Leda</creator><creator>Clopton, Paul</creator><creator>Gardetto, Nancy</creator><creator>Kazanegra, Radmila</creator><creator>Chiu, Albert</creator><creator>Maisel, Alan S.</creator><general>Mosby, Inc</general><general>Elsevier</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>20040901</creationdate><title>A prospective study in search of an optimal B-natriuretic peptide level to screen patients for cardiac dysfunction</title><author>Atisha, Dunya ; Bhalla, Meenakshi A. ; Morrison, L.Katherine ; Felicio, Leda ; Clopton, Paul ; Gardetto, Nancy ; Kazanegra, Radmila ; Chiu, Albert ; Maisel, Alan S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c502t-c49b0e31f613d5eb37bf50e680dc49e1702cef2f62bb987d483fab7a5b97682b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular disease</topic><topic>Echocardiography</topic><topic>Echocardiography, Doppler, Color</topic><topic>Female</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Heart Diseases - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Natriuretic Peptide, Brain - blood</topic><topic>Patients</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Stroke Volume</topic><topic>Ultrasonic imaging</topic><topic>Ventricular Dysfunction, Left - blood</topic><topic>Ventricular Dysfunction, Left - diagnosis</topic><topic>Ventricular Dysfunction, Left - diagnostic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Atisha, Dunya</creatorcontrib><creatorcontrib>Bhalla, Meenakshi A.</creatorcontrib><creatorcontrib>Morrison, L.Katherine</creatorcontrib><creatorcontrib>Felicio, Leda</creatorcontrib><creatorcontrib>Clopton, Paul</creatorcontrib><creatorcontrib>Gardetto, Nancy</creatorcontrib><creatorcontrib>Kazanegra, Radmila</creatorcontrib><creatorcontrib>Chiu, Albert</creatorcontrib><creatorcontrib>Maisel, Alan S.</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>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</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>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</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><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Atisha, Dunya</au><au>Bhalla, Meenakshi A.</au><au>Morrison, L.Katherine</au><au>Felicio, Leda</au><au>Clopton, Paul</au><au>Gardetto, Nancy</au><au>Kazanegra, Radmila</au><au>Chiu, Albert</au><au>Maisel, Alan S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A prospective study in search of an optimal B-natriuretic peptide level to screen patients for cardiac dysfunction</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2004-09-01</date><risdate>2004</risdate><volume>148</volume><issue>3</issue><spage>518</spage><epage>523</epage><pages>518-523</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Although echocardiography is the gold standard test for suspected left ventricular dysfunction, its cost and availability limits its use as a routine screening tool. The high negative predictive value of B-natriuretic peptide (BNP) in dyspneic patients suggests its possible utility in screening patients prior to echocardiography. Determining an appropriate BNP level below which the need for echocardiography is precluded would be valuable. We hypothesized that a fixed plasma BNP level of 20 pg/mL and simple clinical parameters are an effective pre-echocardiographic screening tool for left ventricular dysfunction.
Two hundred and two patients at a Veterans Administration facility with symptoms suggestive of heart disease (male to female ratio 193:9, mean age 65 years) were screened prior to echocardiography. Patients with known cardiac dysfunction were excluded.
BNP levels of ≥20 pg/mL were 79% sensitive and 44% specific in screening for any abnormality of ventricular function. The negative predictive value was 69%. When broken down into categories of dysfunction, the cutoff point of 20 pg/mL had a better negative predictive value for those with systolic dysfunction (96%) or systolic plus diastolic dysfunction (100%) if patients with diastolic dysfunction were excluded. The majority of patients with falsely low BNP levels (<20 pg/mL with positive echocardiographic findings) had mild diastolic dysfunction, with 3 patients exhibiting mild systolic dysfunction.
BNP may be a useful screening tool for left ventricular dysfunction in patients with history suggestive of heart disease and be used to assist in forming a pretest probability, which in turn could greatly assist in appropriateness of patient referral and in optimization of drug therapy.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>15389242</pmid><doi>10.1016/j.ahj.2004.03.014</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-8703 |
| ispartof | The American heart journal, 2004-09, Vol.148 (3), p.518-523 |
| issn | 0002-8703 1097-6744 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_66903694 |
| source | Elsevier |
| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Cardiology Cardiology. Vascular system Cardiovascular disease Echocardiography Echocardiography, Doppler, Color Female Heart Heart attacks Heart Diseases - physiopathology Humans Male Medical prognosis Medical sciences Middle Aged Natriuretic Peptide, Brain - blood Patients Predictive Value of Tests Prospective Studies Sensitivity and Specificity Stroke Volume Ultrasonic imaging Ventricular Dysfunction, Left - blood Ventricular Dysfunction, Left - diagnosis Ventricular Dysfunction, Left - diagnostic imaging |
| title | A prospective study in search of an optimal B-natriuretic peptide level to screen patients for cardiac dysfunction |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-12T00%3A23%3A11IST&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=A%20prospective%20study%20in%20search%20of%20an%20optimal%20B-natriuretic%20peptide%20level%20to%20screen%20patients%20for%20cardiac%20dysfunction&rft.jtitle=The%20American%20heart%20journal&rft.au=Atisha,%20Dunya&rft.date=2004-09-01&rft.volume=148&rft.issue=3&rft.spage=518&rft.epage=523&rft.pages=518-523&rft.issn=0002-8703&rft.eissn=1097-6744&rft.coden=AHJOA2&rft_id=info:doi/10.1016/j.ahj.2004.03.014&rft_dat=%3Cproquest_cross%3E3237561681%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c502t-c49b0e31f613d5eb37bf50e680dc49e1702cef2f62bb987d483fab7a5b97682b3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1504459202&rft_id=info:pmid/15389242&rfr_iscdi=true |