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Abusnina W, Elhouderi E, Walters RW, Al-Abdouh A, Mostafa MR, Liu JL, Mazozy R, Mhanna M, Ben-Dor I, Dufani J, Kabach A, Michos ED, Aboeata A, Mamas MA. Sex Differences in the Clinical Outcomes of Patients With Takotsubo Stress Cardiomyopathy: A Meta-Analysis of Observational Studies. Am J Cardiol 2024; 211:316-325. [PMID: 37923154 DOI: 10.1016/j.amjcard.2023.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
The incidence of takotsubo stress cardiomyopathy (TSCM) in males is low compared with females. Gender-based differences in clinical outcomes of TSCM are not well characterized. The aim of this meta-analysis was to analyze whether gender-based differences are observed in TSCM clinical outcomes. A comprehensive literature search of PubMed, Embase, Cochrane Library database, and Web of Science was performed from inception to June 20, 2022, for studies comparing the clinical outcomes between male and female patients with TSCM. The primary outcome of interest was in-hospital all-cause mortality and cardiogenic shock. The secondary outcomes were cardiovascular mortality, receipt of mechanical ventilation, intra-aortic balloon pump, occurrence of ventricular arrhythmia, and left ventricular thrombus. A random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CI). Heterogenicity was assessed using the Higgins I2 index. Twelve observational studies involving 51,213 patients (4,869 males and 46,344 females) were included in the meta-analysis. Male gender was associated with statistically significant higher in-hospital all-cause mortality compared with females in patients with TSCM (RR 2.17, 95% CI 1.77 to 2.67, p <0.001). The rate of cardiogenic shock was significantly higher in males with TSCM compared with females (RR 1.66, 95% CI 1.29 to 2.12, p <0.001). Our meta-analysis showed a difference in the clinical outcomes of TSCM between men and women. Male gender was associated with a two-fold greater in-hospital all-cause mortality risk compared with female gender. The higher mortality risk associated with male gender deserves further study, particularly whether it represents later recognition of the condition and disparities in treatments.
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Affiliation(s)
- Waiel Abusnina
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA; Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington DC.
| | - Eiman Elhouderi
- Department of Medicine, Beaumont Hospital, Dearborn, MI, USA
| | - Ryan W Walters
- Department of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, NE, USA
| | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Mostafa R Mostafa
- Department of Medicine, Rochester Regional Health/Unity Hospital, Rochester, New York, USA
| | - John L Liu
- Creighton University School of Medicine, Omaha, NE, USA
| | - Ruqayah Mazozy
- Department of Cardiology, Zliten Medical Center, Zliten, Libya
| | - Mohammed Mhanna
- Division of Cardiology, Department of Medicine, University of Iowa, IA, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, Medstar Washington Hospital Center, Washington DC
| | - Jalal Dufani
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Amjad Kabach
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahemd Aboeata
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
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Abuelazm M, Saleh O, Hassan AR, Ahmad S, Albarakat MM, Abdalshafy H, Katamesh BE, Abdelazeem B, Paul TK. Sex Difference in Clinical and Management Outcomes in Patients With Takotsubo Syndrome: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101545. [PMID: 36563919 DOI: 10.1016/j.cpcardiol.2022.101545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
Takotsubo syndrome (TTS) is being increasingly recognized globally with a female sex predilection. However, sex-related differences in clinical outcomes are yet to be identified. Therefore, we aim to investigate the sex differences in clinical outcomes in patients with TTS. We included cohort studies retrieved from the Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane until September 14, 2022. The risk ratio (RR) for dichotomous outcomes with the corresponding 95% confidence interval (CI) was used. The study protocol was registered in PROSPERO with ID: CRD42022363349. Thirteen retrospective cohort studies, with a total of 104,410 patients were included. Men had a higher risk of in-hospital mortality (RR: 2.42 with 95% CI [1.53, 3.83], P = 0.0002), long-term mortality (RR: 1.59 with 95% CI [1.40, 1.80], P = 0.00001), cardiogenic shock (RR: 1.65 with 95% CI [1.52, 1.79], P = 0.00001), arrhythmia (RR: 1.70 with 95% CI [1.56, 1.86], P = 0.00001), and acute kidney injury (RR: 1.71 with 95% CI [1.50, 1.96]. P = 0.00001), as compared with women. However, no significant difference was observed in stroke (RR: 1.22 with 95% CI [0.78, 1.89], P = 0.39), left ventricular thrombus (RR: 0.96 with 95% CI [0.40, 2.33], P = 0.93), and TTS recurrence (RR: 1.11 with 95% CI [0.68, 1.82], P = 0.67) between men and women. Despite women having a higher incidence of TTS, men have higher morbidity and mortality rates. Hence, further studies are necessary to identify the pathophysiological factors of this sex difference in clinical outcomes, including hormonal and psychological variables.
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Affiliation(s)
| | - Othman Saleh
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | | | - Soban Ahmad
- Department of Internal Medicine, East Carolina University, Greenville, NC
| | - Majd M Albarakat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, MI; Department of Internal Medicine, Michigan State University, East Lansing, MI
| | - Timir K Paul
- Department of Clinical Medical Education, The University of Tennessee Health Sciences Center at Nashville, Nashville, TN
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3
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Sex Differences in Stress-Induced (Takotsubo) Cardiomyopathy. CJC Open 2023; 5:120-127. [PMID: 36880077 PMCID: PMC9984900 DOI: 10.1016/j.cjco.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Takotsubo cardiomyopathy (TC) affects predominantly women. Prior studies have suggested that men might have worse short-term outcomes, but limited data are available regarding long-term outcomes. We hypothesized that men, compared to women, with TC have worse short- and long-term outcomes. Methods A retrospective study of patients diagnosed with TC between 2005 and 2018 in the Veteran Affairs system was performed. Primary outcomes were in-hospital death, 30-day risk of stroke, death, and long-term mortality. Results A total of 641 patients were included (444 men [69%]; 197 women [31%]). Men had a higher median age (65 vs 60 years; P < 0.001), and women were more likely to present with chest pain (68.7% vs 44.1%; P < 0.001). Physical triggers were more common in men (68.7% vs 44.1%, P < 0.001). Men had a higher in-hospital mortality rate (8.1% vs 1%; P < 0.001). On multivariable regression analysis, female sex was an independent predictor for improved in-hospital mortality, compared to men (odds ratio 0.25, 95% confidence interval 0.06-1.10; P = 0.04). On 30-day follow-up, no difference occurred in a combined outcome of stroke and death (3.9% vs 1.5%; P = 0.12). On long-term follow-up (3.7 ± 3.1 years), female sex was identified as an independent predictor of lower mortality (hazard ratio 0.71, 95% CI 0.51-0.97; P = 0.032). Women were more likely to have TC recurrence (3.6% vs 1.1%; P = 0.04). Conclusions In our study with a predominantly male population, men had less-favourable short- and long-term outcomes after TC, compared to those of women.
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Schneider B, Stöllberger C. Geschlechtsspezifische Unterschiede beim Takotsubo Syndrom. AKTUELLE KARDIOLOGIE 2022. [DOI: 10.1055/a-1692-0902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungDas Takotsubo Syndrom (TTS) ist gekennzeichnet durch akut auftretende transiente
Wandbewegungsstörungen des linken Ventrikels, denen angiografisch keine signifikanten
Koronarstenosen zugrunde liegen. Die Erkrankung tritt überwiegend bei älteren Frauen in
der Menopause auf, prinzipiell können jedoch Patienten jeden Alters und beiderlei
Geschlechts betroffen sein. Insgesamt wird bei etwa 2% aller Patienten mit dem Verdacht
auf ein akutes Koronarsyndrom (ACS) die Diagnose eines TTS gestellt; bei Frauen mit
ACS-Verdacht liegt die Inzidenz mit 6–9% deutlich höher. Als Triggerfaktor für ein TTS
findet sich bei Frauen häufiger emotionaler Stress und bei Männern physischer Stress. Im
Akutstadium der Erkrankung können schwerwiegende Komplikationen auftreten, die
Krankenhausmortalität ist vergleichbar mit der beim akuten Myokardinfarkt und bei Männern
infolge von Begleiterkrankungen höher als bei Frauen mit einem TTS. Aktuell existiert
keine evidenzbasierte Therapie. Um die Prognose des TTS im Akutstadium verbessern und
Rezidive verhindern zu können, sind prospektive randomisierte Studien erforderlich.
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Affiliation(s)
- Birke Schneider
- Medizinische Klinik II, Sana Kliniken Lübeck GmbH, Lübeck,
Deutschland
| | - Claudia Stöllberger
- 2. Medizinische Abteilung mit Kardiologie und internistischer
Intensivmedizin, Krankenanstalt Rudolfstiftung, Wien, Österreich
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Lu X, Li P, Teng C, Cai P, Jin L, Li C, Liu Q, Pan S, Dixon RA, Wang B. Prognostic factors of Takotsubo cardiomyopathy: a systematic review. ESC Heart Fail 2021; 8:3663-3689. [PMID: 34374223 PMCID: PMC8497208 DOI: 10.1002/ehf2.13531] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/04/2021] [Accepted: 07/05/2021] [Indexed: 02/05/2023] Open
Abstract
Takotsubo cardiomyopathy (TCM), characterized by reversible ventricular dysfunction, has similar mortality to acute coronary syndrome. With the growing interest in the diagnosis of and interventions for TCM, many risk factors had been found to affect the prognosis of TCM patients, such as age, sex, and pre-existing diseases. Because of the incomplete understanding of the pathophysiologic mechanism in TCM, evidence-based medical therapy for this condition is lacking. Early intervention on risk factors may improve the outcomes of TCM. In this review, we sought to provide up-to-date evidence on risk factors and medical therapies that affect TCM outcome. We found that male sex, physical triggers, and certain comorbidities such as chronic kidney disease, malignant disease, higher body mass index, sepsis, chronic obstructive pulmonary disease, and anaemia were associated with poor TCM prognosis. In contrast, race, hyperlipidaemia, diabetes mellitus, and mood disorders were not clearly associated with TCM prognosis. We also reviewed the effect of medical therapies on TCM outcome, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, calcium channel blockers, and statins. The evidence that these medications confer a survival benefit on TCM patients is limited. Understanding these prognostic factors could help develop risk-stratification tools for TCM and establish effective prevention and interventions for this not-so-benign condition. Further multicentre clinical studies with large samples and meta-analyses of findings from previous studies are needed to address the inconsistent findings among the many potential risk factors for TCM.
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Affiliation(s)
- Xiaojia Lu
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
| | - Pengyang Li
- Division of CardiologyPauley Heart Center, Virginia Commonwealth UniversityRichmondVAUSA
| | - Catherine Teng
- Department of MedicineYale New Haven Health Greenwich HospitalGreenwichCTUSA
| | - Peng Cai
- Department of Mathematical SciencesWorcester Polytechnic InstituteWorcesterMAUSA
| | - Ling Jin
- Department of MedicineMetrowest Medical CenterFraminghamMAUSA
| | - Chenlin Li
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
| | - Qi Liu
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Su Pan
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Richard A.F. Dixon
- Wafic Said Molecular Cardiology Research LaboratoryTexas Heart InstituteHoustonTXUSA
| | - Bin Wang
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical College57 Changping RoadShantou515041China
- Clinical Research Centerthe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
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Pogran E, Abd El-Razek A, Gargiulo L, Weihs V, Kaufmann C, Horváth S, Geppert A, Nürnberg M, Wessely E, Smetana P, Huber K. Long-term outcome in patients with takotsubo syndrome : A single center study from Vienna. Wien Klin Wochenschr 2021; 134:261-268. [PMID: 34415428 DOI: 10.1007/s00508-021-01925-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/16/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is an increasing amount of evidence suggesting multiple fatal complications in takotsubo syndrome; however, findings on the long-term outcome are scarce and show inconsistent evidence. METHODS This is a single center study of long-term prognosis in takotsubo patients admitted to the Klinik Ottakring, Vienna, Austria, from September 2006 to August 2019. We investigated the clinical features, prognostic factors and outcome of patients with takotsubo syndrome. Furthermore, survivors and non-survivors and patients with a different cause of death were compared. RESULTS Overall, 147 patients were included in the study and 49 takotsubo patients (33.3%) died during the follow-up, with a median of 126 months. The most common cause of death was a non-cardiac cause (71.4% of all deaths), especially malignancies (26.5% of all deaths). Moreover, non-survivors were older and more often men with more comorbidities (chronic kidney disease, malignancy). Patients who died because of cardiovascular disease were older and more often women than patients who died due to non-cardiovascular cause. Adjusted analysis showed no feature of an independent predictor of cardiovascular mortality for takotsubo patients. Female gender (HR = 0.32, CI: 0.16-0.64, p < 0.001), cancer (HR = 2.35, CI: 1.15-4.8, p = 0.019) and chronic kidney disease (HR = 2.61, CI: 1.11-6.14, p = 0.028) showed to be independent predictors of non-cardiovascular mortality. CONCLUSION Long-term prognosis of takotsubo patients is not favorable, mainly due to noncardiac comorbidities. Hence, consequent outpatient care in regular intervals after a takotsubo event based on risk factor control and early detection of malignancies seems justified.
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Affiliation(s)
- Edita Pogran
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria. .,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Ahmed Abd El-Razek
- Medical School, Sigmund Freud Private University, Freudplatz 1, 1020, Vienna, Austria
| | - Laura Gargiulo
- Medical School, Sigmund Freud Private University, Freudplatz 1, 1020, Vienna, Austria
| | - Valerie Weihs
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria
| | - Christoph Kaufmann
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria.,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Samuel Horváth
- King Abdullah University of Science and Technology, 23955, Thuwal, Saudi Arabia
| | - Alexander Geppert
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria.,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Nürnberg
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria.,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Emil Wessely
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria.,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Smetana
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria.,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department for Cardiology and Intensive Care Medicine, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria.,Ludwig Boltzmann Institute for Interventional Cardiology and Rhythmology, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Medical School, Sigmund Freud Private University, Freudplatz 1, 1020, Vienna, Austria
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Syed M, Khan MZ, Osman M, Alharbi A, Khan MU, Munir MB, Balla S. Comparison of Outcomes in Patients With Takotsubo Syndrome With-vs-Without Cardiogenic Shock. Am J Cardiol 2020; 136:24-31. [PMID: 32941812 DOI: 10.1016/j.amjcard.2020.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 02/08/2023]
Abstract
There is limited data on the in-hospital outcomes of cardiogenic shock (CS) secondary to takotsubo syndrome (TS). We aimed to assess the incidence, predictors, and outcomes of CS in hospitalized patients with TS. All patients with TS were identified from the National Inpatient Sample database from September 2006 to December 2017. The cohort was divided into those with versus without CS and logistic regression analysis was used to identify predictors of CS and mortality in patients admitted with TS. A total of 260,144 patients with TS were included in our study, of whom 14,703 (6%) were diagnosed with CS. In-hospital mortality in patients with CS was approximately six-fold higher compared with those without CS (23% vs 4%, p <0.01). TS patients with CS had a higher incidence of malignant arrhythmias like ventricular tachycardia or ventricular fibrillation (15.0% vs 4%, p <0.01) and non-shockable cardiac arrests (12% vs 2%, p <0.01). Independent predictors of CS were male gender, Asian and Hispanic ethnicity, increased burden of co-morbidities including congestive heart failure, chronic pulmonary disease, and chronic diabetes. Independent predictors of mortality were male gender, advanced age, history of congestive heart failure, chronic renal failure, and chronic liver disease. In conclusion, CS occurs in approximately 6% of patients admitted with TS, in-hospital mortality in TS patients with CS was approximately six-fold higher compared with those without CS (23% vs 4%, p <0.01), male gender and increased burden of co-morbidities at baseline were independent predictors of CS and mortality.
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Predictors of 90-Day Readmission and in-Hospital Mortality in Takotsubo Cardiomyopathy: An Analysis of 28,079 Index Admissions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:973-979. [DOI: 10.1016/j.carrev.2019.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022]
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Matsuura T, Ueno M, Iwanaga Y, Miyazaki S. Importance of sympathetic nervous system activity during left ventricular functional recovery and its association with in-hospital complications in Takotsubo syndrome. Heart Vessels 2019; 34:1317-1324. [DOI: 10.1007/s00380-019-01359-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/08/2019] [Indexed: 12/13/2022]
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Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2018; 12:451-466. [DOI: 10.1016/j.jcct.2018.10.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 12/21/2022]
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¿Cómo se les rompe el corazón a los hombres? Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2018.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Schneider B, Sechtem U. Do Male Hearts Break Differently? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:695-696. [PMID: 29573972 DOI: 10.1016/j.rec.2018.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/20/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Birke Schneider
- Medizinische Klinik II, Sana Kliniken Lübeck, Kahlhorststrasse 17, D-23562, Lübeck, Germany.
| | - Udo Sechtem
- Abteilung für Kardiologie, Robert-Bosch-Krankenhaus, Auerbachstrasse 110, D-70376, Stuttgart, Germany
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