1
|
Ananthakrishna R, Rajvi BP, Hancock DE, Kholmurodova F, Woodman RJ, Patil S, Horsfall M, Chew DP, Daril NDM, Selvanayagam JB. Utility of cardiovascular magnetic resonance in patients with stable troponin elevation. Eur Heart J Cardiovasc Imaging 2023; 24:192-201. [PMID: 36336838 DOI: 10.1093/ehjci/jeac215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS Cardiovascular magnetic resonance (CMR) imaging has a potential role in the evaluation of symptomatic patients with stable troponin elevation; however, its utility remains unexplored. We sought to determine the incremental diagnostic value of CMR in this unique cohort and assess the long-term clinical outcomes. METHODS AND RESULTS Two hundred twenty-five consecutive patients presenting with cardiac chest pain/dyspnoea, stable troponin elevation, and undergoing CMR assessment were identified retrospectively from registry database. The study cohort was prospectively followed for major adverse cardiac events (MACEs) (defined as composite of all-cause mortality and cardiovascular readmissions). The primary outcome measure was the diagnostic utility of CMR, i.e. percentage of patients for whom CMR identified the cause of stable troponin elevation. Secondary outcome measures included the incremental value of CMR and occurrence of MACE. CMR was able to identify the cause for stable troponin elevation in 160 (71%) patients. A normal CMR was identified in 17% and an inconclusive CMR in 12% of the patients. CMR changed the referral diagnosis in 59 (26%) patients. Utilizing a baseline prediction model (pre-CMR referral diagnosis), the net reclassification index was 0.11 and integrated discriminatory improvement index measured 0.33 following CMR. Over a median follow-up of 4.3 years (interquartile range 2.8-6.3), 72 (32%) patients experienced MACE. CONCLUSION CMR identified a cause for stable troponin elevation in 7 of 10 cases, and a new diagnosis was evident in 1 of 4 cases. CMR improved the net reclassification of patients with stable troponin elevation.
Collapse
Affiliation(s)
- Rajiv Ananthakrishna
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia.,Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia
| | - Benita P Rajvi
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia
| | - Diana E Hancock
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia
| | - Feruza Kholmurodova
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia
| | - Sanjana Patil
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia
| | - Matthew Horsfall
- Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia.,Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia
| | - Noor Darinah Mohd Daril
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia
| | - Joseph B Selvanayagam
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia.,Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia
| |
Collapse
|
2
|
Chaulin AM. Elevation Mechanisms and Diagnostic Consideration of Cardiac Troponins under Conditions Not Associated with Myocardial Infarction. Part 2. Life (Basel) 2021; 11:1175. [PMID: 34833051 PMCID: PMC8619207 DOI: 10.3390/life11111175] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 01/19/2023] Open
Abstract
This article proceeds with a discussion of the causes and mechanisms of an elevation in cardiac troponins in pathological conditions not associated with acute myocardial infarction. The second part of the article discusses the causes and mechanisms of cardiac troponins elevation in diabetes mellitus, arterial hypertension, hereditary cardiomyopathies, cardiac arrhythmias (atrial fibrillation, supraventricular tachycardia), acute aortic dissection, and diseases of the central nervous system (strokes, subarachnoidal hemorrhage). The final chapter of this article discusses in detail the false-positive causes and mechanisms of elevated cardiac troponins.
Collapse
Affiliation(s)
- Aleksey M. Chaulin
- Department of Cardiology and Cardiovascular Surgery, Samara State Medical University, 443099 Samara, Russia; ; Tel.: +7-(927)-770-25-87
- Department of Histology and Embryology, Samara State Medical University, 443099 Samara, Russia
| |
Collapse
|
3
|
Predictors associated with increased troponin in acute decompensated and chronic heart failure patients. REV ROMANA MED LAB 2021. [DOI: 10.2478/rrlm-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background: Myocardial injury (INJ) expressed by elevated high-sensitivity troponin (hs-Tn) is common in heart failure (HF), due to cardiovascular and non-cardiac conditions. The mechanisms of INJ in acute decompensated HF (ADHF) versus chronic HF (CHF) are still debated. This study’s purpose was to evaluate the determinants of elevated hs-TnT in ADHF and CHF.
Methods: We retrospectively analyzed consecutive HF patients with hs-TnT measured on admission, hospitalized in a tertiary-care hospital. Rehospitalizations, acute coronary syndromes, embolisms, infections, autoimmunity and malignancy were excluded. Cut-off point for hs-TnT was 14 ng/L.
Results: Our study included 488 HF patients, 56.55% with ADHF. Mean age was 72.52±10.09 years. 53.89% were females. 67.75% ADHF and 45.75% CHF patients had elevated hs-TnT. Median hs-TnT was higher in ADHF versus CHF (21.05[IQR 12.74-33.81] vs 13.20[IQR 7.93-23.25], p<0.0001). In multivariable analysis in ADHF and CHF, log10NT-proBNP (HR=5.30, 95%CI 2.71–10.38, p<0.001, respectively HR=5.49, 95%CI 1.71–17.57, p=0.004) and eGFR (HR=0.72, 95%CI 0.62–0.85, p<0.001, respectively HR=0.71, 95%CI 0.55–0.93, p=0.014) were independent predictors for increased hs-TnT. Independent factors associated with elevated hs-TnT in ADHF were male sex (HR=2.52, 95%CI 1.31-4.87, p=0.006) and chronic pulmonary obstructive disease (COPD) (HR=10.57, 95%CI 1.26-88.40, p=0.029), while in CHF were age (HR=2.68, 95%CI 1.42-5.07, p=0.002) and previous stroke (HR=5.35, 95%CI 0.98-29.20, p=0.053).
Conclusion: HF severity, expressed by NT-proBNP levels, and kidney disease progression, expressed by eGFR, were independent predictors associated with increased hs-TnT in both ADHF and CHF. Specific independent predictors were also indentified in ADHF (male sex, COPD) and CHF (age, history of stroke).
Collapse
|
4
|
Healthcare and Resource Use in Patients With Stable High-Sensitivity Cardiac Troponin T Levels. Am J Cardiol 2020; 128:67-74. [PMID: 32650926 DOI: 10.1016/j.amjcard.2020.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/21/2022]
Abstract
Patients with elevated but stable levels of high-sensitivity cardiac troponin (hs-cTn) have a high risk of premature death and cardiovascular events. This study aimed to investigate the association between stable hs-cTnT levels and healthcare and resource use in patients with chest pain in the emergency department (ED). We included all patients who presented with chest pain and stable hs-cTnT levels without any concurrent acute medical condition at Karolinska University Hospital, Stockholm, Sweden, from 2011 to 2014. A negative binomial regression model was used to calculate incidence rates and incidence rate ratios with 95% confidence intervals (CIs) for the number of hospital visits, hospital days, and investigations performed during follow-up, in different categories of hs-cTnT levels (reference: hs-cTnT <5 ng/l). A total of 19,437 patients were included. During a follow-up of 4.1 years, 36,617 hospital visits and 206,808 hospital days were observed. Yearly rates of hospital visits and days gradually rose with increasing hs-cTnT levels from 0.3 and 1.27 (<5 ng/l) to 1.7 and 13 (≥50 ng/l) per person. In patients with hs-cTnT levels >14 ng/l, adjusted risks of in-hospital days were more than doubled (adjusted incidence rate ratio (95% CI) 2.31 (2.14 to 2.50), 2.88 (2.55 to 3.26), and 2.89 (2.45 to 3.40) in patients with hs-cTnT levels of 15 to 29, 30 to 49, and ≥50 ng/l, respectively) compared with the reference. Computed tomography, but not coronary angiography, increased with increasing hs-cTnT levels. In conclusion, stable hs-cTnT levels are associated with a higher rate of hospitalization, length of hospital stay, and resource use in patients with chest pain.
Collapse
|
5
|
Fan S, Xiao M, Han F, Xia P, Bai X, Chen H, Zhang H, Ding X, Zhao H, Zhao J, Sun X, Jiang W, Wang C, Cao W, Guo F, Tian R, Gao P, Wu W, Ma J, Wu D, Liu Z, Zhou X, Wang J, Guan T, Qin Y, Li T, Xu Y, Zhang D, Chen Y, Xie J, Li Y, Yan X, Zhu Y, Peng B, Cui L, Zhang S, Guan H. Neurological Manifestations in Critically Ill Patients With COVID-19: A Retrospective Study. Front Neurol 2020; 11:806. [PMID: 32754114 PMCID: PMC7365850 DOI: 10.3389/fneur.2020.00806] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023] Open
Abstract
Background: The complications of coronavirus disease 2019 (COVID-19) involved multiple organs or systems, especially in critically ill patients. We aim to investigate the neurological complications in critically ill patients with COVID-19. Methods: This retrospective single-center case series analyzed critically ill patients with COVID-19 at the intensive care unit of Tongji Hospital, Wuhan, China from February 5 to April 2, 2020. Demographic data, clinical and laboratory findings, comorbidities and treatments were collected and analyzed. Results: Among 86 patients with confirmed COVID-19, 54 patients (62.8%) were male, and the mean (SD) age was 66.6 (11.1) years. Overall, 65% patients presented with at least one neurological symptom. Twenty patients (23.3%) had symptoms involving the central nervous system, including delirium, cerebrovascular diseases and hypoxic-ischemic brain injury, while 6 patients (7%) had neuromuscular involvement. Seven of 86 patients exhibited new stroke and 6 (7%) cases were ischemic. A significantly higher prevalence of antiphospholipid antibodies was observed in patients with ischemic stroke than in those without stroke (83.3 vs. 26.9%, p < 0.05). Patients with ischemic stroke were more likely to have a higher myoglobulin level, and a lower hemoglobin level. Conclusions: The clinical spectrum of neurological complications in critically ill patients with COVID-19 was broad. Stroke, delirium and neuromuscular diseases are common neurological complications of COVID-19. Physicians should pay close attention to neurological complications in critically ill patients with COVID-19.
Collapse
Affiliation(s)
- Siyuan Fan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Meng Xiao
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Fei Han
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Xia
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyin Bai
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Huan Chen
- Department of Intensive Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongmin Zhang
- Department of Intensive Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Ding
- Department of Intensive Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hua Zhao
- Department of Intensive Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Zhao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuefeng Sun
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Jiang
- Department of Medical Intensive Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chunyao Wang
- Department of Medical Intensive Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Cao
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Fan Guo
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ran Tian
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Gao
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Wu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Ma
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dong Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhengyin Liu
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiang Zhou
- Department of Intensive Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinglan Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tianjia Guan
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Qin
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Taisheng Li
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingchun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dong Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu Chen
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Xie
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongzhe Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaowei Yan
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongzhi Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
6
|
Abstract
Cardiospecific isoforms of troponins are the most sensitive and specific biomarkers for the diagnosis of myocardial infarction. However, though elevated troponin levels indicate myocardial damage, they do not determine the cause and mechanism of the damage. With the new highly sensitive methods, very minor damages of the heart muscle can be detected. Myocardial damage can occur in many non-coronarogenic diseases. In this review, we discuss the mechanisms of elevation, the diagnostic value of cardiac troponins in the renal failure, tachyarrhythmias, endocarditis, myocarditis, pericarditis, sepsis, neurogenic pathologies (stroke), pulmonary embolism. In addition, we pay attention to the main reasons for a false-positive increase of the concentration of cardiac troponins: heterophilic antibodies, rheumatoid factor, alkaline phosphatase, cross-reactions with skeletal muscle troponins.
Collapse
|
7
|
Broersen LHA, Stengl H, Nolte CH, Westermann D, Endres M, Siegerink B, Scheitz JF. Association Between High-Sensitivity Cardiac Troponin and Risk of Stroke in 96 702 Individuals: A Meta-Analysis. Stroke 2020; 51:1085-1093. [PMID: 32078461 DOI: 10.1161/strokeaha.119.028323] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background and Purpose- Our study aim was to estimate risk of incident stroke based on levels of hs-cTn (high-sensitivity cardiac troponin), a specific biomarker indicating myocardial injury, in the general population, patients with atrial fibrillation, and patients with previous stroke. Methods- Embase, PubMed, and Web of Science were searched until March 14, 2019 to identify relevant articles. Randomized controlled trials and cohort studies assessing the risk of incident stroke based on hs-cTn were eligible. Pooled adjusted hazard ratios including 95% CI were calculated using a random-effects model due to study heterogeneity per population, coding of hs-cTn (categorical/continuous data), per hs-cTn subunit (T or I), for low risk of bias, and for all-cause and ischemic stroke separately. Results- We included 17 articles with 96 702 participants. In studies conducted in the general population (n=12; 77 780 participants), the pooled adjusted hazard ratio for incident stroke was 1.25 (CI, 1.10-1.40) for high versus low hs-cTn (as defined by included studies) during an average follow-up of 1 to 20 years (median 10). When categorical data were used, this was increased to 1.58 (CI, 1.26-1.90). The results were robust when accounting for stroke classification (all-cause stroke/ischemic stroke), hs-cTn subunit, risk of bias, and coding of hs-cTn. In patients with atrial fibrillation (4 studies; 18 725 participants), the pooled adjusted hazard ratio for incident stroke was 1.95 (CI, 1.29-2.62) for high versus low hs-cTn. Due to lack of data (one study, 197 participants), no meta-analysis could be performed in patients with previous stroke. Conclusions- This meta-analysis suggests that hs-cTn can be regarded as a risk marker for incident stroke, with different effect size in different subgroups. More research about the association between hs-cTn and incident stroke in high-risk populations is needed, especially in patients with history of ischemic stroke.
Collapse
Affiliation(s)
- Leonie H A Broersen
- From the Klinik für Neurologie mit Experimenteller Neurologie (L.H.A.B., H.S., C.H.N., M.E., J.F.S.), Charité-Universitätsmedizin Berlin, Germany.,Center for Stroke Research Berlin (CSB) (L.H.A.B., H.S., C.H.N., M.E., B.S., J.F.S.), Charité-Universitätsmedizin Berlin, Germany
| | - Helena Stengl
- From the Klinik für Neurologie mit Experimenteller Neurologie (L.H.A.B., H.S., C.H.N., M.E., J.F.S.), Charité-Universitätsmedizin Berlin, Germany.,Center for Stroke Research Berlin (CSB) (L.H.A.B., H.S., C.H.N., M.E., B.S., J.F.S.), Charité-Universitätsmedizin Berlin, Germany
| | - Christian H Nolte
- From the Klinik für Neurologie mit Experimenteller Neurologie (L.H.A.B., H.S., C.H.N., M.E., J.F.S.), Charité-Universitätsmedizin Berlin, Germany.,Center for Stroke Research Berlin (CSB) (L.H.A.B., H.S., C.H.N., M.E., B.S., J.F.S.), Charité-Universitätsmedizin Berlin, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislaufforschung), partner site Berlin (C.H.N., M.E., J.F.S.), Charité-Universitätsmedizin Berlin, Germany.,Berlin Institute of Health (C.H.N., M.E., J.F.S.), partner site Berlin, Germany.,German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen) (C.H.N., M.E.), partner site Berlin, Germany
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Centre Hamburg, Germany (D.W.).,German Centre for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Germany (D.W.)
| | - Matthias Endres
- From the Klinik für Neurologie mit Experimenteller Neurologie (L.H.A.B., H.S., C.H.N., M.E., J.F.S.), Charité-Universitätsmedizin Berlin, Germany.,Center for Stroke Research Berlin (CSB) (L.H.A.B., H.S., C.H.N., M.E., B.S., J.F.S.), Charité-Universitätsmedizin Berlin, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislaufforschung), partner site Berlin (C.H.N., M.E., J.F.S.), Charité-Universitätsmedizin Berlin, Germany.,Berlin Institute of Health (C.H.N., M.E., J.F.S.), partner site Berlin, Germany.,German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen) (C.H.N., M.E.), partner site Berlin, Germany
| | - Bob Siegerink
- Center for Stroke Research Berlin (CSB) (L.H.A.B., H.S., C.H.N., M.E., B.S., J.F.S.), Charité-Universitätsmedizin Berlin, Germany
| | - Jan F Scheitz
- From the Klinik für Neurologie mit Experimenteller Neurologie (L.H.A.B., H.S., C.H.N., M.E., J.F.S.), Charité-Universitätsmedizin Berlin, Germany.,Center for Stroke Research Berlin (CSB) (L.H.A.B., H.S., C.H.N., M.E., B.S., J.F.S.), Charité-Universitätsmedizin Berlin, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislaufforschung), partner site Berlin (C.H.N., M.E., J.F.S.), Charité-Universitätsmedizin Berlin, Germany.,Berlin Institute of Health (C.H.N., M.E., J.F.S.), partner site Berlin, Germany
| |
Collapse
|