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Lazzeroni D, Ciraci C, Sommaruga M, Oggioni C, Saccò M, Ziveri V, Paglialonga L, Bini M, Moderato L, Brambilla L, Coruzzi P, Cruciani G, Lingiardi V, Tanzilli A, Galli F. Perceived Anxiety, Coping, and Autonomic Function in Takotsubo Syndrome Long after the Acute Event. Life (Basel) 2022; 12:1376. [PMID: 36143412 PMCID: PMC9502860 DOI: 10.3390/life12091376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Anxiety and depressive disorders represent predisposing factors for the autonomic dysfunctions that characterize the acute phase of Takotsubo syndrome (TS). However, there is insufficient data on this relationship after the acute event. The present study aimed at evaluating the psychological and autonomic status of patients with a history of TS. METHODS Ten TS patients whose acute event occurred at least 1 year prior to the evaluation and nine healthy age- and sex-matched subjects were evaluated. The cardiovascular assessment included a clinical examination, beat-to-beat heart rate monitoring to assess heart rate variability, and a psychological examination using the 16 Personality Factors-C Form (16PF), the Acceptance and Action Questionnaire-II, the Coping Orientations to Problems Experienced (COPE), the Beck Depression Inventory-II, and the State-Trait Anxiety Inventory (STAI). RESULTS TS patients scored significantly higher on the STAI (i.e., Anxiety Trait), 16PF (i.e., Tension), and COPE (i.e., Transcendental Orientation). TS patients also showed lower heart rate variability. Moreover, a significant inverse correlation was found between sympathetic tone (LF/HF ratio) and coping orientation. CONCLUSIONS Long after the acute event, TS patients are characterized by elevated anxiety, high tension, and a specific religious coping strategy.
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Affiliation(s)
| | | | - Marinella Sommaruga
- Psychology Unit, Istituti Clinici Scientifici Maugeri, IRCSS Milano, 20138 Milano, Italy
| | | | | | | | | | - Matteo Bini
- IRCCS Fondazione Don C. Gnocchi, 20132 Milan, Italy
| | - Luca Moderato
- Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | | | | | - Gianluca Cruciani
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy
| | - Federica Galli
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy
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Casagrande M, Forte G, Favieri F, Agostini F, Giovannoli J, Arcari L, Passaseo I, Semeraro R, Camastra G, Langher V, Pazzaglia M, Cacciotti L. The Broken Heart: The Role of Life Events in Takotsubo Syndrome. J Clin Med 2021; 10:4940. [PMID: 34768460 PMCID: PMC8585024 DOI: 10.3390/jcm10214940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 01/30/2023] Open
Abstract
The onset of Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is thought to be associated with some life events. This study focuses on clarifying life event characteristics and the role of triggers in the onset of TTS. Participants with TTS (n = 54) were compared to those with acute myocardial infarction (AMI; n = 52) and healthy individuals (n = 54). Using a modified version of the Interview for Recent Life Events, information about general life events perceived as stressful and triggers preceding the onset of a cardiac syndrome was collected. The assessment included the impact of these events as indicated by the participants and estimated by the interviewer; finally, the objective impact was considered. Although the number of events and the objective impact did not differ among the groups, patients with TTS reported a more negative perceived impact. Moreover, 61% of these patients objectively and subjectively reported a more stressful trigger before the onset of the disease (in the 24 h preceding the cardiac event) than those reported by patients with AMI. The dynamic between life events and individual responses could help differentiate TTS from other cardiovascular events, such as AMI. This study suggests that patients' perception of some life events (whether triggers or general life events) could represent a possible marker of TTS.
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Affiliation(s)
- Maria Casagrande
- Dipartimento di Psicologia Dinamica, Clinica e Salute, Università di Roma “Sapienza”, Via Degli Apuli 1, 00185 Roma, Italy;
| | - Giuseppe Forte
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Francesca Favieri
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Francesca Agostini
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
| | - Jasmine Giovannoli
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
| | - Luca Arcari
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
| | - Ilaria Passaseo
- Divisione di Cardiologia, Policlinico Casilino, Via Casilina, 00169 Roma, Italy;
| | - Raffaella Semeraro
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
| | - Giovanni Camastra
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
| | - Viviana Langher
- Dipartimento di Psicologia Dinamica, Clinica e Salute, Università di Roma “Sapienza”, Via Degli Apuli 1, 00185 Roma, Italy;
| | - Mariella Pazzaglia
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Luca Cacciotti
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
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Psychiatric conditions in patients presenting with Takotsubo syndrome: A systematic review and synthesis of case studies. Gen Hosp Psychiatry 2020; 65:54-63. [PMID: 32497926 DOI: 10.1016/j.genhosppsych.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The purpose of this systematic review was to describe psychiatric presentations observed among Takotsubo syndrome (TS) patients, how psychiatric conditions and associated treatments impact TS events, and how psychiatric conditions are managed alongside TS medical treatment and follow-up. METHODS We searched MEDLINE, Cochrane Database of Systematic Reviews, Embase, PsycInfo, CINAHL, and Web of Science between 1990 and 2019 for case reports of TS with comorbid psychiatric conditions, behaviors, or substance use. RESULTS Of 2403 records, we included 243 records comprising 252 total cases. Common psychiatric conditions included depression (n = 98; 39%), anxiety (n = 44, 17%), alcohol use (n = 35, 14%), suicidality (n = 30, 12%), and severe mental illness (n = 25, 10%). Psychiatric conditions were frequently associated with triggering TS events (61%). Less than one-third of cases reported providing psychiatric care during hospitalization (n = 80, 32%). Only 33 cases (13%) described psychiatric functioning at follow-up. All case studies were assessed to be of low quality; patterns of reporting bias were observed. CONCLUSIONS Despite heterogeneous psychiatric presentations among TS patients, psychiatric treatment was rarely incorporated into the medical care or addressed at follow-up. This gap may be better attended to by integrating psychiatrists and psychologists into the multidisciplinary treatment team. PROSPERO REGISTRATION NUMBER CRD42019119998.
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Sundelin R, Bergsten C, Tornvall P, Lyngå P. Self-rated stress and experience in patients with Takotsubo syndrome: a mixed methods study. Eur J Cardiovasc Nurs 2020; 19:740-747. [PMID: 32491953 PMCID: PMC7817986 DOI: 10.1177/1474515120919387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND A relation to stress and stressful triggers is often, but not always, described in patients with Takotsubo syndrome. Few studies have focused on patients' self-rated stress in combination with qualitative experiences of stress in Takotsubo syndrome. AIMS The aim of this study was to describe stress before and after the onset of Takotsubo syndrome. METHODS Twenty patients were recruited from five major hospitals in Stockholm, Sweden between December 2014 and November 2018. A mixed methods design was used containing the validated questionnaire, perceived stress scale (PSS-14) filled in at baseline and at a 6 and 12-month follow-up, respectively. Qualitative interviews were made at the 6-month follow-up. RESULTS Self-rated stress, measured by the perceived stress scale, showed stress levels above the cut-off value of 25, at the onset of Takotsubo syndrome (median 30.5). Stress had decreased significantly at the 12-month follow-up (median 20.5, P = 0.039) but remained high in one third of the patients. Qualitative interviews confirmed a high long-term stress and half of the patients had an acute stress trigger before the onset of Takotsubo syndrome. The qualitative interviews showed that the patients had reflected on and tried to find ways to deal with stress, but for many this was not successful. CONCLUSION Patients with Takotsubo syndrome reported long-term stress sometimes with an acute stress trigger before the onset of Takotsubo syndrome. Stress decreased over time but remained high for a considerable number of patients. Despite reflection over stress and attempts to deal with stress many were still affected after 6 months. New treatment options are needed for patients with Takotsubo syndrome.
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Affiliation(s)
- Runa Sundelin
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
| | - Chatarina Bergsten
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
| | - Per Tornvall
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
| | - Patrik Lyngå
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset and Cardiology Unit, Sweden
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Modifiable lifestyle factors in women with Takotsubo syndrome: A case-control study. Heart Lung 2020; 49:524-529. [PMID: 32199679 DOI: 10.1016/j.hrtlng.2020.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/27/2020] [Accepted: 03/04/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is limited information on the relationship between modifiable lifestyle factors and Takotsubo syndrome (TS). OBJECTIVES To determine the association of physical activity, smoking, alcohol use, and caffeinated coffee consumption with TS. METHODS This case-control study enrolled women with newly diagnosed TS (n = 45), women post-myocardial infarction (MI; n = 32), and healthy women volunteers (HC; n = 30). Information on physical activity, smoking, alcohol use, and caffeinated coffee consumption was collected 1-month post-discharge for TS and MI, and 1-month post-enrollment for HC. RESULTS TS women reported a higher prevalence of lifetime smoking and cigarette packs/day, greater coffee consumption, and less physical activity than HC. Associations with cigarette and coffee use remained significant in adjusted models. Physical activity, smoking, and coffee consumption were similar in TS and MI women. CONCLUSIONS Use of psychostimulants (caffeine and cigarettes) may play a role in TS pathophysiology. These findings need to be confirmed in larger, fully powered studies.
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Takotsubo syndrome: How the broken heart deals with negative emotions. NEUROIMAGE-CLINICAL 2019; 25:102124. [PMID: 31884222 PMCID: PMC6938811 DOI: 10.1016/j.nicl.2019.102124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/05/2019] [Accepted: 12/13/2019] [Indexed: 01/17/2023]
Abstract
Takotsubo patients show lower bilateral superior parietal activity during the processing of negative expected pictures compared to healthy control subjects. Takotsubo patients show lower decoding of negative versus neutral pictures in a widespread network consisting of frontal, parietal, occipital, and cerebellar brain regions. The lower involvement of brain regions observed in Takotsubo patients suggests an impairment in emotional regulation, which might be of etiological importance in this brain-heart disease.
Objectives Patients suffering from Takotsubo syndrome have a higher prevalence of anxiety and depressive disorders compared to those with acute myocardial infarction and might thus show impaired regulation and processing of emotions. Methods In this cross-sectional study, neural activity during an emotional picture processing task was examined in 26 Takotsubo patients (on average 27 months after the Takotsubo event) and 22 healthy age- and gender-matched control subjects undergoing functional magnetic resonance imaging. Imaging data were analyzed with two complementary approaches: First, univariate analysis was used to detect brain regions showing condition-specific differences in mean neural activity between groups. Second, multivariate pattern analysis was applied to decode the experimental conditions from individual activity patterns. Results In the univariate analysis approach, patients showed lower bilateral superior parietal activity during the processing of negative expected pictures compared to the control subjects. The multivariate pattern analysis revealed group differences in decoding negative versus neutral pictures from a widespread network consisting of frontal, parietal, occipital, and cerebellar brain regions. Additionally, differences in decoding the expectation of a negative versus positive upcoming picture were observed in the visual cortex. Conclusion The lower involvement of brain regions observed in Takotsubo patients suggests an impairment in emotion regulation, which might be of etiological importance in this brain-heart disease.
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Abstract
Great advances have been made in our understanding of Takotsubo syndrome in the past decade, but the aetiology of the condition remains incompletely understood. The most established theory, that catecholamine-mediated myocardial stunning is provoked by emotional or physiological stress, is supported by the presence of supraphysiological levels of plasma catecholamines in patients with Takotsubo syndrome. For this reason, the hyperexcitability of the autonomic nervous system under conditions of physical and emotional stress is often assessed in these patients. Observational studies have indicated that a predisposing influence of chronic or traumatic stress, anxiodepressive disorders, and maladaptive personality traits are linked to the pathogenesis of Takotsubo syndrome. Chronic stress can influence autonomic function through dysregulation of the hypothalamic-pituitary-adrenal axis and contribute to the development of cardiovascular disorders. In this Perspectives article, we discuss the current knowledge of the psychoneuroendocrinological and psychosocial mechanisms underlying the pathophysiology of Takotsubo syndrome.
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Scantlebury DC, Rohe DE, Best PJM, Lennon RJ, Lerman A, Prasad A. Stress-coping skills and neuroticism in apical ballooning syndrome (Takotsubo/stress cardiomyopathy). Open Heart 2016; 3:e000312. [PMID: 26870388 PMCID: PMC4746526 DOI: 10.1136/openhrt-2015-000312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 12/24/2015] [Accepted: 01/08/2016] [Indexed: 02/07/2023] Open
Abstract
Introduction Apical ballooning syndrome (ABS) is typically associated with an antecedent stressful situation. Affected patients have been reported to have higher frequencies of premorbid affective disorders. We hypothesised that patients with ABS would have elevated levels of neuroticism (tendency to experience negative affect) and greater vulnerability to stress. Methods In this cross-sectional study, all active participants in the Mayo Clinic ABS prospective follow-up registry were invited to complete the third edition of the NEO Personality Inventory (NEO-PI-3). The NEO-PI-3 is the universally accepted measure of the ‘Five-Factor Model’ of personality. Inventory responses were scored using the NEO-PI-3 computer program and the data were compared with US normative sample used in standardisation of the inventory. Significance was set at 0.0014 to account for multiple comparisons. Results Of 106 registry participants approached, 53 completed the inventory. There was no difference in age, gender, time from ABS diagnosis, type of antecedent stressor (emotional, physical or none) or severity of initial illness between the responders and non-responders. Responders had mean Neuroticism T-scores of 48.0±10.6 (95% CI 45.1 to 50.9); p=0.18, when compared with the normal mean of 50. There was also no significant difference in the facet scale of Vulnerability: 46.9±8.4 (44.6 to 49.2), p=0.038, at α=0.0014. Conclusions Contrary to our hypothesis, patients with ABS do not manifest higher levels of neuroticism and do not have greater vulnerability to stress than the general population. These findings have implications for the clinicians’ perception of, and approach to, patients with ABS.
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Affiliation(s)
- Dawn C Scantlebury
- Division of Cardiovascular Diseases, Department of Internal Medicine , Mayo Clinic , Rochester, Minnesota , USA
| | - Daniel E Rohe
- Department of Psychiatry and Psychology , Mayo Clinic , Rochester, Minnesota , USA
| | - Patricia J M Best
- Division of Cardiovascular Diseases, Department of Internal Medicine , Mayo Clinic , Rochester, Minnesota , USA
| | - Ryan J Lennon
- Department of Health Sciences Research , Mayo Clinic , Rochester, Minnesota , USA
| | - Amir Lerman
- Division of Cardiovascular Diseases, Department of Internal Medicine , Mayo Clinic , Rochester, Minnesota , USA
| | - Abhiram Prasad
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA; Cardiovascular and Cell Sciences Institute, St. George's University of London, London, UK
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Kastaun S, Gerriets T, Yeniguen M, Nef H, Moellmann H, Sammer G, Juenemann M. Locus of control and stress management strategies in women with takotsubo cardiomyopathy. Int J Cardiol 2014; 177:658-60. [PMID: 25308089 DOI: 10.1016/j.ijcard.2014.09.173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 09/27/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Sabrina Kastaun
- Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Giessen, Germany; Department of Heart Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Tibo Gerriets
- Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Giessen, Germany; Department of Neurology, Buergerhospital Friedberg, Friedberg, Germany
| | - Mesut Yeniguen
- Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Giessen, Germany; Department of Neurology, Buergerhospital Friedberg, Friedberg, Germany
| | - Holger Nef
- Department of Cardiology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Helge Moellmann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Gebhard Sammer
- Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Giessen, Germany; Department of Psychiatry, University Hospital Giessen and Marburg, Giessen, Germany
| | - Martin Juenemann
- Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Giessen, Germany; Department of Neurology, Buergerhospital Friedberg, Friedberg, Germany.
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Hefner J, Michalke F, Csef H. Stress management in females with Tako-Tsubo cardiomyopathy compared to females with acute coronary syndrome. Int J Cardiol 2014; 170:e1-2. [PMID: 24383066 DOI: 10.1016/j.ijcard.2013.10.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Dahlviken RM, Fridlund B, Mathisen L. Women's experiences of Takotsubo cardiomyopathy in a short-term perspective - a qualitative content analysis. Scand J Caring Sci 2014; 29:258-67. [DOI: 10.1111/scs.12158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/20/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Rønnaug M. Dahlviken
- Institute of Nursing; Bergen University College; Bergen Norway
- Department of Cardiology; Oslo University Hospital; Oslo Norway
| | - Bengt Fridlund
- Institute of Nursing; Bergen University College; Bergen Norway
- School of Health Sciences; Jönköping University; Jönköping Sweden
| | - Lars Mathisen
- Lovisenberg Diaconal University College; Oslo Norway
- Department of Cardiothoracic Surgery; Oslo University Hospital; Oslo Norway
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