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Liu L, Yu L, Wang Y, Zhou L, Liu Y, Pan X, Huang J. Unravelling the impact of RNA methylation genetic and epigenetic machinery in the treatment of cardiomyopathy. Pharmacol Res 2024; 207:107305. [PMID: 39002868 DOI: 10.1016/j.phrs.2024.107305] [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: 04/19/2024] [Revised: 07/01/2024] [Accepted: 07/10/2024] [Indexed: 07/15/2024]
Abstract
Cardiomyopathy (CM) represents a heterogeneous group of diseases primarily affecting cardiac structure and function, with genetic and epigenetic dysregulation playing a pivotal role in its pathogenesis. Emerging evidence from the burgeoning field of epitranscriptomics has brought to light the significant impact of various RNA modifications, notably N6-methyladenosine (m6A), 5-methylcytosine (m5C), N7-methylguanosine (m7G), N1-methyladenosine (m1A), 2'-O-methylation (Nm), and 6,2'-O-dimethyladenosine (m6Am), on cardiomyocyte function and the broader processes of cardiac and vascular remodelling. These modifications have been shown to influence key pathological mechanisms including mitochondrial dysfunction, oxidative stress, cardiomyocyte apoptosis, inflammation, immune response, and myocardial fibrosis. Importantly, aberrations in the RNA methylation machinery have been observed in human CM cases and animal models, highlighting the critical role of RNA methylating enzymes and their potential as therapeutic targets or biomarkers for CM. This review underscores the necessity for a deeper understanding of RNA methylation processes in the context of CM, to illuminate novel therapeutic avenues and diagnostic tools, thereby addressing a significant gap in the current management strategies for this complex disease.
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Affiliation(s)
- Li Liu
- Department of Cardiology, Affiliated Hospital of Youjiang Medical University for Nationalities, Youjiang Medical University for Nationalities, Baise 533000, China; Laboratory of the Atherosclerosis and Ischemic Cardiovascular Diseases, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, China
| | - Linxing Yu
- Graduate School of Youjiang Medical University for Nationalities, Baise 533000, China
| | - Yubo Wang
- Graduate School of Youjiang Medical University for Nationalities, Baise 533000, China
| | - Liufang Zhou
- Department of Cardiology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, China
| | - Yan Liu
- Laboratory of the Atherosclerosis and Ischemic Cardiovascular Diseases, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, China; Department of Cardiology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, China
| | - Xingshou Pan
- Laboratory of the Atherosclerosis and Ischemic Cardiovascular Diseases, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, China; Department of Cardiology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, China.
| | - Jianjun Huang
- Youjiang Medical University for Nationalities, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, China.
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2
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Arabadjian M, Montgomery S, Pleasure M, Nicolas B, Collins M, Reuter M, Massera D, Shimbo D, Sherrid MV. Clinical course of adults with co-occurring hypertrophic cardiomyopathy and hypertension: A scoping review. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 39:100367. [PMID: 38510995 PMCID: PMC10945972 DOI: 10.1016/j.ahjo.2024.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 03/22/2024]
Abstract
Introduction Hypertension affects approximately 50 % of patients with hypertrophic cardiomyopathy (HCM) but clinical course in adults with co-occurring HCM and hypertension is underexplored. Management may be challenging as routine anti-hypertensive medications may worsen obstructive HCM, the most common HCM phenotype. In this scoping review, we sought to synthesize the available literature related to clinical course and outcomes in adults with both conditions and to highlight knowledge gaps to inform future research directions. Methods We searched 5 electronic databases (PubMed, CINAHL, Scopus, Embase, Web of Science) to identify peer-reviewed articles, 2011-2023. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review (PRISMA-ScR) guideline. Results Eleven articles met eligibility. Adults with both conditions were older and had higher rates of obesity and diabetes than adults with HCM alone. Results related to functional class and arrhythmia were equivocal in cross-sectional studies. Only 1 article investigated changes in medical therapy among adults with both conditions. Hypertension was a predictor of worse functional class, but was not associated with all-cause mortality, heart failure-related mortality, or sudden-death. No data was found that related to common hypertension-related outcomes, including renal disease progression, nor patient-reported outcomes, including quality of life. Conclusions Our results highlight areas for future research to improve understanding of co-occurring HCM and hypertension. These include a need for tailored approaches to medical management to optimize outcomes, evaluation of symptom burden and quality of life, and investigation of hypertension-related outcomes, like renal disease and ischemic stroke, to inform cardiovascular risk mitigation strategies.
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Affiliation(s)
- Milla Arabadjian
- Center for Population and Health Services Research, Department of Foundations of Medicine, NYU Grossman Long Island School of Medicine, Mineola, NY, United States of America
| | - Sophie Montgomery
- NYU Grossman School of Medicine, New York, NY, United States of America
| | - Mitchell Pleasure
- NYU Grossman School of Medicine, New York, NY, United States of America
| | - Barnaby Nicolas
- Department of Foundations of Medicine, NYU Grossman Long Island School of Medicine, Mineola, NY, United States of America
| | - Maxine Collins
- School of Nursing University of Connecticut, Storrs, CT, United States of America
| | - Maria Reuter
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Daniele Massera
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Daichi Shimbo
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Mark V. Sherrid
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY, United States of America
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Glavaški M, Velicki L. Shared Molecular Mechanisms of Hypertrophic Cardiomyopathy and Its Clinical Presentations: Automated Molecular Mechanisms Extraction Approach. Life (Basel) 2021; 11:life11080785. [PMID: 34440529 PMCID: PMC8398249 DOI: 10.3390/life11080785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 12/30/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease with a prevalence of 1 in 500 people and varying clinical presentations. Although there is much research on HCM, underlying molecular mechanisms are poorly understood, and research on the molecular mechanisms of its specific clinical presentations is scarce. Our aim was to explore the molecular mechanisms shared by HCM and its clinical presentations through the automated extraction of molecular mechanisms. Molecular mechanisms were congregated by a query of the INDRA database, which aggregates knowledge from pathway databases and combines it with molecular mechanisms extracted from abstracts and open-access full articles by multiple machine-reading systems. The molecular mechanisms were extracted from 230,072 articles on HCM and 19 HCM clinical presentations, and their intersections were found. Shared molecular mechanisms of HCM and its clinical presentations were represented as networks; the most important elements in the intersections’ networks were found, centrality scores for each element of each network calculated, networks with reduced level of noise generated, and cooperatively working elements detected in each intersection network. The identified shared molecular mechanisms represent possible mechanisms underlying different HCM clinical presentations. Applied methodology produced results consistent with the information in the scientific literature.
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Affiliation(s)
- Mila Glavaški
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
- Correspondence: or
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
- Institute of Cardiovascular Diseases Vojvodina, Put Doktora Goldmana 4, 21204 Sremska Kamenica, Serbia
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Batzner A, Aicha D, Pfeiffer B, Neugebauer A, Seggewiss H. Sex-related differences in symptomatic patients with hypertrophic obstructive cardiomyopathy - Time for a new definition? Int J Cardiol 2020; 328:117-121. [PMID: 33359283 DOI: 10.1016/j.ijcard.2020.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/06/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Sex-related differences in diagnosis and treatment of hypertrophic obstructive cardiomyopathy (HOCM) are still unclear. Therefore, we analyzed baseline characteristics of symptomatic patients with indication for alcohol septal ablation (PTSMA) with respect to gender. METHODS AND RESULTS Between 05/2000 and 06/2017 indication for PTSMA was seen in 1014 patients (420 (41.4%) women and 594 (58.6%) men). Women were older (61.4 ± 15.0 vs. 51.8 ± 13.6 years; p < 0.00001) and suffered more often from dyspnea NYHA III/IV (81.4% vs. 67.7%; p < 0.001), whereas angina pectoris and syncopes were comparable. Echocardiographic gradients were comparable in women (66.4 ± 39.1 mmHg at rest and 106.5 ± 46.6 mmHg at Valsalva) and men (62.7 ± 38.8 mmHg at rest and 103.7 ± 42.7 mmHg at Valsalva). Women had smaller absolute diameter of the left atrium (LA) (44.4 ± 6.9 vs. 47.2 ± 6.5 mm; p < 0.0001), septal thickness (IVS) (20.5 ± 4.1 vs. 21.4 ± 4.5 mm; p < 0.01), and left ventricular posterior wall thickness (LVPW) (12.7 ± 2.8 vs. 13.6 ± 2.9 mm; p < 0.0001). But, indexed for BSA the relationship reversed in LA (25.2 ± 4.3 mm/m2 in women vs. 23.1 ± 3.4 mm/m2), IVS (11.7 ± 2.7 mm/m2 in women vs. 10.6 ± 2.5 mm/m2) and LVPW (7.3 ± 1.7 mm/m2 in women vs. 6.7 ± 1.6 mm/m2), p < 0.00001 each. CONCLUSION Women with HOCM and indication for PTSMA are older and more symptomatic with advanced disease progression. Reconsideration of disease definition and awareness maybe necessary in order to avoid delayed diagnosis and treatment of HOCM in women.
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Affiliation(s)
- Angelika Batzner
- Comprehensive Heart Failure Center (CHFC), University Clinic, Wuerzburg, Germany; Medizinische Klinik 1, Leopoldina-Krankenhaus, Schweinfurt, Germany
| | - Diaa Aicha
- Medizinische Klinik 1, Leopoldina-Krankenhaus, Schweinfurt, Germany
| | - Barbara Pfeiffer
- Medizinische Klinik 1, Leopoldina-Krankenhaus, Schweinfurt, Germany
| | - Anna Neugebauer
- Medizinische Klinik 1, Leopoldina-Krankenhaus, Schweinfurt, Germany
| | - Hubert Seggewiss
- Comprehensive Heart Failure Center (CHFC), University Clinic, Wuerzburg, Germany; Medizinische Klinik 1, Leopoldina-Krankenhaus, Schweinfurt, Germany.
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5
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Lombardo B, Izzo V, Terracciano D, Ranieri A, Mazzaccara C, Fimiani F, Cesaro A, Gentile L, Leggiero E, Pero R, Izzo B, D'Alicandro AC, Ercolini D, D'Alicandro G, Frisso G, Pastore L, Calabrò P, Scudiero O. Laboratory medicine: health evaluation in elite athletes. Clin Chem Lab Med 2020; 57:1450-1473. [PMID: 30835249 DOI: 10.1515/cclm-2018-1107] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/24/2019] [Indexed: 02/06/2023]
Abstract
The need to evaluate the health status of an athlete represents a crucial aim in preventive and protective sports science in order to identify the best diagnostic strategy to improve performance and reduce risks related to physical exercise. In the present review we aim to define the main biochemical and haematological markers that vary significantly during and after sports training to identify risk factors, at competitive and professional levels and to highlight the set up of a specific parameter's panel for elite athletes. Moreover, we also intend to consider additional biomarkers, still under investigation, which could further contribute to laboratory sports medicine and provide reliable data that can be used by athlete's competent staff in order to establish personal attitudes and prevent sports injuries.
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Affiliation(s)
- Barbara Lombardo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy
| | - Viviana Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Annaluisa Ranieri
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy
| | - Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy
| | - Fabio Fimiani
- Division of Cardiology, Department of Cardio-Thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Arturo Cesaro
- Division of Cardiology, Department of Cardio-Thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | | | - Raffaela Pero
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,Task Force on Microbiome Studies, University of Naples "Federico II", Naples, Italy
| | - Barbara Izzo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Danilo Ercolini
- Task Force on Microbiome Studies, University of Naples "Federico II", Naples, Italy.,Division of Microbiology, Department of Agricultural Sciences, University of Naples "Federico II", Naples, Italy
| | - Giovanni D'Alicandro
- Department of Neuroscience and Rehabilitation, Center of Sports Medicine and Disability, AORN, Santobono-Pausillipon, Naples, Italy
| | - Giulia Frisso
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy
| | - Lucio Pastore
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy.,Task Force on Microbiome Studies, University of Naples "Federico II", Naples, Italy
| | - Paolo Calabrò
- Division of Cardiology, Department of Cardio-Thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Olga Scudiero
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy.,Task Force on Microbiome Studies, University of Naples "Federico II", Naples, Italy
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Ferreira-González I, Sánchez-Recalde Á, Abu-Assi E, Arias MÁ, Gallego P, Del Río I. Revista Española de Cardiología: annual report 2019. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:410-417. [PMID: 32291243 DOI: 10.1016/j.rec.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | | | | | | | | | - Iria Del Río
- Editorial Director, Revista Española de Cardiología
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7
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Ferreira-González I, Sánchez-Recalde Á, Abu-Assi E, Arias MÁ, Gallego P, del Río I. Revista Española de Cardiología: anuario de 2019. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2020.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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8
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Sex-related differences in cardiomyopathies. Int J Cardiol 2019; 286:239-243. [DOI: 10.1016/j.ijcard.2018.10.091] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/10/2018] [Accepted: 10/26/2018] [Indexed: 01/14/2023]
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9
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Peña-Peña ML, Monserrat L. Papel de la genética en la estratificación del riesgo de pacientes con miocardiopatía dilatada no isquémica. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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10
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11
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Peña-Peña ML, Monserrat L. Risk Stratification in Patients With Nonisquemic Dilated Cardiomyopathy. The Role of Genetic Testing. ACTA ACUST UNITED AC 2019; 72:333-340. [PMID: 30792015 DOI: 10.1016/j.rec.2018.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/24/2018] [Indexed: 12/28/2022]
Abstract
Dilated cardiomyopathy is inherited in nearly 50% of cases. More than 90 genes have been associated with this disease, which is one of the main causes of heart transplant and has been associated with an increased risk of sudden cardiac death. Risk stratification in these patients continues to be challenging. The identification of the specific etiology of the disease is very useful for the early detection of mutation carriers. Genetic study often provides prognostic information and can determine the therapeutic approach. Wide phenotypic variability is observed depending on the mutated gene, the type of mutation, and the presence of additional genetic and environmental factors.
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Affiliation(s)
- Maria Luisa Peña-Peña
- Unidad de Cardiopatías Familiares, Departamento de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain; Departamento de Cardiología, Health in Code, A Coruña, Spain.
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12
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Pérez-Sánchez I, Sabater-Molina M, Muñoz-Esparza C, Gimeno-Blanes JR. Factores modificadores del fenotipo en la miocardiopatía hipertrófica. Respuesta. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2018.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Pérez-Sánchez I, Sabater-Molina M, Muñoz-Esparza C, Gimeno-Blanes JR. Phenotype-modifying Factors in Hypertrophic Cardiomyopathy. Response. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:770-771. [PMID: 29954718 DOI: 10.1016/j.rec.2018.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Inmaculada Pérez-Sánchez
- Unidad de Cardiopatías Hereditarias, Instituto Médico de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Murcia, Spain
| | - María Sabater-Molina
- Unidad de Cardiopatías Hereditarias, Instituto Médico de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Murcia, Spain; Departamento de Medicina Interna, Universidad de Murcia, Murcia, Spain.
| | - Carmen Muñoz-Esparza
- Departamento de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Juan Ramón Gimeno-Blanes
- Unidad de Cardiopatías Hereditarias, Instituto Médico de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Murcia, Spain; Departamento de Medicina Interna, Universidad de Murcia, Murcia, Spain; Departamento de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
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Limeres Freire J. Factores modificadores del fenotipo en la miocardiopatía hipertrófica. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2018.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Limeres Freire J. Phenotype-modifying Factors in Hypertrophic Cardiomyopathy. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:770. [PMID: 29844006 DOI: 10.1016/j.rec.2018.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 03/14/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Javier Limeres Freire
- Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
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Retos y controversias en miocardiopatía hipertrófica: visión integral desde la investigación básica, clínica y genética. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.06.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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17
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Pasipoularides A. Challenges and Controversies in Hypertrophic Cardiomyopathy: Clinical, Genomic and Basic Science Perspectives. ACTA ACUST UNITED AC 2017; 71:132-138. [PMID: 28802532 DOI: 10.1016/j.rec.2017.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/05/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ares Pasipoularides
- Department of Surgery, School of Medicine, Duke University, Durham, North Carolina, United States.
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