Zusammenfassung
Vorhofflimmern (VHF) ist die häufigste Arrhythmie im klinischen Alltag und ist mit elektrischem und strukturellem atrialen Remodeling assoziiert. Obwohl die Katheterablation eine der wichtigsten nichtmedikamentösen Therapiestrategien bei VHF-Patienten ist, treten VHF-Rezidive relativ häufig auch nach mehreren Prozeduren auf. Leider sind klinische Komplikationen und Rhythmuserfolg nach der interventionellen Therapie nur eingeschränkt vorhersagbar, und neue therapeutische Konzepte – basierend auf individuellen Risikofaktoren – existieren (noch) nicht. Bisherige Versuche zur Verbesserung der diagnostischen Methoden führten jedoch zur Identifizierung diverser Biomarker, die eine wichtige Rolle in der Vorhersage von VHF-Entstehung, Progression und Rezidiven sowie assoziierten kardio- und zerebrovaskulären Ereignissen spielen. Der Begriff Biomarker bezieht sich im weitesten Sinne auf diverse biologische Marker, z. B. Proteine in Blut und Urin, aber auch auf Bildgebung usw. Anhand dieser Biomarker – z. B. im Blut (von-Willebrand-Faktor, D‑Dimer, natriuretische Peptide), Urin (Proteinurie, GFR), Bildgebung (Echokardiographie, CT oder MRT) – kann ein klinischer Score berechnet werden, um Hochrisikopatienten zu identifizieren und klinisch relevante Ereignisse vorherzusagen. Die wichtigste Zielsetzung dieser Übersichtsarbeit ist es, die Rolle von unterschiedlichen Biomarkern und deren Prädiktionskraft für wichtige VHF-assoziierte Ereignisse zu diskutieren.
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in clinical praxis and is associated with an increased risk for cardio- and cerebrovascular complications leading to an increased mortality. Catheter ablation represents one of the most important and efficient therapy strategies in AF patients. Nevertheless, the high incidence of arrhythmia recurrences after catheter ablation leads to repeated procedures and higher treatment costs. Recently, several scores had been developed to predict rhythm outcomes after catheter ablation. Biomarker research is also of enormous interest. There are many clinical and blood biomarkers pathophysiologically associated with AF occurrence, progression and recurrences. These biomarkers—including different markers in blood (e. g. von Willebrand factor, D‑dimer, natriuretic peptides) or urine (proteins, epidermal grown factor receptor) but also cardiac imaging (echocardiography, computed tomography, magnetic resonance imaging)—could help to improve clinical scores and be useful for individualized AF management and optimized patients’ selection for different AF treatment strategies. In this review, the role of diverse biomarkers and their predictive value related to AF-associated complications are discussed.
Literatur
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener H, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, de Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GYH, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 18:1609–1678
Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo MA, Maseri A (1997) Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation 96:1180–1184
Stefansdottir H, Arnar DO, Aspelund T, Sigurdsson S, Jonsdottir MK, Hjaltason H, Launer LJ, Gudnason V (2013) Atrial fibrillation is associated with reduced brain volume and cognitive function independent of cerebral infarcts. Stroke 44:1020–1025
Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 137:263–272
Coppens M, Eikelboom JW, Hart RG, Yusuf S, Lip GYH, Dorian P, Shestakovska O, Connolly SJ (2013) The CHA2DS2-VASc score identifies those patients with atrial fibrillation and a CHADS2 score of 1 who are unlikely to benefit from oral anticoagulant therapy. Eur Heart J 34:170–176
Kumarathurai P, Mouridsen MR, Mattsson N, Larsen BS, Nielsen OW, Gerds TA, Sajadieh A (2016) Atrial ectopy and N‑terminal pro-B-type natriuretic peptide as predictors of atrial fibrillation: a population-based cohort study. Europace 19(3):364–370. https://doi.org/10.1093/europace/euw017
Canpolat U, Aytemir K, Yorgun H, Sahiner L, Kaya EB, Oto A (2013) A proposal for a new scoring system in the prediction of catheter ablation outcomes: promising results from the Turkish Cryoablation Registry. Int J Cardiol 169:201–206
Kornej J, Hindricks G, Shoemaker MB, Husser D, Arya A, Sommer P, Rolf S, Saavedra P, Kanagasundram A, Whalen PS, Montgomery J, Ellis CR, Darbar D, Bollmann A (2015) The APPLE score: a novel and simple score for the prediction of rhythm outcomes after catheter ablation of atrial fibrillation. Clin Res Cardiol 104:871–876
Mujovic N, Marinkovic M, Markovic N, Shantsila A, Lip GYH, Potpara TS (2017) Prediction of very late arrhythmia recurrence after radiofrequency catheter ablation of atrial fibrillation: the MB-LATER clinical score. Sci Rep 7:40828
Wojcik M, Berkowitsch A, Greiss H, Zaltsberg S, Pajitnev D, Deubner N, Hamm CW, Pitschner HF, Kuniss M, Neumann T (2013) Repeated catheter ablation of atrial fibrillation: how to predict outcome? Circ J 77:2271–2279
Manabe I, Shindo T, Nagai R (2002) Gene expression in fibroblasts and fibrosis: involvement in cardiac hypertrophy. Circ Res 91:1103–1113
Kim SK, Park JH, Kim JY, Choi JI, Joung B, Lee M, Kim SS, Kim Y, Pak H (2011) High plasma concentrations of transforming growth factor-beta and tissue inhibitor of metalloproteinase-1: potential non-invasive predictors for electroanatomical remodeling of atrium in patients with non-valvular atrial fibrillation. Circ J 75:557–564
Issac TT, Dokainish H, Lakkis NM (2007) Role of inflammation in initiation and perpetuation of atrial fibrillation: a systematic review of the published data. J Am Coll Cardiol 50:2021–2028
Engelmann MDM, Svendsen JH (2005) Inflammation in the genesis and perpetuation of atrial fibrillation. Eur Heart J 26:2083–2092
Hu B, Sun Y, Li S, Sun J, Liu T, Wu Z, Feng LI (2016) Association of β1-adrenergic, M2-muscarinic receptor autoantibody with occurrence and development of nonvalvular atrial fibrillation. Pacing Clin Electrophysiol 39:1379–1387
Yalcin MU, Gurses KM, Kocyigit D, Kesikli SA, Dural M, Evranos B, Yorgun H, Sahiner L, Kaya EB, Oto MA, Guc D, Aytemir K, Ozer N (2015) Cardiac sutoantibody levels predict recurrence following cryoballoon-based pulmonary vein isolation in paroxysmal atrial fibrillation patients. J Cardiovasc Electrophysiol 26:615–621
Gurses KM, Yalcin MU, Kocyigit D, Kesikli SA, Canpolat U, Yorgun H, Sahiner ML, Kaya EB, Hazirolan T, Ozer N, Oto MA, Guc D, Aytemir K (2015) M2-muscarinic acetylcholine receptor autoantibody levels predict left atrial fibrosis severity in paroxysmal lone atrial fibrillation patients undergoing cryoablation. Europace 17:239–246
Kornej J, Reinhardt C, Kosiuk J, Arya A, Hindricks G, Adams V, Husser D, Bollmann A (2013) Response of circulating heat shock protein 70 and anti-heat shock protein 70 antibodies to catheter ablation of atrial fibrillation. J Transl Med 11:49
Dobrev D, Nattel S (2008) Calcium handling abnormalities in atrial fibrillation as a target for innovative therapeutics. J Cardiovasc Pharmacol 52:293–299
Abed HS, Samuel CS, Lau DH, Kelly DJ, Royce SG, Alasady M, Mahajan R, Kuklik P, Zhang Y, Brooks AG, Nelson AJ, Worthley SG, Abhayaratna WP, Kalman JM, Wittert GA, Sanders P (2013) Obesity results in progressive atrial structural and electrical remodeling: implications for atrial fibrillation. Heart Rhythm 10:90–100
Tao S, Huang Y, Cai A, Huang C, Zhang Y, Tang S, Yu X, Zhou D, Tan N, Feng Y (2016) Association of serum omentin-1 concentrations with the presence of atrial fibrillation. Med Sci Monit 22:4749–4754
St Rammos K, Koullias GJ, Hassan MO, Argyrakis NP, Voucharas CG, Scarupa SJ, Cowte TG (2002) Low preoperative HSP70 atrial myocardial levels correlate significantly with high incidence of postoperative atrial fibrillation after cardiac surgery. Cardiovasc Surg 10:228–232
Gonzalez-Ramos M, Calleros L, Lopez-Ongil S, Raoch V, Griera M, Rodriguez-Puyol M, de Frutos S, Rodriguez-Puyol D (2013) HSP70 increases extracellular matrix production by human vascular smooth muscle through TGF-beta1 up-regulation. Int J Biochem Cell Biol 45:232–242
Akutsu Y, Kaneko K, Kodama Y, Miyoshi F, Li H, Watanabe N, Asano T, Tanno K, Suyama J, Namiki A, Gokan T, Kobayashi Y (2013) A combination of P wave electrocardiography and plasma brain natriuretic peptide level for predicting the progression to persistent atrial fibrillation: comparisons of sympathetic activity and left atrial size. J Interv Card Electrophysiol 38:79–84
Xi L, Cao H, Zhu J, Røe OD, Li M, Wu Y, Wang D, Chen Y (2013) OPG/RANK/RANKL axis in stabilization of spontaneously restored sinus rhythm in permanent atrial fibrillation patients after mitral valve surgery. Cardiology 124:18–24
Cao H, Zhou Q, Wu Y, Li Q, Røe OD, Chen Y, Wu Z, Wang D (2013) Preoperative serum soluble receptor activator of nuclear factor-κB ligand and osteoprotegerin predict postoperative atrial fibrillation in patients undergoing cardiac valve surgery. Ann Thorac Surg 96:800–806
Ionescu-Ittu R, Abrahamowicz M, Jackevicius CA, Essebag V, Eisenberg MJ, Wynant W, Richard H, Pilote L (2012) Comparative effectiveness of rhythm control vs rate control drug treatment effect on mortality in patients with atrial fibrillation. Arch Intern Med 172:997–1004
Schotten U, Verheule S, Kirchhof P, Goette A (2011) Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev 91:265–325
Matsuo S, Lellouche N, Wright M, Bevilacqua M, Knecht S, Nault I, Lim K, Arantes L, O’Neill MD, Platonov PG, Carlson J, Sacher F, Hocini M, Jais P, Haissaguerre M (2009) Clinical predictors of termination and clinical outcome of catheter ablation for persistent atrial fibrillation. J Am Coll Cardiol 54:788–795
Bisbal F, Guiu E, Calvo N, Marin D, Berruezo A, Arbelo E, Ortiz-Perez J, de Caralt TM, Tolosana JM, Borras R, Sitges M, Brugada J, Mont L (2013) Left atrial sphericity: a new method to assess atrial remodeling. Impact on the outcome of atrial fibrillation ablation. J Cardiovasc Electrophysiol 24:752–759
Kang JH, Lee DI, Kim S, Kim MN, Park YM, Ban JE, Choi JI, Lim HE, Park SW, Kim Y (2012) Prediction of long-term outcomes of catheter ablation of persistent atrial fibrillation by parameters of preablation DC cardioversion. J Cardiovasc Electrophysiol 23:1165–1170
Helms AS, West JJ, Patel A, Lipinski MJ, Mangrum JM, Mounsey JP, Dimarco JP, Ferguson JD (2009) Relation of left atrial volume from three-dimensional computed tomography to atrial fibrillation recurrence following ablation. Am J Cardiol 103:989–993
Psychari SN, Chatzopoulos D, Iliodromitis EK, Apostolou TS, Kremastinos DT (2011) C‑reactive protein, interleukin 6, and N‑terminal pro-brain natriuretic peptide following cardioversion of atrial fibrillation: is there a role of biomarkers in arrhythmia recurrence? Angiology 62:310–316
Lellouche N, Sacher F, Wright M, Nault I, Brottier J, Knecht S, Matsuo S, Lomas O, Hocini M, Haissaguerre M, Jais P (2009) Usefulness of C‑reactive protein in predicting early and late recurrences after atrial fibrillation ablation. Europace 11:662–664
Richter B, Gwechenberger M, Socas A, Zorn G, Albinni S, Marx M, Bergler-Klein J, Binder T, Wojta J, Gossinger HD (2012) Markers of oxidative stress after ablation of atrial fibrillation are associated with inflammation, delivered radiofrequency energy and early recurrence of atrial fibrillation. Clin Res Cardiol 101:217–225
Grubman E, Pavri BB, Lyle S, Reynolds C, Denofrio D, Kocovic DZ (1999) Histopathologic effects of radiofrequency catheter ablation in previously infarcted human myocardium. J Cardiovasc Electrophysiol 10:336–342
McCabe JM, Smith LM, Tseng ZH, Badhwar N, Lee BK, Lee RJ, Scheinman MM, Olgin JE, Marcus GM (2008) Protracted CRP elevation after atrial fibrillation ablation. Pacing Clin Electrophysiol 31:1146–1151
Kornej J, Reinhardt C, Kosiuk J, Arya A, Hindricks G, Adams V, Husser D, Bollmann A (2012) Response of high-sensitive C‑reactive protein to catheter ablation of atrial fibrillation and its relation with rhythm outcome. plos One 7:e44165
Hu Y, Yeh H, Tsao H, Tai C, Lin Y, Chang S, Lo L, Tuan T, Suenari K, Li C, Chao T, Chen S (2012) Electrophysiological correlation and prognostic impact of heat shock protein 27 in atrial fibrillation. Circulation 5:334–340
Latini R, Masson S, Pirelli S, Barlera S, Pulitano G, Carbonieri E, Gulizia M, Vago T, Favero C, Zdunek D, Struck J, Staszewsky L, Maggioni AP, Franzosi MG, Disertori M (2011) Circulating cardiovascular biomarkers in recurrent atrial fibrillation: data from the GISSI-atrial fibrillation trial. J Intern Med 269:160–171
Herrera Siklody C, Arentz T, Minners J, Jesel L, Stratz C, Valina CM, Weber R, Kalusche D, Toti F, Morel O, Trenk D (2012) Cellular damage, platelet activation, and inflammatory response after pulmonary vein isolation: a randomized study comparing radiofrequency ablation with cryoablation. Heart Rhythm 9:189–196
Yalta K, Yilmaz MB, Turgut OO, Tandogan I (2010) Natriuretic peptides: useful biomarkers in predicting the possibility of restoration and maintenance of sinus rhythm in patients with atrial fibrillation undergoing cardioversion? Int J Cardiol 145:233 (author reply 234–5.)
Bartkowiak R, Wozakowska-Kaplon B, Janiszewska G (2010) Plasma NT-proANP in patients with persistent atrial fibrillation who underwent successful cardioversion. Kardiol Pol 68:48–54
Mollmann H, Weber M, Elsasser A, Nef H, Dill T, Rixe J, Schmitt J, Sperzel J, Hamm CW (2008) NT-ProBNP predicts rhythm stability after cardioversion of lone atrial fibrillation. Circ J 72:921–925
Tveit A, Seljeflot I, Grundvold I, Abdelnoor M, Arnesen H, Smith P (2009) Candesartan, NT-proBNP and recurrence of atrial fibrillation after electrical cardioversion. Int J Cardiol 131:234–239
Hussein AA, Saliba WI, Martin DO, Shadman M, Kanj M, Bhargava M, Dresing T, Chung M, Callahan T, Baranowski B, Tchou P, Lindsay BD, Natale A, Wazni OM (2011) Plasma B‑type natriuretic peptide levels and recurrent arrhythmia after successful ablation of lone atrial fibrillation. Circulation 123:2077–2082
den Uijl DW, Delgado V, Tops LF, Ng ACT, Boersma E, Trines SA, Zeppenfeld K, Schalij MJ, van der Laarse A, Bax JJ (2011) Natriuretic peptide levels predict recurrence of atrial fibrillation after radiofrequency catheter ablation. Am Heart J 161:197–203
Hwang HJ, Son JW, Nam B, Joung B, Lee B, Kim J, Lee M, Jang Y, Chung N, Shim W, Cho S, Kim SS (2009) Incremental predictive value of pre-procedural N‑terminal pro-B-type natriuretic peptide for short-term recurrence in atrial fibrillation ablation. Clin Res Cardiol 98:213–218
Shin SY, Na JO, Lim HE, Choi CU, Choi JI, Kim SH, Kim EJ, Park SW, Rha S, Park CG, Seo HS, Oh DJ, Kim Y (2011) Improved endothelial function in patients with atrial fibrillation through maintenance of sinus rhythm by successful catheter ablation. J Cardiovasc Electrophysiol 22:376–382
Marin F, Roldan V, Climent VE, Ibanez A, Garcia A, Marco P, Sogorb F, Lip GYH (2004) Plasma von Willebrand factor, soluble thrombomodulin, and fibrin D‑dimer concentrations in acute onset non-rheumatic atrial fibrillation. Heart 90:1162–1166
Nakazawa Y, Ashihara T, Tsutamoto T, Ito M, Horie M (2009) Endothelin-1 as a predictor of atrial fibrillation recurrence after pulmonary vein isolation. Heart Rhythm 6:725–730
Davlouros PA, Simeonidou E, Tsakas S, Vlachojannis I, Alexopoulos D, Manolis AS (2005) Release of endothelin-1 from human endocardium after radiofrequency catheter ablation and coronary angioplasty: comparative results. Int J Cardiol 102:187–193
Kornej J, Dinov B, Blann AD, Rolf S, Arya A, Schmidl J, Husser D, Hindricks G, Bollmann A, Lip GYH (2014) Effects of radiofrequency catheter ablation of atrial fibrillation on soluble P‑selectin, von Willebrand factor and IL-6 in the peripheral and cardiac circulation. PLoS ONE 9:e111760
Bulava A, Slavik L, Fiala M, Heinc P, Skvarilova M, Lukl J, Krcova V, Indrak K (2004) Endothelial damage and activation of the hemostatic system during radiofrequency catheter isolation of pulmonary veins. J Interv Card Electrophysiol 10:271–279
Kallergis EM, Goudis CA, Kanoupakis EM, Mavrakis HE, Maliaraki NE, Tzanakis N, Vardas PE (2014) Sinus rhythm restoration affects collagen turnover in patients with persistent atrial fibrillation. Europace 16:1726–1730
Xia W, Qu X, Yu Y, Zhang X, Feng W, Song Y (2008) Asymmetric dimethylarginine concentration and early recurrence of atrial fibrillation after electrical cardioversion. Pacing Clin Electrophysiol 31:1036–1040
Kato K, Fujimaki T, Yoshida T, Oguri M, Yajima K, Hibino T, Murohara T (2009) Impact of matrix metalloproteinase-2 levels on long-term outcome following pharmacological or electrical cardioversion in patients with atrial fibrillation. Europace 11:332–337
Takemoto Y, Ramirez RJ, Yokokawa M, Kaur K, Ponce-Balbuena D, Sinno MC, Willis BC, Ghanbari H, Ennis SR, Guerrero-Serna G, Henzi BC, Latchamsetty R, Ramos-Mondragon R, Musa H, Martins RP, Pandit SV, Noujaim SF, Crawford T, Jongnarangsin K, Pelosi F, Bogun F, Chugh A, Berenfeld O, Morady F, Oral H, Jalife J (2016) Galectin-3 regulates atrial fibrillation remodeling and predicts catheter ablation outcomes. JACC Basic Transl Sci 1:143–154
Wang W, Liu L, Li Y, Hu S, Song Y, Wang X (2012) Does the expression of transforming growth factor beta-1: affect the outcome of the radiofrequency modified maze procedure in patients with rheumatic atrial fibrillation? Tex Heart Inst J 39:17–23
Kim SK, Pak H, Park JH, Ko KJ, Lee JS, Choi JI, Choi DH, Kim Y (2009) Clinical and serological predictors for the recurrence of atrial fibrillation after electrical cardioversion. Europace 11:1632–1638
Wu C, Hu Y, Chou C, Lin Y, Chang S, Lo L, Tuan T, Li C, Chao T, Chung F, Liao J, Chen S (2013) Transforming growth factor-beta1 level and outcome after catheter ablation for nonparoxysmal atrial fibrillation. Heart Rhythm 10:10–15
Okumura Y, Watanabe I, Nakai T, Ohkubo K, Kofune T, Kofune M, Nagashima K, Mano H, Sonoda K, Kasamaki Y, Hirayama A (2011) Impact of biomarkers of inflammation and extracellular matrix turnover on the outcome of atrial fibrillation ablation: importance of matrix metalloproteinase-2 as a predictor of atrial fibrillation recurrence. J Cardiovasc Electrophysiol 22:987–993
Kornej J, Ueberham L, Schmidl J, Husser D, Adams V, Hindricks G, Bollmann A (2016) Addition of TGF-beta1 to existing clinical risk scores does not improve prediction for arrhythmia recurrences after catheter ablation of atrial fibrillation. Int J Cardiol 221:52–54
Hijazi Z, Wallentin L, Siegbahn A, Andersson U, Christersson C, Ezekowitz J, Gersh BJ, Hanna M, Hohnloser S, Horowitz J, Huber K, Hylek EM, Lopes RD, McMurray JJV, Granger CB (2013) N‑terminal pro-B-type natriuretic peptide for risk assessment in patients with atrial fibrillation: insights from the ARISTOTLE Trial (Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation). J Am Coll Cardiol 61:2274–2284
Inoue S, Murakami Y, Sano K, Katoh H, Shimada T (2000) Atrium as a source of brain natriuretic polypeptide in patients with atrial fibrillation. J Card Fail 6:92–96
Hijazi Z, Lindback J, Alexander JH, Hanna M, Held C, Hylek EM, Lopes RD, Oldgren J, Siegbahn A, Stewart RAH, White HD, Granger CB, Wallentin L (2016) The ABC (age, biomarkers, clinical history) stroke risk score: a biomarker-based risk score for predicting stroke in atrial fibrillation. Eur Heart J 37:1582–1590
Sato M, Suzuki A, Nagata K, Uchiyama S (2006) Increased von Willebrand factor in acute stroke patients with atrial fibrillation. J Stroke Cerebrovasc Dis 15:1–7
Heppell RM, Berkin KE, McLenachan JM, Davies JA (1997) Haemostatic and haemodynamic abnormalities associated with left atrial thrombosis in non-rheumatic atrial fibrillation. Heart 77:407–411
Pigott R, Dillon LP, Hemingway IH, Gearing AJ (1992) Soluble forms of E‑selectin, ICAM-1 and VCAM-1 are present in the supernatants of cytokine activated cultured endothelial cells. Biochem Biophys Res Commun 187:584–589
Duygu H, Barisik V, Kurt H, Turk U, Ercan E, Kose S (2008) Prognostic value of plasma soluble CD40 ligand in patients with chronic non-valvular atrial fibrillation. Europace 10:210–214
Choudhury A, Chung I, Panja N, Patel J, Lip GYH (2008) Soluble CD40 ligand, platelet surface CD40 ligand, and total platelet CD40 ligand in atrial fibrillation: relationship to soluble P‑selectin, stroke risk factors, and risk factor intervention. Chest 134:574–581
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Kornej, J., Schumacher, K., Husser, D. et al. Biomarker und Vorhofflimmern. Herzschr Elektrophys 29, 219–227 (2018). https://doi.org/10.1007/s00399-018-0558-y
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DOI: https://doi.org/10.1007/s00399-018-0558-y