Loading…
The occurrence of postoperative atrial fibrillation according to different surgical settings in cardiac surgery patients
OBJECTIVES Atrial fibrillation is the most common arrhythmia after cardiac surgery. The pathogenesis of postoperative atrial fibrillation is multifactorial. The aim of the study was to analyse preoperative, intraoperative and postoperative factors and their relationships with the occurrence and dura...
Saved in:
| Published in: | Interactive cardiovascular and thoracic surgery 2012-12, Vol.15 (6), p.1007-1012 |
|---|---|
| Main Authors: | , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Request full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c416t-1194a18617c0af03baf31a934ecafbeb9f151eac2143239a9c3f59dc8d6280193 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c416t-1194a18617c0af03baf31a934ecafbeb9f151eac2143239a9c3f59dc8d6280193 |
| container_end_page | 1012 |
| container_issue | 6 |
| container_start_page | 1007 |
| container_title | Interactive cardiovascular and thoracic surgery |
| container_volume | 15 |
| creator | Jakubová, Marta Mitro, Peter Stan ák, Branislav Sabol, František Kolesár, Adrián Cisarik, Paul Nagy, Vincent |
| description | OBJECTIVES
Atrial fibrillation is the most common arrhythmia after cardiac surgery. The pathogenesis of postoperative atrial fibrillation is multifactorial. The aim of the study was to analyse preoperative, intraoperative and postoperative factors and their relationships with the occurrence and duration of atrial fibrillation.
METHODS
One hundred and ninety-six patients with coronary heart disease (152 men, age 62.7 ± 10.1 years) underwent surgical revascularization. Extracorporeal circulation was used in 64 patients and minimal extracorporeal circulation was used in 75 patients. Fifty-seven patients underwent surgery without extracorporeal circulation. During the first three postoperative days, subjects were monitored for the duration and incidence of atrial fibrillation, laboratory markers of inflammation (C-reactive protein, leucocytes) and serum potassium.
RESULTS
Demographic data and associated cardiovascular diseases in the groups were not statistically different. The overall incidence of atrial fibrillation was 56% (110 patients). The highest incidence of atrial fibrillation was found in the extracorporeal circulation subgroup, with a significantly lower incidence using minimal extracorporeal circulation, and in patients operated on without extracorporeal circulation (75 vs 47 vs 46%, P |
| doi_str_mv | 10.1093/icvts/ivs361 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_TOX</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3501296</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/icvts/ivs361</oup_id><sourcerecordid>1179489962</sourcerecordid><originalsourceid>FETCH-LOGICAL-c416t-1194a18617c0af03baf31a934ecafbeb9f151eac2143239a9c3f59dc8d6280193</originalsourceid><addsrcrecordid>eNp9kb1vFDEQxS0EIh_QpUbuoMgRj71fbiJFESRIkWhCbc3O2hdHe-vF9p6S_x6TC6ekofLI7zdv7HmMnYD4CkKrM0_bnM78NqkG3rBDqBu90rKr3-5rrQ7YUUr3QoAWSrxnB1Jq2ULbHrKH2zvLA9ESo52olI7PIeUw24jZby3HHD2O3Pk--nEsd2HiSBTi4Kc1z4EP3jlbmjNPS1x7KnCyORc1cT9xwkIiPYk2PvK5WBQ4fWDvHI7Jfnw-j9mv799uL69XNz-vflxe3KyogiavAHSF0DXQkkAnVI9OAWpVWULX2147qMEiSaiUVBo1KVfrgbqhkV35rzpm5zvfeek3dqAyO-Jo5ug3GB9NQG9eK5O_M-uwNaoWIHVTDL48G8Twe7Epm41PZMsuJhuWZABaXXVaN7KgpzuUYkgpWrcfA8L8Dcs8hWV2YRX808un7eF_6RTg8w4Iy_x_qz_YtqRt</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1179489962</pqid></control><display><type>article</type><title>The occurrence of postoperative atrial fibrillation according to different surgical settings in cardiac surgery patients</title><source>Oxford Open</source><creator>Jakubová, Marta ; Mitro, Peter ; Stan ák, Branislav ; Sabol, František ; Kolesár, Adrián ; Cisarik, Paul ; Nagy, Vincent</creator><creatorcontrib>Jakubová, Marta ; Mitro, Peter ; Stan ák, Branislav ; Sabol, František ; Kolesár, Adrián ; Cisarik, Paul ; Nagy, Vincent</creatorcontrib><description>OBJECTIVES
Atrial fibrillation is the most common arrhythmia after cardiac surgery. The pathogenesis of postoperative atrial fibrillation is multifactorial. The aim of the study was to analyse preoperative, intraoperative and postoperative factors and their relationships with the occurrence and duration of atrial fibrillation.
METHODS
One hundred and ninety-six patients with coronary heart disease (152 men, age 62.7 ± 10.1 years) underwent surgical revascularization. Extracorporeal circulation was used in 64 patients and minimal extracorporeal circulation was used in 75 patients. Fifty-seven patients underwent surgery without extracorporeal circulation. During the first three postoperative days, subjects were monitored for the duration and incidence of atrial fibrillation, laboratory markers of inflammation (C-reactive protein, leucocytes) and serum potassium.
RESULTS
Demographic data and associated cardiovascular diseases in the groups were not statistically different. The overall incidence of atrial fibrillation was 56% (110 patients). The highest incidence of atrial fibrillation was found in the extracorporeal circulation subgroup, with a significantly lower incidence using minimal extracorporeal circulation, and in patients operated on without extracorporeal circulation (75 vs 47 vs 46%, P <0.001). The longest duration of atrial fibrillation was found in patients operated on with extracorporeal circulation compared with minimal extracorporeal circulation, and without extracorporeal circulation (9.7 ± 11.6 vs 4.9 ± 8.3 vs 3.1 ± 5.2, P ≤0.001). The incidence of postoperative atrial fibrillation significantly correlated with elevation of inflammatory markers (C-reactive protein, leucocytes) compared with patients who were free of atrial fibrillation (P ≤0.001, P ≤0.05). The values of serum potassium were not significantly different. The relationship between postoperative atrial fibrillation and echocardiographic parameters was not confirmed.
CONCLUSIONS
The use of extracorporeal circulation leads to a higher incidence of postoperative atrial fibrillation compared with the use of minimal extracorporeal circulation or with surgery without extracorporeal circulation, probably due to enhanced systemic inflammatory response.</description><identifier>ISSN: 1569-9293</identifier><identifier>EISSN: 1569-9285</identifier><identifier>DOI: 10.1093/icvts/ivs361</identifier><identifier>PMID: 22927177</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Analysis of Variance ; Atrial Fibrillation - blood ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - epidemiology ; Atrial Fibrillation - immunology ; Biomarkers - blood ; C-Reactive Protein - metabolism ; Coronary Artery Bypass - adverse effects ; Coronary Artery Bypass, Off-Pump - adverse effects ; Coronary Disease - epidemiology ; Coronary Disease - surgery ; Creatine Kinase, MB Form - blood ; Electrocardiography, Ambulatory ; Extracorporeal Membrane Oxygenation - adverse effects ; Female ; Humans ; Incidence ; Inflammation Mediators - blood ; Leukocyte Count ; Male ; Middle Aged ; Original ; Postoperative Period ; Potassium - blood ; Risk Factors ; Slovakia - epidemiology ; Systemic Inflammatory Response Syndrome - blood ; Systemic Inflammatory Response Syndrome - epidemiology ; Systemic Inflammatory Response Syndrome - immunology ; Time Factors ; Treatment Outcome ; Troponin - blood</subject><ispartof>Interactive cardiovascular and thoracic surgery, 2012-12, Vol.15 (6), p.1007-1012</ispartof><rights>The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c416t-1194a18617c0af03baf31a934ecafbeb9f151eac2143239a9c3f59dc8d6280193</citedby><cites>FETCH-LOGICAL-c416t-1194a18617c0af03baf31a934ecafbeb9f151eac2143239a9c3f59dc8d6280193</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/PMC3501296/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3501296/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,1598,27903,27904,53769,53771</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/icvts/ivs361$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22927177$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jakubová, Marta</creatorcontrib><creatorcontrib>Mitro, Peter</creatorcontrib><creatorcontrib>Stan ák, Branislav</creatorcontrib><creatorcontrib>Sabol, František</creatorcontrib><creatorcontrib>Kolesár, Adrián</creatorcontrib><creatorcontrib>Cisarik, Paul</creatorcontrib><creatorcontrib>Nagy, Vincent</creatorcontrib><title>The occurrence of postoperative atrial fibrillation according to different surgical settings in cardiac surgery patients</title><title>Interactive cardiovascular and thoracic surgery</title><addtitle>Interact Cardiovasc Thorac Surg</addtitle><description>OBJECTIVES
Atrial fibrillation is the most common arrhythmia after cardiac surgery. The pathogenesis of postoperative atrial fibrillation is multifactorial. The aim of the study was to analyse preoperative, intraoperative and postoperative factors and their relationships with the occurrence and duration of atrial fibrillation.
METHODS
One hundred and ninety-six patients with coronary heart disease (152 men, age 62.7 ± 10.1 years) underwent surgical revascularization. Extracorporeal circulation was used in 64 patients and minimal extracorporeal circulation was used in 75 patients. Fifty-seven patients underwent surgery without extracorporeal circulation. During the first three postoperative days, subjects were monitored for the duration and incidence of atrial fibrillation, laboratory markers of inflammation (C-reactive protein, leucocytes) and serum potassium.
RESULTS
Demographic data and associated cardiovascular diseases in the groups were not statistically different. The overall incidence of atrial fibrillation was 56% (110 patients). The highest incidence of atrial fibrillation was found in the extracorporeal circulation subgroup, with a significantly lower incidence using minimal extracorporeal circulation, and in patients operated on without extracorporeal circulation (75 vs 47 vs 46%, P <0.001). The longest duration of atrial fibrillation was found in patients operated on with extracorporeal circulation compared with minimal extracorporeal circulation, and without extracorporeal circulation (9.7 ± 11.6 vs 4.9 ± 8.3 vs 3.1 ± 5.2, P ≤0.001). The incidence of postoperative atrial fibrillation significantly correlated with elevation of inflammatory markers (C-reactive protein, leucocytes) compared with patients who were free of atrial fibrillation (P ≤0.001, P ≤0.05). The values of serum potassium were not significantly different. The relationship between postoperative atrial fibrillation and echocardiographic parameters was not confirmed.
CONCLUSIONS
The use of extracorporeal circulation leads to a higher incidence of postoperative atrial fibrillation compared with the use of minimal extracorporeal circulation or with surgery without extracorporeal circulation, probably due to enhanced systemic inflammatory response.</description><subject>Aged</subject><subject>Analysis of Variance</subject><subject>Atrial Fibrillation - blood</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Atrial Fibrillation - immunology</subject><subject>Biomarkers - blood</subject><subject>C-Reactive Protein - metabolism</subject><subject>Coronary Artery Bypass - adverse effects</subject><subject>Coronary Artery Bypass, Off-Pump - adverse effects</subject><subject>Coronary Disease - epidemiology</subject><subject>Coronary Disease - surgery</subject><subject>Creatine Kinase, MB Form - blood</subject><subject>Electrocardiography, Ambulatory</subject><subject>Extracorporeal Membrane Oxygenation - adverse effects</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Inflammation Mediators - blood</subject><subject>Leukocyte Count</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Postoperative Period</subject><subject>Potassium - blood</subject><subject>Risk Factors</subject><subject>Slovakia - epidemiology</subject><subject>Systemic Inflammatory Response Syndrome - blood</subject><subject>Systemic Inflammatory Response Syndrome - epidemiology</subject><subject>Systemic Inflammatory Response Syndrome - immunology</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Troponin - blood</subject><issn>1569-9293</issn><issn>1569-9285</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNp9kb1vFDEQxS0EIh_QpUbuoMgRj71fbiJFESRIkWhCbc3O2hdHe-vF9p6S_x6TC6ekofLI7zdv7HmMnYD4CkKrM0_bnM78NqkG3rBDqBu90rKr3-5rrQ7YUUr3QoAWSrxnB1Jq2ULbHrKH2zvLA9ESo52olI7PIeUw24jZby3HHD2O3Pk--nEsd2HiSBTi4Kc1z4EP3jlbmjNPS1x7KnCyORc1cT9xwkIiPYk2PvK5WBQ4fWDvHI7Jfnw-j9mv799uL69XNz-vflxe3KyogiavAHSF0DXQkkAnVI9OAWpVWULX2147qMEiSaiUVBo1KVfrgbqhkV35rzpm5zvfeek3dqAyO-Jo5ug3GB9NQG9eK5O_M-uwNaoWIHVTDL48G8Twe7Epm41PZMsuJhuWZABaXXVaN7KgpzuUYkgpWrcfA8L8Dcs8hWV2YRX808un7eF_6RTg8w4Iy_x_qz_YtqRt</recordid><startdate>20121201</startdate><enddate>20121201</enddate><creator>Jakubová, Marta</creator><creator>Mitro, Peter</creator><creator>Stan ák, Branislav</creator><creator>Sabol, František</creator><creator>Kolesár, Adrián</creator><creator>Cisarik, Paul</creator><creator>Nagy, Vincent</creator><general>Oxford University Press</general><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><scope>5PM</scope></search><sort><creationdate>20121201</creationdate><title>The occurrence of postoperative atrial fibrillation according to different surgical settings in cardiac surgery patients</title><author>Jakubová, Marta ; Mitro, Peter ; Stan ák, Branislav ; Sabol, František ; Kolesár, Adrián ; Cisarik, Paul ; Nagy, Vincent</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c416t-1194a18617c0af03baf31a934ecafbeb9f151eac2143239a9c3f59dc8d6280193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Analysis of Variance</topic><topic>Atrial Fibrillation - blood</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Atrial Fibrillation - immunology</topic><topic>Biomarkers - blood</topic><topic>C-Reactive Protein - metabolism</topic><topic>Coronary Artery Bypass - adverse effects</topic><topic>Coronary Artery Bypass, Off-Pump - adverse effects</topic><topic>Coronary Disease - epidemiology</topic><topic>Coronary Disease - surgery</topic><topic>Creatine Kinase, MB Form - blood</topic><topic>Electrocardiography, Ambulatory</topic><topic>Extracorporeal Membrane Oxygenation - adverse effects</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Inflammation Mediators - blood</topic><topic>Leukocyte Count</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Postoperative Period</topic><topic>Potassium - blood</topic><topic>Risk Factors</topic><topic>Slovakia - epidemiology</topic><topic>Systemic Inflammatory Response Syndrome - blood</topic><topic>Systemic Inflammatory Response Syndrome - epidemiology</topic><topic>Systemic Inflammatory Response Syndrome - immunology</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Troponin - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jakubová, Marta</creatorcontrib><creatorcontrib>Mitro, Peter</creatorcontrib><creatorcontrib>Stan ák, Branislav</creatorcontrib><creatorcontrib>Sabol, František</creatorcontrib><creatorcontrib>Kolesár, Adrián</creatorcontrib><creatorcontrib>Cisarik, Paul</creatorcontrib><creatorcontrib>Nagy, Vincent</creatorcontrib><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><collection>PubMed Central (Full Participant titles)</collection><jtitle>Interactive cardiovascular and thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Jakubová, Marta</au><au>Mitro, Peter</au><au>Stan ák, Branislav</au><au>Sabol, František</au><au>Kolesár, Adrián</au><au>Cisarik, Paul</au><au>Nagy, Vincent</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The occurrence of postoperative atrial fibrillation according to different surgical settings in cardiac surgery patients</atitle><jtitle>Interactive cardiovascular and thoracic surgery</jtitle><addtitle>Interact Cardiovasc Thorac Surg</addtitle><date>2012-12-01</date><risdate>2012</risdate><volume>15</volume><issue>6</issue><spage>1007</spage><epage>1012</epage><pages>1007-1012</pages><issn>1569-9293</issn><eissn>1569-9285</eissn><abstract>OBJECTIVES
Atrial fibrillation is the most common arrhythmia after cardiac surgery. The pathogenesis of postoperative atrial fibrillation is multifactorial. The aim of the study was to analyse preoperative, intraoperative and postoperative factors and their relationships with the occurrence and duration of atrial fibrillation.
METHODS
One hundred and ninety-six patients with coronary heart disease (152 men, age 62.7 ± 10.1 years) underwent surgical revascularization. Extracorporeal circulation was used in 64 patients and minimal extracorporeal circulation was used in 75 patients. Fifty-seven patients underwent surgery without extracorporeal circulation. During the first three postoperative days, subjects were monitored for the duration and incidence of atrial fibrillation, laboratory markers of inflammation (C-reactive protein, leucocytes) and serum potassium.
RESULTS
Demographic data and associated cardiovascular diseases in the groups were not statistically different. The overall incidence of atrial fibrillation was 56% (110 patients). The highest incidence of atrial fibrillation was found in the extracorporeal circulation subgroup, with a significantly lower incidence using minimal extracorporeal circulation, and in patients operated on without extracorporeal circulation (75 vs 47 vs 46%, P <0.001). The longest duration of atrial fibrillation was found in patients operated on with extracorporeal circulation compared with minimal extracorporeal circulation, and without extracorporeal circulation (9.7 ± 11.6 vs 4.9 ± 8.3 vs 3.1 ± 5.2, P ≤0.001). The incidence of postoperative atrial fibrillation significantly correlated with elevation of inflammatory markers (C-reactive protein, leucocytes) compared with patients who were free of atrial fibrillation (P ≤0.001, P ≤0.05). The values of serum potassium were not significantly different. The relationship between postoperative atrial fibrillation and echocardiographic parameters was not confirmed.
CONCLUSIONS
The use of extracorporeal circulation leads to a higher incidence of postoperative atrial fibrillation compared with the use of minimal extracorporeal circulation or with surgery without extracorporeal circulation, probably due to enhanced systemic inflammatory response.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>22927177</pmid><doi>10.1093/icvts/ivs361</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext_linktorsrc |
| identifier | ISSN: 1569-9293 |
| ispartof | Interactive cardiovascular and thoracic surgery, 2012-12, Vol.15 (6), p.1007-1012 |
| issn | 1569-9293 1569-9285 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3501296 |
| source | Oxford Open |
| subjects | Aged Analysis of Variance Atrial Fibrillation - blood Atrial Fibrillation - diagnosis Atrial Fibrillation - epidemiology Atrial Fibrillation - immunology Biomarkers - blood C-Reactive Protein - metabolism Coronary Artery Bypass - adverse effects Coronary Artery Bypass, Off-Pump - adverse effects Coronary Disease - epidemiology Coronary Disease - surgery Creatine Kinase, MB Form - blood Electrocardiography, Ambulatory Extracorporeal Membrane Oxygenation - adverse effects Female Humans Incidence Inflammation Mediators - blood Leukocyte Count Male Middle Aged Original Postoperative Period Potassium - blood Risk Factors Slovakia - epidemiology Systemic Inflammatory Response Syndrome - blood Systemic Inflammatory Response Syndrome - epidemiology Systemic Inflammatory Response Syndrome - immunology Time Factors Treatment Outcome Troponin - blood |
| title | The occurrence of postoperative atrial fibrillation according to different surgical settings in cardiac surgery patients |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T10%3A41%3A39IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_TOX&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20occurrence%20of%20postoperative%20atrial%20fibrillation%20according%20to%20different%20surgical%20settings%20in%20cardiac%20surgery%20patients&rft.jtitle=Interactive%20cardiovascular%20and%20thoracic%20surgery&rft.au=Jakubov%C3%A1,%20Marta&rft.date=2012-12-01&rft.volume=15&rft.issue=6&rft.spage=1007&rft.epage=1012&rft.pages=1007-1012&rft.issn=1569-9293&rft.eissn=1569-9285&rft_id=info:doi/10.1093/icvts/ivs361&rft_dat=%3Cproquest_TOX%3E1179489962%3C/proquest_TOX%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c416t-1194a18617c0af03baf31a934ecafbeb9f151eac2143239a9c3f59dc8d6280193%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1179489962&rft_id=info:pmid/22927177&rft_oup_id=10.1093/icvts/ivs361&rfr_iscdi=true |