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Özbek Ö, Can MM. Comparison of the Effects of Recent Coronavirus 2019 Infection and Vaccination on the Prognosis of Acute Coronary Syndrome: A Retrospective Study Conducted in a Single Center in Türkiye. Anatol J Cardiol 2024; 28:294-304. [PMID: 38770698 PMCID: PMC11168708 DOI: 10.14744/anatoljcardiol.2024.4372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/29/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND We aimed to examine the effects of COVID-19 infection versus vaccination within the month prior to acute coronary syndrome (ACS) diagnosis with respect to their impact on the development of mortality or major adverse cardiovascular events (MACE). METHODS This retrospective cohort study included patients hospitalized with a diagnosis of ACS between June 2020 and December 2022. Patients diagnosed with ACS were grouped according to the presence of COVID-19 infection (post-COVID), vaccination (post-vaccine), or non-exposure during the month prior to ACS diagnosis. Patients with and without MACE were also compared separately. RESULTS We analyzed 1890 ACS patients (mean age 57.43 ± 11.53 years, 79.15% males). Of these, 319 (16.88%) were in the post-vaccine group, and 334 (17.67%) were in the post-COVID group. Major adverse cardiovascular events occurred in 569 (30.11%) patients. Mortality was recorded in 271 (14.34%) patients. In the post-COVID group, the frequencies of MACE and mortality and length of stay in hospital were significantly higher (vs. post-vaccine and vs. non-exposure groups; both P <.001). High age, ST-elevation myocardial infarction, having suffered from Post-COVID ACS, and high glucose were independently associated with increased MACE risk; whereas, hyperlipidemia, 3 or more COVID vaccinations, receipt of the Biontech vaccine, and high estimated glomerular filtration rate were independently associated with decreased MACE risk. CONCLUSION Acute coronary syndrome patients who have recently had COVID-19 infection may have a worse prognostic course compared to those with recent vaccination, necessitating continuing care for pandemic-related risk factors as well as previously known factors impacting MACE and prognosis.
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Affiliation(s)
- Özlem Özbek
- Department of Cardiology, Haseki Training and Research Hospital, İstanbul, Türkiye
| | - Mehmet Mustafa Can
- Department of Cardiology, Haseki Training and Research Hospital, İstanbul, Türkiye
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2
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Vitolo M, Bonini N, Imberti JF, Boriani G. Atrial fibrillation in pneumonia: what clinical implications at long-term? Intern Emerg Med 2023; 18:347-350. [PMID: 36550262 PMCID: PMC9780088 DOI: 10.1007/s11739-022-03181-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
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3
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Impact of COVID-19 on Non-Pulmonary Critical Illness: Prevalence, Clinical Manifestations, Management, and Outcomes. Clin Chest Med 2022; 44:249-262. [PMID: 37085218 PMCID: PMC9682059 DOI: 10.1016/j.ccm.2022.11.011] [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] [Indexed: 11/25/2022]
Abstract
Although respiratory manifestations are the most common driver of hospitalization, SARS-CoV-2 infection has a wide range of manifestations, including multisystem organ failure in severe cases. This review discusses the prevalence, pathophysiology, clinical manifestations, treatment, and outcomes of nonpulmonary organ dysfunction from SARS-CoV2, including renal, liver, cardiac, neurologic, and coagulation system dysfunction. At this time, management largely focuses on supportive care practices that are applicable regardless of the cause of organ injury.
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Huang D, Yang H, Yu H, Wang T, Chen Z, Yao R, Liang Z. A prediction model for major adverse cardiovascular events (MACE) in patients with coronavirus disease 2019 (COVID-19). BMC Pulm Med 2022; 22:343. [PMID: 36096832 PMCID: PMC9466355 DOI: 10.1186/s12890-022-02143-3] [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: 05/31/2021] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Emerging evidence shows that cardiovascular injuries and events in coronavirus disease 2019 (COVID-19) should be considered. The current study was conducted to develop an early prediction model for major adverse cardiovascular events (MACE) during hospitalizations of COVID-19 patients. Methods This was a retrospective, multicenter, observational study. Hospitalized COVID-19 patients from Wuhan city, Hubei Province and Sichuan Province, China, between January 14 and March 9, 2020, were randomly divided into a training set (70% of patients) and a testing set (30%). All baseline data were recorded at admission or within 24 h after admission to hospitals. The primary outcome was MACE during hospitalization, including nonfatal myocardial infarction, nonfatal stroke and cardiovascular death. The risk factors were selected by LASSO regression and multivariate logistic regression analysis. The nomogram was assessed by calibration curve and decision curve analysis (DCA). Results Ultimately, 1206 adult COVID-19 patients were included. In the training set, 48 (5.7%) patients eventually developed MACE. Six factors associated with MACE were included in the nomogram: age, PaO2/FiO2 under 300, unconsciousness, lymphocyte counts, neutrophil counts and blood urea nitrogen. The C indices were 0.93 (95% CI 0.90, 0.97) in the training set and 0.81 (95% CI 0.70, 0.93) in the testing set. The calibration curve and DCA demonstrated the good performance of the nomogram. Conclusions We developed and validated a nomogram to predict the development of MACE in hospitalized COVID-19 patients. More prospective multicenter studies are needed to confirm our results. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02143-3.
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Affiliation(s)
- Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Huan Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - He Yu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Ting Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zhu Chen
- Department of Infectional Inpatient Ward Two, Chengdu Public Health Clinical Medical Center, Chengdu, Sichuan, China
| | - Rong Yao
- Department of Emergency Medicine, Emergency Medical Laboratory, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China. .,Disaster Medical Center, Sichuan University, Chengdu, Sichuan, China.
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
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Affiliation(s)
- Dipali Anand Taggarsi
- Department of Critical Care Medicine, St John's Medical College and Hospital, Bengaluru, Karnataka, India
- Dipali Anand Taggarsi, Department of Critical Care Medicine, St John's Medical College and Hospital, Bengaluru, Karnataka, India, Phone: +91 9902586487, e-mail:
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Cancro FP, Bellino M, Esposito L, Romei S, Centore M, D'Elia D, Cristiano M, Maglio A, Carrizzo A, Rasile B, Alfano C, Vecchione C, Galasso G. Acute Coronary Syndrome in Patients with SARS-CoV-2 Infection: Pathophysiology and Translational Perspectives. Transl Med UniSa 2022; 24:1-11. [PMID: 36447945 PMCID: PMC9673986 DOI: 10.37825/2239-9754.1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 01/12/2023] Open
Abstract
Acute coronary syndromes (ACS) may complicate the clinical course of patients with Coronavirus Disease 2019 (COVID-19). It is still unclear whether this condition is a direct consequence of the primary disease. However, several mechanisms including direct cellular damage, endothelial dysfunction, in-situ thrombosis, systemic inflammatory response, and oxygen supply-demand imbalance have been described in patients with COVID-19. The onset of a prothrombotic state may also be facilitated by the endothelial dysfunction secondary to the systemic inflammatory response and to the direct viral cell damage. Moreover, dysfunctional endothelial cells may enhance vasospasm and platelet aggregation. The combination of these factors promotes atherosclerotic plaque instability, thrombosis and, consequently, type 1 myocardial infarction. Furthermore, severe hypoxia due to extensive pulmonary involvement, in association with other conditions described in COVID-19 such as sepsis, tachyarrhythmias, anemia, hypotension, and shock, may lead to mismatch between oxygen supply and demand, and cause type 2 myocardial infarction. A deeper understanding of the potential pathophysiological mechanisms underlying ACS in patients with COVID-19 could help the therapeutic management of these very high-risk patients.
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Affiliation(s)
- Francesco P. Cancro
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy,Corresponding author at: Department of Medicine, Surgery and Dentistry, University of Salerno, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Largo Città di Ippocrate, 84131 Salerno, Italy. Fax: +39 089 089 672805. E-mail address: (M. Bellino)
| | - Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Stefano Romei
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Mario Centore
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Debora D'Elia
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Mario Cristiano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Isernia,
Italy
| | - Barbara Rasile
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Carmine Alfano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Isernia,
Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno,
Italy
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Dini FL, Franzoni F, Scarfò G, Pugliese NR, Imazio M. Acute pericarditis in patients receiving coronavirus disease 2019 vaccines: a case series from the community. J Cardiovasc Med (Hagerstown) 2022; 23:551-558. [PMID: 35904995 DOI: 10.2459/jcm.0000000000001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND International agencies reported that cases of pericarditis occur very rarely following the administration of coronavirus disease 2019 (COVID-19) vaccines. Herewith, we described a series of patients from the community diagnosed with acute pericarditis after vaccination. METHODS We retrospectively included 28 patients (median age 51 years, 79% female) with or without a positive history of acute respiratory syndrome coronavirus 2 recovered infection who were diagnosed with acute pericarditis following the administration of COVID-19 vaccine. We excluded specific identifiable causes of pericarditis, including infectious, autoimmune, neoplastic and metabolic disease. Patients were referred for a complete cardiovascular evaluation. Transthoracic echocardiography (TTE) was performed and diagnosis of acute pericarditis was achieved according to current guidelines. RESULTS There were 16 patients administered with Pfizer-BioNTech/Comirnaty vaccine, 8 with Moderna/Spikevax vaccine and 4 with Astra Zeneca/Vaxzevria vaccine. Nine patients had been previously diagnosed with COVID-19, while the others had no prior history of COVID-19. Eleven patients had no comorbidity while the others had between one and four comorbidities. Ten patients had a history of rheumatic or autoimmune diseases. Chest pain was present in 24 patients. Minor ECG abnormalities were detected in 10 patients, T-wave inversion in 6, and 7 patients had concave ST elevation. The majority of patients showed mild pericardial effusions at TTE. Only two patients exhibited large pericardial effusions. CONCLUSION This case series shows a higher incidence of acute pericarditis in patients administered with COVID-19 vaccines than previously estimated, probably because of a more comprehensive assessment of clinical as well as echocardiographic parameters.
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Affiliation(s)
- Frank L Dini
- Centro Medico Sant'Agostino, Milano, Italy
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Giorgia Scarfò
- Department of Clinical and Experimental Medicine, University of Pisa
| | | | - Massimo Imazio
- Cardiology, Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Italy
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Ranucci M, Parati G, Di Dedda U, Bussotti M, Agricola E, Menicanti L, Bombace S, De Martino F, Giovinazzo S, Zambon A, Menè R, La Rovere MT. When Outcomes Diverge: Age and Cardiovascular Risk as Determinants of Mortality and ICU Admission in COVID-19. J Clin Med 2022; 11:jcm11144099. [PMID: 35887864 PMCID: PMC9316345 DOI: 10.3390/jcm11144099] [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: 06/17/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Hospital mortality and admission to the Intensive Care Unit (ICU) are markers of disease severity in COVID-19 patients. Cardiovascular co-morbidities are one of the main determinants of negative outcomes. In this study we investigated the impact of cardiovascular co-morbidities on mortality and admission to the ICU in first-wave COVID-19 patients. Methods: A multicenter, retrospective, cohort study. A total of 1077 patients were analyzed for mortality and ICU admission. Cardiovascular risk factors were explored as determinants of the outcomes after correction for other confounders. Results: In the multivariable model, after correction for age, only a history of heart failure remained independently associated (p = 0.0013) with mortality (hazard ratio 2.22, 95% confidence interval 1.37 to 3.62). Age showed a mortality risk increase of 8% per year (hazard ratio 1.08, 95% confidence interval 1.05 to 1.10, p = 0.001). The transition from ward to the ICU had, as a single determinant, the age, but in a reversed fashion (hazard ratio 0.96, 95% confidence interval 0.94 to 0.98, p = 0.0002). Conclusions: Once adjusted for the main determinant of mortality (age) heart failure only remained independently associated with mortality. Admission to the ICU was less likely for elderly patients. This may reflect the catastrophic impact of the first wave of COVID-19 pandemic in terms of ICU bed availability in Lombardy, leading to a selection process for ICU admission.
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Affiliation(s)
- Marco Ranucci
- Department of Cardiovascular Anesthesia and ICU, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
- Correspondence: ; Tel.: +39-02-52774754
| | - Gianfranco Parati
- Department of Cardiovascular Neural and Metabolic Sciences, Department of Medicine and Surgery, IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, 20126 Milan, Italy;
| | - Umberto Di Dedda
- Department of Cardiovascular Anesthesia and ICU, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
| | - Maurizio Bussotti
- Department of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy;
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Vita-Salute University, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
| | - Lorenzo Menicanti
- Scientific Directorate, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
| | - Sara Bombace
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy;
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Fabiana De Martino
- Heart Failure Unit, Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, 20138 Milan, Italy;
| | - Stefano Giovinazzo
- Cardiovascular Disease Unit, Cardiac, Thoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Antonella Zambon
- Biostatistics Unit, IRCCS Istituto Auxologico Italiano, 20126 Milan, Italy;
- Department of Statistics and Quantitative Methods, Università di Milano-Bicocca, 20126 Milan, Italy
| | - Roberto Menè
- Department of Cardiology, IRCCS Istituto Auxologico Italiano, Università di Milano-Bicocca, 20126 Milan, Italy;
| | - Maria Teresa La Rovere
- Department of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri, 28843 Montescano, Italy;
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Fraser M, Agdamag ACC, Maharaj VR, Mutschler M, Charpentier V, Chowdhury M, Alexy T. COVID-19-Associated Myocarditis: An Evolving Concern in Cardiology and Beyond. BIOLOGY 2022; 11:biology11040520. [PMID: 35453718 PMCID: PMC9025425 DOI: 10.3390/biology11040520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 01/08/2023]
Abstract
Simple Summary Coronavirus disease-2019 (COVID-19) affects many organs in the body, including the heart. One complication of particular concern is inflammation of the heart muscle, called myocarditis. This paper presents updated research data on COVID-19-associated myocarditis. Specifically, we review the incidence, potential mechanisms, blood and imaging tests that can be used to detect the disease. We emphasize that, in contrast with early reports, recent data suggest that myocarditis in the setting of COVID-19 is relatively uncommon, yet infected individuals are at a substantially increased risk for poor outcomes. It is important to continue research in this area. Abstract The direct and indirect adverse effects of SARS-CoV-2 infection on the cardiovascular system, including myocarditis, are of paramount importance. These not only affect the disease course but also determine clinical outcomes and recovery. In this review, the authors aimed at providing an update on the incidence of Coronavirus disease-2019 (COVID-19)-associated myocarditis. Our knowledge and experience relevant to this area continues to evolve rapidly since the beginning of the pandemic. It is crucial for the scientific and medical community to stay abreast of current information. Contrasting early reports, recent data suggest that the overall incidence of SARS-CoV-2-associated myocarditis is relatively low, yet infected individuals are at a substantially increased risk. Therefore, understanding the pathophysiology and diagnostic evaluation, including the use of serum biomarkers and imaging modalities, remain important. This review aims to summarize the most recent data in these areas as they relate to COVID-19-associated myocarditis. Given its increasing relevance, a brief update is included on the proposed mechanisms of myocarditis in COVID-19 vaccine recipients.
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Affiliation(s)
- Meg Fraser
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
| | - Arianne Clare C. Agdamag
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
| | - Valmiki R. Maharaj
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
| | - Melinda Mutschler
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
| | | | | | - Tamas Alexy
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
- Correspondence: ; Tel.: +1-612-625-9100
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