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Vieitez Florez JM, Hinojar R, Pascual M, Ramos J, Jimenez Nacher JJ, Sanchez D, Carvelli A, Esteban A, Kristo D, Moya JL, Abellas M, Lorente A, Zamorano JL, Fernandez-Golfin C. P727 Unexpected ventricular aneurysm: further ischemic aetiology. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Ventricular aneurysm is an infrequent complication of myocardial infarction. In absence of an ischemic event, alternative aetiologies include: thoracic trauma, hypertrophic cardiomyopathy, myocarditis, Chagas disease, cardiac sarcoidosis or arrythmogenic cardiomyopathy. In the absence of any of the previous, congenital aneurysm diagnosis is made.
Case
We present the case of 57-year-old man referred to cardiology department because a new onset of atrial fibrillation with left bundle branch block. Past medical history included high blood pressure and dyslipidaemia without any history or smoking, alcohol consumption or any other toxic abuse. No chest pain, shortness of breath or other significant symptoms were reported. Physical examination was unremarkable except for an arrhythmic pulse at 85-90 bpm.
Echocardiogram showed moderate dilated left ventricle with mild-moderate LV dysfunction (EF 40% ) with a septal aneurysm of 2.4x1cm (Picture A). A coronary CT was performed that ruled out coronary heart disease and confirmed the presence of the septal aneurysm (Picture B). To better characterize this image, a cardiac magnetic resonance (CMR) was performed. Moderate dilated LV with significant dysfunction (EF 31%) was reported. A septal aneurysm of 13 x 22 x 33 mm composed of a 2.8 m thin wall of true myocardial tissue was documented (picture C and D-late gadolinium enhance). No myocardial delayed enhancement was detected in any area of the LV. Moreover, no signs of myocardial non compaction, arrythmogenic cardiomyopathy, hypertrophic cardiomyopathy or myocarditis were seen. Chagas serology as well as sarcoidosis diagnosis work up were negative. Patient denied any thoracic traumatism. Congenital aneurysm diagnosis was finally established.
Electrical cardioversion was performed after 1 month of correct oral anticoagulation and heart failure treatment was started. Case was presented in the Heart Team session and a conservative management was decided based on asymptomatic status and absence of ventricular arrhythmias. After 3 years of clinical follow up, the patients is in good status, asymptomatic and in sinus rhythm. Discussion: Congenital ventricular aneurysm is a rare cardiac malformation that arises during the fourth embryonic week. Most frequently, left ventricular aneurysms are found in the apex and the perivalvular area, being the septal location an atypical one. Most patients are asymptomatic but when symptoms occur, they are mostly related to the presence of ventricular arrhythmias. Aneurysm rupture incidence is variable, ranging from 3.7% to 12 % according to the different series. For this reason, surgery is recommended in symptomatic patients. However, management of asymptomatic patients is not clear since prognosis studies are lacking.
Abstract P727 Figure. A.Echo B.-CT C.-CMR. D.-CMR gadolinium
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Affiliation(s)
| | - R Hinojar
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - M Pascual
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - J Ramos
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | | | - D Sanchez
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - A Carvelli
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - A Esteban
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - D Kristo
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - J L Moya
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - M Abellas
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - A Lorente
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - J L Zamorano
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
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Pardo Sanz A, Santoro C, Hinojar R, Rajjoub E, Pascual M, Salido L, Gonzalez A, Garcia A, Jimenez JJ, Casas E, Abellas M, Hernandez S, Hernandez R, Zamorano JL, Fernandez-Golfin C. P3370Prevalence of right ventricular dysfunction according to different parameters: basal and one year after transcatheter aortic valve implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricle (RV) is not often specifically studied in patients with severe aortic stenosis (AS). It's difficult to find the correct tool to assess RV function with echocardiographic parameters, and the percentage of patients with dysfunction may vary depending on the parameter that we use.
The aim of the study was to evaluate the prevalence of RV dysfunction basal and one year after transcatheter aortic valve implantation (TAVI), according to different parameters.
Methods
Consecutive patients with severe AS undergoing TAVI from January 2016 to July 2017 were included. RV anatomical and functional parameters were analyzed according to ESC and ASE guidelines. RV dysfunction was assessed using tricuspid annular plane systolic excursion (TAPSE) <17 mm, fractional area change <35%, systolic movement of the RV lateral wall by tissue Doppler imaging (RV-S'TDI) <9.5 cm/s, global longitudinal (RV-GLS) and free wall strain (RV-FWS) using as cutting point [20]. Pre procedure echo, immediate post procedure and 1 year echo were analyzed. Statistical analysis was performed using SSPS version 22.
Results
The final study population consisted of 78 patients (115 patients were included, 37 were excluded due to suboptimal acoustic window for RV anatomical and functional evaluation), mean age 83.73±6.31 year-old, 38.2% females. We analyzed the percentages of RV dysfunction according to the different parameters evaluated before and in the control one year after. They are shown in Figure 1.
Prevalence of RV dysfunction
Conclusions
The presence of RV dysfunction in patients with severe AS is higher than expected Our data suggest that RV function improve one year after TAVI, in terms of a reduction in the number of patients with dysfunction. The assessment of RV function is difficult, and there is no agreement on what tools are more accurate and useful. RV strain seems to be the most sensible parameter to assess RV function in patients with AS undergoing TAVI. Impact of these measurements in patients management needs further evaluation.
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Affiliation(s)
- A Pardo Sanz
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - C Santoro
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - R Hinojar
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - E Rajjoub
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - M Pascual
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - L Salido
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - A Gonzalez
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - A Garcia
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - J J Jimenez
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - E Casas
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - M Abellas
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - S Hernandez
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - R Hernandez
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - J L Zamorano
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - C Fernandez-Golfin
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
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Santoro C, Pardo A, Hinojar R, Garcia A, Salido L, Gonzalez-Gomez A, Jimenez-Nacher JJ, Marco Del Castillo A, Abellas M, Hernandez-Antolin R, Zamorano JL, Fernandez-Golfin C. 2139Left atrial dysfunction assessed by strain correlates with symptoms and severity of aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) results in high pressure afterload causing detrimental effect especially on the left chambers. Structural and functional changes of the left ventricle (LV) usually corresponds to concomitant remodelling of the left atrium (LA). However, how this pressure afterload specifically affects LA function and whether the study of LA function could help in stratifying patients with different degree of AS it is not known.
Purpose
We aim to evaluate the differences in LA and LV function according different degree of AS by standard and speckle tracking echocardiographic.
Methods
From January 2016 to May 2018 we recruited 135 patients referring to our echo-lab with diagnosis of AS (mean age 79.5±4.4; 60/55% female). We divided this population according to AS severity in patients with moderate AS, severe asymptomatic and severe symptomatic AS and matched with 35 control group with no aortic stenosis (n=45, mean age: 77.6±4.5). All patients underwent standard and 2-dimensional speckle tracking echocardiography computing global longitudinal strain (GLS) of LV and peak atrial strain of LA (PALS).
Results
In all patients PALS was a good predictor of E/e' ratio after correction for LV EF and age (p<0.001, β: −0.48). LVEF and GLS progressively decreased together with worsening of AS degree, as well as parameters of geometry and function of LA (Table1). By excluding patients with LV dysfunction the reduction gradient of parameters of LA geometry and function was still present. However, when severe symptomatic with asymptomatic severe AS are compared, no difference in E/e' ratio was found while both GLS and PALS were significantly reduced (both p<0.0001).
Variables Overall population (180) Control (45) Moderate AS (45) Severe asympt AS (45) Severe sympt. AS (45) p LVEF 65.0±11.1 67.7±5.6 69.4±8.5 66.1±10.7 59.5±13.5 0.0001 GLS −20.4±4.1 −23.1±2.4 −21.5±2.9 −21.4±3.2 −17.1±4.3 0.0001 LA vol index 41.6±21.5 28.2±10.4 40.1±19.7 39.8±16.7 52.3±24.9 0.0001 LA strain 23.6±10.9 30.8±10.3 27.8±9.2 24.4±9.7 15.2±7.1 0.0001 LA reservoir 46.4±15.9 51.9±11.5 53.0±15.0 48.3±14.1 37.2±16.1 0.0001 Ee' ratio 14.8±7.0 9.6±2.7 13.7±6.3 15.4±6.2 19.3±7.2 0.0001
Conclusions
LA function seems to progressively decrease according to the degree of AS, independently from LV function. Significant difference was found between parameters of LA remodelling and dysfunction between symptomatic and asymptomatic AS patients. The assessment of LA function by strain may help stratify the patients with AS, identifying those who need intensive medical/surgical treatment.
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Affiliation(s)
- C Santoro
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - A Pardo
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - R Hinojar
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - A Garcia
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - L Salido
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - A Gonzalez-Gomez
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - J J Jimenez-Nacher
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - A Marco Del Castillo
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - M Abellas
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - R Hernandez-Antolin
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - J L Zamorano
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - C Fernandez-Golfin
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
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Pardo Sanz A, Santoro C, Hinojar R, Garcia A, Salido Tahoces L, Abellas M, Marco A, Gonzalez A, Jimenez Nacher JJ, Del Val D, Del Prado S, Valverde M, Hernandez-Antolin R, Zamorano JL, Fernandez-Golfin C. 4921Differences in right ventricular function in patients with severe aortic stenosis with normal flow/low flow undergoing TAVI. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.4921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Pardo Sanz
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - C Santoro
- Federico II, University Hospital, Napol, Italy
| | - R Hinojar
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - A Garcia
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - L Salido Tahoces
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - M Abellas
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - A Marco
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - A Gonzalez
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - J J Jimenez Nacher
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - D Del Val
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - S Del Prado
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - M Valverde
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - R Hernandez-Antolin
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - J L Zamorano
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - C Fernandez-Golfin
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
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5
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Rodriguez Olivares R, Lorente Ros A, Vieitez JM, Abellas M, Lopez-Menendez J, Salido-Tahoces L, Hernandez-Antolin RA, Rodriguez-Roda J, Zamorano-Gomez JL. P3611Identification of candidates for coronary artery bypass grafting admitted with STEMI and Multivessel Disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - A Lorente Ros
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - J M Vieitez
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - M Abellas
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | - J Lopez-Menendez
- University Hospital Ramon y Cajal de Madrid, Cardiac Surgery, Madrid, Spain
| | - L Salido-Tahoces
- University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain
| | | | - J Rodriguez-Roda
- University Hospital Ramon y Cajal de Madrid, Cardiac Surgery, Madrid, Spain
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Fernandez-Golfin C, Hinojar-Baydes R, Esteban Peris A, Gonzalez-Gomez A, Fernandez MA, Alonso Salinas G, Monteagudo JM, Pardo A, Abellas M, Garcia-Martin A, Jimenez-Nacher JJ, Zamorano JL. P4678Cardiac magnetic resonance left ventricular myocardial mechanics in patients with significant aortic resgurgitation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | - M A Fernandez
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | | | - J M Monteagudo
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | - A Pardo
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | - M Abellas
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | | | | | - J L Zamorano
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
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Gonzalez Gomez A, Abellas M, Monteagudo Ruiz JM, Hinojar Baydes R, Garcia Martin A, Marco A, Casas Rojo E, Jimenez Nacher JJ, Moya JL, Ruiz Leria S, Barrios V, Zamorano JL, Fernandez-Golfin C. P3416Low gradient severe aortic stenosis with preserved ejection fraction: reclassification of severity by 3D transesophageal echocardiography. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Gonzalez Gomez
- University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain
| | - M Abellas
- University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain
| | | | - R Hinojar Baydes
- University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain
| | - A Garcia Martin
- University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain
| | - A Marco
- University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain
| | - E Casas Rojo
- University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain
| | - J J Jimenez Nacher
- University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain
| | - J L Moya
- University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain
| | - S Ruiz Leria
- University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain
| | - V Barrios
- University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain
| | - J L Zamorano
- University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain
| | - C Fernandez-Golfin
- University Hospital Ramon y Cajal, Department of Cardiology, Madrid, Spain
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Pardo Sanz A, Abellas M, Garcia A, Rincon LM, Moya JL, Casas E, Gonzalez A, Hinojar R, Jimenez-Nacher JJ, Monteagudo JM, Rodriguez D, Franco E, Moreno J, Zamorano JL, Fernandez-Golfin C. P6468Echocardiographic predictors for early recurrence of atrial fibrillation undergoing catheter ablation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Pardo Sanz
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - M Abellas
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - A Garcia
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - L M Rincon
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - J L Moya
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - E Casas
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - A Gonzalez
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - R Hinojar
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - J J Jimenez-Nacher
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - J M Monteagudo
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - D Rodriguez
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - E Franco
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - J Moreno
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - J L Zamorano
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
| | - C Fernandez-Golfin
- University Hospital Ramon y Cajal de Madrid, Ramόn y Cajal Hospital, Madrid, Spain
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