Myocardial injury determination improves risk stratification and predicts mortality in COVID-19 patients.
Identifieur interne : 000153 ( Main/Exploration ); précédent : 000152; suivant : 000154Myocardial injury determination improves risk stratification and predicts mortality in COVID-19 patients.
Auteurs : Alvaro Lorente-Ros [Espagne] ; Juan Manuel Monteagudo Ruiz [Espagne] ; Luis M. Rinc N [Espagne] ; Rodrigo Ortega Pérez [Espagne] ; Sonia Rivas [Espagne] ; Rafael Martínez-Moya [Espagne] ; Maria Ascensi N Sanromán [Espagne] ; Luis Manzano [Espagne] ; Gonzalo Luis Alonso [Espagne] ; Borja Ibá Ez [Espagne] ; Jose Luis Zamorano [Espagne]Source :
- Cardiology journal [ 1897-5593 ] ; 2020.
Abstract
BACKGROUND
Despite being associated with worse prognosis in patients with COVID-19, systematic determination of myocardial injury is not recommended. The aim of the study was to study the effect of myocardial injury assessment on risk stratification of COVID-19 patients.
METHODS
Seven hundred seven consecutive adult patients admitted to a large tertiary hospital with confirmed COVID-19 were included. Demographic data, comorbidities, laboratory results and clinical outcomes were recorded. Charlson comorbidity index (CCI) was calculated in order to quantify the degree of comorbidities. Independent association of cardiac troponin I (cTnI) increase with outcomes was evaluated by multivariate regression analyses and area under curve. In addition, propensity-score matching was performed to assemble a cohort of patients with similar baseline characteristics.
RESULTS
In the matched cohort (mean age 66.76 ± 15.7 years, 37.3% females), cTnI increase above the upper limit was present in 20.9% of the population and was associated with worse clinical outcomes, including all-cause mortality within 30 days (45.1% vs. 23.2%; p = 0.005). The addition of cTnI to a multivariate prediction model showed a significant improvement in the area under the time-dependent receiver operating characteristic curve (0.775 vs. 0.756, ΔC-statistic = 0.019; 95% CI 0.001-0.037). Use of renin-angiotensin-aldosterone system inhibitors was not associated with mortality after adjusting by baseline risk factors.
CONCLUSIONS
Myocardial injury is independently associated with adverse outcomes irrespective of baseline comorbidities and its addition to multivariate regression models significantly improves their performance in predicting mortality. The determination of myocardial injury biomarkers on hospital admission and its combination with CCI can classify patients in three risk groups (high, intermediate and low) with a clearly distinct 30-day mortality.
DOI: 10.5603/CJ.a2020.0089
PubMed: 32589258
Affiliations:
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Quironsalud, Av Reyes Catolicos 2, 28040 Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Cardiology, IIS-Hospital Universitario Fundación Jiménez Díaz - Quironsalud, Av Reyes Catolicos 2, 28040 Madrid</wicri:regionArea><placeName><region nuts="2" type="communauté">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Zamorano, Jose Luis" sort="Zamorano, Jose Luis" uniqKey="Zamorano J" first="Jose Luis" last="Zamorano">Jose Luis Zamorano</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Cardiology, University Hospital Ramon y Cajal, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32589258</idno><idno type="pmid">32589258</idno><idno type="doi">10.5603/CJ.a2020.0089</idno><idno type="wicri:Area/Main/Corpus">000106</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000106</idno><idno type="wicri:Area/Main/Curation">000106</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000106</idno><idno type="wicri:Area/Main/Exploration">000106</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Myocardial injury determination improves risk stratification and predicts mortality in COVID-19 patients.</title><author><name sortKey="Lorente Ros, Alvaro" sort="Lorente Ros, Alvaro" uniqKey="Lorente Ros A" first="Alvaro" last="Lorente-Ros">Alvaro Lorente-Ros</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain. alvarolr91@gmail.com.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Cardiology, University Hospital Ramon y Cajal, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Monteagudo Ruiz, Juan Manuel" sort="Monteagudo Ruiz, Juan Manuel" uniqKey="Monteagudo Ruiz J" first="Juan Manuel" last="Monteagudo Ruiz">Juan Manuel Monteagudo Ruiz</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Cardiology, University Hospital Ramon y Cajal, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Rinc N, Luis M" sort="Rinc N, Luis M" uniqKey="Rinc N L" first="Luis M" last="Rinc N">Luis M. Rinc N</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Cardiology, University Hospital Ramon y Cajal, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Ortega Perez, Rodrigo" sort="Ortega Perez, Rodrigo" uniqKey="Ortega Perez R" first="Rodrigo" last="Ortega Pérez">Rodrigo Ortega Pérez</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Cardiology, University Hospital Ramon y Cajal, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Rivas, Sonia" sort="Rivas, Sonia" uniqKey="Rivas S" first="Sonia" last="Rivas">Sonia Rivas</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Cardiology, University Hospital Ramon y Cajal, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Martinez Moya, Rafael" sort="Martinez Moya, Rafael" uniqKey="Martinez Moya R" first="Rafael" last="Martínez-Moya">Rafael Martínez-Moya</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Cardiology, University Hospital Ramon y Cajal, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Sanroman, Maria Ascensi N" sort="Sanroman, Maria Ascensi N" uniqKey="Sanroman M" first="Maria Ascensi N" last="Sanromán">Maria Ascensi N Sanromán</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Cardiology, University Hospital Ramon y Cajal, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Manzano, Luis" sort="Manzano, Luis" uniqKey="Manzano L" first="Luis" last="Manzano">Luis Manzano</name><affiliation wicri:level="3"><nlm:affiliation>Hospital Ramon y Cajal, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Hospital Ramon y Cajal, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Alonso, Gonzalo Luis" sort="Alonso, Gonzalo Luis" uniqKey="Alonso G" first="Gonzalo Luis" last="Alonso">Gonzalo Luis Alonso</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Cardiology, University Hospital Ramon y Cajal, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Iba Ez, Borja" sort="Iba Ez, Borja" uniqKey="Iba Ez B" first="Borja" last="Ibá Ez">Borja Ibá Ez</name><affiliation wicri:level="3"><nlm:affiliation>Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation><affiliation wicri:level="1"><nlm:affiliation>CIBER Cardiovascular, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>CIBER Cardiovascular</wicri:regionArea></affiliation><affiliation wicri:level="2"><nlm:affiliation>Department of Cardiology, IIS-Hospital Universitario Fundación Jiménez Díaz - Quironsalud, Av Reyes Catolicos 2, 28040 Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Cardiology, IIS-Hospital Universitario Fundación Jiménez Díaz - Quironsalud, Av Reyes Catolicos 2, 28040 Madrid</wicri:regionArea><placeName><region nuts="2" type="communauté">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Zamorano, Jose Luis" sort="Zamorano, Jose Luis" uniqKey="Zamorano J" first="Jose Luis" last="Zamorano">Jose Luis Zamorano</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Cardiology, University Hospital Ramon y Cajal, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author></analytic><series><title level="j">Cardiology journal</title><idno type="eISSN">1897-5593</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Despite being associated with worse prognosis in patients with COVID-19, systematic determination of myocardial injury is not recommended. The aim of the study was to study the effect of myocardial injury assessment on risk stratification of COVID-19 patients.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Seven hundred seven consecutive adult patients admitted to a large tertiary hospital with confirmed COVID-19 were included. Demographic data, comorbidities, laboratory results and clinical outcomes were recorded. Charlson comorbidity index (CCI) was calculated in order to quantify the degree of comorbidities. Independent association of cardiac troponin I (cTnI) increase with outcomes was evaluated by multivariate regression analyses and area under curve. In addition, propensity-score matching was performed to assemble a cohort of patients with similar baseline characteristics.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>In the matched cohort (mean age 66.76 ± 15.7 years, 37.3% females), cTnI increase above the upper limit was present in 20.9% of the population and was associated with worse clinical outcomes, including all-cause mortality within 30 days (45.1% vs. 23.2%; p = 0.005). The addition of cTnI to a multivariate prediction model showed a significant improvement in the area under the time-dependent receiver operating characteristic curve (0.775 vs. 0.756, ΔC-statistic = 0.019; 95% CI 0.001-0.037). Use of renin-angiotensin-aldosterone system inhibitors was not associated with mortality after adjusting by baseline risk factors.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Myocardial injury is independently associated with adverse outcomes irrespective of baseline comorbidities and its addition to multivariate regression models significantly improves their performance in predicting mortality. The determination of myocardial injury biomarkers on hospital admission and its combination with CCI can classify patients in three risk groups (high, intermediate and low) with a clearly distinct 30-day mortality.</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">32589258</PMID><DateRevised><Year>2020</Year><Month>06</Month><Day>26</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1897-5593</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Jun</Month><Day>26</Day></PubDate></JournalIssue><Title>Cardiology journal</Title><ISOAbbreviation>Cardiol J</ISOAbbreviation></Journal><ArticleTitle>Myocardial injury determination improves risk stratification and predicts mortality in COVID-19 patients.</ArticleTitle><ELocationID EIdType="doi" ValidYN="Y">10.5603/CJ.a2020.0089</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Despite being associated with worse prognosis in patients with COVID-19, systematic determination of myocardial injury is not recommended. The aim of the study was to study the effect of myocardial injury assessment on risk stratification of COVID-19 patients.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Seven hundred seven consecutive adult patients admitted to a large tertiary hospital with confirmed COVID-19 were included. Demographic data, comorbidities, laboratory results and clinical outcomes were recorded. Charlson comorbidity index (CCI) was calculated in order to quantify the degree of comorbidities. Independent association of cardiac troponin I (cTnI) increase with outcomes was evaluated by multivariate regression analyses and area under curve. In addition, propensity-score matching was performed to assemble a cohort of patients with similar baseline characteristics.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">In the matched cohort (mean age 66.76 ± 15.7 years, 37.3% females), cTnI increase above the upper limit was present in 20.9% of the population and was associated with worse clinical outcomes, including all-cause mortality within 30 days (45.1% vs. 23.2%; p = 0.005). The addition of cTnI to a multivariate prediction model showed a significant improvement in the area under the time-dependent receiver operating characteristic curve (0.775 vs. 0.756, ΔC-statistic = 0.019; 95% CI 0.001-0.037). Use of renin-angiotensin-aldosterone system inhibitors was not associated with mortality after adjusting by baseline risk factors.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Myocardial injury is independently associated with adverse outcomes irrespective of baseline comorbidities and its addition to multivariate regression models significantly improves their performance in predicting mortality. The determination of myocardial injury biomarkers on hospital admission and its combination with CCI can classify patients in three risk groups (high, intermediate and low) with a clearly distinct 30-day mortality.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Lorente-Ros</LastName><ForeName>Alvaro</ForeName><Initials>A</Initials><Identifier Source="ORCID">0000-0001-7319-270X</Identifier><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain. alvarolr91@gmail.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Monteagudo Ruiz</LastName><ForeName>Juan Manuel</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rincón</LastName><ForeName>Luis M</ForeName><Initials>LM</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ortega Pérez</LastName><ForeName>Rodrigo</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Rivas</LastName><ForeName>Sonia</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Martínez-Moya</LastName><ForeName>Rafael</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sanromán</LastName><ForeName>Maria Ascensión</ForeName><Initials>MA</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Manzano</LastName><ForeName>Luis</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Hospital Ramon y Cajal, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Alonso</LastName><ForeName>Gonzalo Luis</ForeName><Initials>GL</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ibáñez</LastName><ForeName>Borja</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>CIBER Cardiovascular, Spain.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Cardiology, IIS-Hospital Universitario Fundación Jiménez Díaz - Quironsalud, Av Reyes Catolicos 2, 28040 Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zamorano</LastName><ForeName>Jose Luis</ForeName><Initials>JL</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>06</Month><Day>26</Day></ArticleDate></Article><MedlineJournalInfo><Country>Poland</Country><MedlineTA>Cardiol J</MedlineTA><NlmUniqueID>101392712</NlmUniqueID><ISSNLinking>1898-018X</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">cardiac injury</Keyword><Keyword MajorTopicYN="N">cardiovascular disease</Keyword><Keyword MajorTopicYN="N">coronavirus</Keyword><Keyword MajorTopicYN="N">myocardial injury</Keyword><Keyword MajorTopicYN="N">troponin</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>06</Month><Day>17</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>06</Month><Day>19</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2020</Year><Month>06</Month><Day>19</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>6</Month><Day>27</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>6</Month><Day>27</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>6</Month><Day>27</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32589258</ArticleId><ArticleId IdType="pii">VM/OJS/J/69561</ArticleId><ArticleId IdType="doi">10.5603/CJ.a2020.0089</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Espagne</li></country><region><li>Communauté de Madrid</li></region><settlement><li>Madrid</li></settlement></list><tree><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="Lorente Ros, Alvaro" sort="Lorente Ros, Alvaro" uniqKey="Lorente Ros A" first="Alvaro" last="Lorente-Ros">Alvaro Lorente-Ros</name></region><name sortKey="Alonso, Gonzalo Luis" sort="Alonso, Gonzalo Luis" uniqKey="Alonso G" first="Gonzalo Luis" last="Alonso">Gonzalo Luis Alonso</name><name sortKey="Iba Ez, Borja" sort="Iba Ez, Borja" uniqKey="Iba Ez B" first="Borja" last="Ibá Ez">Borja Ibá Ez</name><name sortKey="Iba Ez, Borja" sort="Iba Ez, Borja" uniqKey="Iba Ez B" first="Borja" last="Ibá Ez">Borja Ibá Ez</name><name sortKey="Iba Ez, Borja" sort="Iba Ez, Borja" uniqKey="Iba Ez B" first="Borja" last="Ibá Ez">Borja Ibá Ez</name><name sortKey="Manzano, Luis" sort="Manzano, Luis" uniqKey="Manzano L" first="Luis" last="Manzano">Luis Manzano</name><name sortKey="Martinez Moya, Rafael" sort="Martinez Moya, Rafael" uniqKey="Martinez Moya R" first="Rafael" last="Martínez-Moya">Rafael Martínez-Moya</name><name sortKey="Monteagudo Ruiz, Juan Manuel" sort="Monteagudo Ruiz, Juan Manuel" uniqKey="Monteagudo Ruiz J" first="Juan Manuel" last="Monteagudo Ruiz">Juan Manuel Monteagudo Ruiz</name><name sortKey="Ortega Perez, Rodrigo" sort="Ortega Perez, Rodrigo" uniqKey="Ortega Perez R" first="Rodrigo" last="Ortega Pérez">Rodrigo Ortega Pérez</name><name sortKey="Rinc N, Luis M" sort="Rinc N, Luis M" uniqKey="Rinc N L" first="Luis M" last="Rinc N">Luis M. Rinc N</name><name sortKey="Rivas, Sonia" sort="Rivas, Sonia" uniqKey="Rivas S" first="Sonia" last="Rivas">Sonia Rivas</name><name sortKey="Sanroman, Maria Ascensi N" sort="Sanroman, Maria Ascensi N" uniqKey="Sanroman M" first="Maria Ascensi N" last="Sanromán">Maria Ascensi N Sanromán</name><name sortKey="Zamorano, Jose Luis" sort="Zamorano, Jose Luis" uniqKey="Zamorano J" first="Jose Luis" last="Zamorano">Jose Luis Zamorano</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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