Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19).
Identifieur interne : 000309 ( Main/Exploration ); précédent : 000308; suivant : 000310Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19).
Auteurs : Tao Guo [République populaire de Chine] ; Yongzhen Fan [République populaire de Chine] ; Ming Chen [République populaire de Chine] ; Xiaoyan Wu [République populaire de Chine] ; Lin Zhang [République populaire de Chine] ; Tao He [République populaire de Chine] ; Hairong Wang [République populaire de Chine] ; Jing Wan [République populaire de Chine] ; Xinghuan Wang [République populaire de Chine] ; Zhibing Lu [République populaire de Chine]Source :
- JAMA cardiology [ 2380-6591 ] ; 2020.
Abstract
Importance
Increasing numbers of confirmed cases and mortality rates of coronavirus disease 2019 (COVID-19) are occurring in several countries and continents. Information regarding the impact of cardiovascular complication on fatal outcome is scarce.
Objective
To evaluate the association of underlying cardiovascular disease (CVD) and myocardial injury with fatal outcomes in patients with COVID-19.
Design, Setting, and Participants
This retrospective single-center case series analyzed patients with COVID-19 at the Seventh Hospital of Wuhan City, China, from January 23, 2020, to February 23, 2020. Analysis began February 25, 2020.
Main Outcomes and Measures
Demographic data, laboratory findings, comorbidities, and treatments were collected and analyzed in patients with and without elevation of troponin T (TnT) levels.
Result
Among 187 patients with confirmed COVID-19, 144 patients (77%) were discharged and 43 patients (23%) died. The mean (SD) age was 58.50 (14.66) years. Overall, 66 (35.3%) had underlying CVD including hypertension, coronary heart disease, and cardiomyopathy, and 52 (27.8%) exhibited myocardial injury as indicated by elevated TnT levels. The mortality during hospitalization was 7.62% (8 of 105) for patients without underlying CVD and normal TnT levels, 13.33% (4 of 30) for those with underlying CVD and normal TnT levels, 37.50% (6 of 16) for those without underlying CVD but elevated TnT levels, and 69.44% (25 of 36) for those with underlying CVD and elevated TnTs. Patients with underlying CVD were more likely to exhibit elevation of TnT levels compared with the patients without CVD (36 [54.5%] vs 16 [13.2%]). Plasma TnT levels demonstrated a high and significantly positive linear correlation with plasma high-sensitivity C-reactive protein levels (β = 0.530, P < .001) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (β = 0.613, P < .001). Plasma TnT and NT-proBNP levels during hospitalization (median [interquartile range (IQR)], 0.307 [0.094-0.600]; 1902.00 [728.35-8100.00]) and impending death (median [IQR], 0.141 [0.058-0.860]; 5375 [1179.50-25695.25]) increased significantly compared with admission values (median [IQR], 0.0355 [0.015-0.102]; 796.90 [401.93-1742.25]) in patients who died (P = .001; P < .001), while no significant dynamic changes of TnT (median [IQR], 0.010 [0.007-0.019]; 0.013 [0.007-0.022]; 0.011 [0.007-0.016]) and NT-proBNP (median [IQR], 352.20 [174.70-636.70]; 433.80 [155.80-1272.60]; 145.40 [63.4-526.50]) was observed in survivors (P = .96; P = .16). During hospitalization, patients with elevated TnT levels had more frequent malignant arrhythmias, and the use of glucocorticoid therapy (37 [71.2%] vs 69 [51.1%]) and mechanical ventilation (41 [59.6%] vs 14 [10.4%]) were higher compared with patients with normal TnT levels. The mortality rates of patients with and without use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 36.8% (7 of 19) and 25.6% (43 of 168).
Conclusions and Relevance
Myocardial injury is significantly associated with fatal outcome of COVID-19, while the prognosis of patients with underlying CVD but without myocardial injury is relatively favorable. Myocardial injury is associated with cardiac dysfunction and arrhythmias. Inflammation may be a potential mechanism for myocardial injury. Aggressive treatment may be considered for patients at high risk of myocardial injury.
DOI: 10.1001/jamacardio.2020.1017
PubMed: 32219356
PubMed Central: PMC7101506
Affiliations:
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of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="Zhang, Lin" sort="Zhang, Lin" uniqKey="Zhang L" first="Lin" last="Zhang">Lin Zhang</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="He, Tao" sort="He, Tao" uniqKey="He T" first="Tao" last="He">Tao He</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="Wang, Hairong" sort="Wang, Hairong" uniqKey="Wang H" first="Hairong" last="Wang">Hairong Wang</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="Wan, Jing" sort="Wan, Jing" uniqKey="Wan J" first="Jing" last="Wan">Jing Wan</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="Wang, Xinghuan" sort="Wang, Xinghuan" uniqKey="Wang X" first="Xinghuan" last="Wang">Xinghuan Wang</name><affiliation wicri:level="3"><nlm:affiliation>Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="Lu, Zhibing" sort="Lu, Zhibing" uniqKey="Lu Z" first="Zhibing" last="Lu">Zhibing Lu</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32219356</idno><idno type="pmid">32219356</idno><idno type="doi">10.1001/jamacardio.2020.1017</idno><idno type="pmc">PMC7101506</idno><idno 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type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="Fan, Yongzhen" sort="Fan, Yongzhen" uniqKey="Fan Y" first="Yongzhen" last="Fan">Yongzhen Fan</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="Chen, Ming" sort="Chen, Ming" uniqKey="Chen M" first="Ming" last="Chen">Ming Chen</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="Wu, Xiaoyan" sort="Wu, Xiaoyan" uniqKey="Wu X" first="Xiaoyan" last="Wu">Xiaoyan Wu</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="Zhang, Lin" sort="Zhang, Lin" uniqKey="Zhang L" first="Lin" last="Zhang">Lin Zhang</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="He, Tao" sort="He, Tao" uniqKey="He T" first="Tao" last="He">Tao He</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="Wang, Hairong" sort="Wang, Hairong" uniqKey="Wang H" first="Hairong" last="Wang">Hairong Wang</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="Wan, Jing" sort="Wan, Jing" uniqKey="Wan J" first="Jing" last="Wan">Jing Wan</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="Wang, Xinghuan" sort="Wang, Xinghuan" uniqKey="Wang X" first="Xinghuan" last="Wang">Xinghuan Wang</name><affiliation wicri:level="3"><nlm:affiliation>Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author><author><name sortKey="Lu, Zhibing" sort="Lu, Zhibing" uniqKey="Lu Z" first="Zhibing" last="Lu">Zhibing Lu</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan</wicri:regionArea><placeName><settlement type="city">Wuhan</settlement><region type="région">Hubei</region></placeName></affiliation></author></analytic><series><title level="j">JAMA cardiology</title><idno type="eISSN">2380-6591</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>Importance</b></p><p>Increasing numbers of confirmed cases and mortality rates of coronavirus disease 2019 (COVID-19) are occurring in several countries and continents. Information regarding the impact of cardiovascular complication on fatal outcome is scarce.</p></div><div type="abstract" xml:lang="en"><p><b>Objective</b></p><p>To evaluate the association of underlying cardiovascular disease (CVD) and myocardial injury with fatal outcomes in patients with COVID-19.</p></div><div type="abstract" xml:lang="en"><p><b>Design, Setting, and Participants</b></p><p>This retrospective single-center case series analyzed patients with COVID-19 at the Seventh Hospital of Wuhan City, China, from January 23, 2020, to February 23, 2020. Analysis began February 25, 2020.</p></div><div type="abstract" xml:lang="en"><p><b>Main Outcomes and Measures</b></p><p>Demographic data, laboratory findings, comorbidities, and treatments were collected and analyzed in patients with and without elevation of troponin T (TnT) levels.</p></div><div type="abstract" xml:lang="en"><p><b>Result</b></p><p>Among 187 patients with confirmed COVID-19, 144 patients (77%) were discharged and 43 patients (23%) died. The mean (SD) age was 58.50 (14.66) years. Overall, 66 (35.3%) had underlying CVD including hypertension, coronary heart disease, and cardiomyopathy, and 52 (27.8%) exhibited myocardial injury as indicated by elevated TnT levels. The mortality during hospitalization was 7.62% (8 of 105) for patients without underlying CVD and normal TnT levels, 13.33% (4 of 30) for those with underlying CVD and normal TnT levels, 37.50% (6 of 16) for those without underlying CVD but elevated TnT levels, and 69.44% (25 of 36) for those with underlying CVD and elevated TnTs. Patients with underlying CVD were more likely to exhibit elevation of TnT levels compared with the patients without CVD (36 [54.5%] vs 16 [13.2%]). Plasma TnT levels demonstrated a high and significantly positive linear correlation with plasma high-sensitivity C-reactive protein levels (β = 0.530, P < .001) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (β = 0.613, P < .001). Plasma TnT and NT-proBNP levels during hospitalization (median [interquartile range (IQR)], 0.307 [0.094-0.600]; 1902.00 [728.35-8100.00]) and impending death (median [IQR], 0.141 [0.058-0.860]; 5375 [1179.50-25695.25]) increased significantly compared with admission values (median [IQR], 0.0355 [0.015-0.102]; 796.90 [401.93-1742.25]) in patients who died (P = .001; P < .001), while no significant dynamic changes of TnT (median [IQR], 0.010 [0.007-0.019]; 0.013 [0.007-0.022]; 0.011 [0.007-0.016]) and NT-proBNP (median [IQR], 352.20 [174.70-636.70]; 433.80 [155.80-1272.60]; 145.40 [63.4-526.50]) was observed in survivors (P = .96; P = .16). During hospitalization, patients with elevated TnT levels had more frequent malignant arrhythmias, and the use of glucocorticoid therapy (37 [71.2%] vs 69 [51.1%]) and mechanical ventilation (41 [59.6%] vs 14 [10.4%]) were higher compared with patients with normal TnT levels. The mortality rates of patients with and without use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 36.8% (7 of 19) and 25.6% (43 of 168).</p></div><div type="abstract" xml:lang="en"><p><b>Conclusions and Relevance</b></p><p>Myocardial injury is significantly associated with fatal outcome of COVID-19, while the prognosis of patients with underlying CVD but without myocardial injury is relatively favorable. Myocardial injury is associated with cardiac dysfunction and arrhythmias. Inflammation may be a potential mechanism for myocardial injury. Aggressive treatment may be considered for patients at high risk of myocardial injury.</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">32219356</PMID><DateRevised><Year>2020</Year><Month>03</Month><Day>31</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">2380-6591</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Mar</Month><Day>27</Day></PubDate></JournalIssue><Title>JAMA cardiology</Title><ISOAbbreviation>JAMA Cardiol</ISOAbbreviation></Journal><ArticleTitle>Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19).</ArticleTitle><ELocationID EIdType="doi" ValidYN="Y">10.1001/jamacardio.2020.1017</ELocationID><Abstract><AbstractText Label="Importance" NlmCategory="UNASSIGNED">Increasing numbers of confirmed cases and mortality rates of coronavirus disease 2019 (COVID-19) are occurring in several countries and continents. Information regarding the impact of cardiovascular complication on fatal outcome is scarce.</AbstractText><AbstractText Label="Objective" NlmCategory="UNASSIGNED">To evaluate the association of underlying cardiovascular disease (CVD) and myocardial injury with fatal outcomes in patients with COVID-19.</AbstractText><AbstractText Label="Design, Setting, and Participants" NlmCategory="UNASSIGNED">This retrospective single-center case series analyzed patients with COVID-19 at the Seventh Hospital of Wuhan City, China, from January 23, 2020, to February 23, 2020. Analysis began February 25, 2020.</AbstractText><AbstractText Label="Main Outcomes and Measures" NlmCategory="UNASSIGNED">Demographic data, laboratory findings, comorbidities, and treatments were collected and analyzed in patients with and without elevation of troponin T (TnT) levels.</AbstractText><AbstractText Label="Result" NlmCategory="UNASSIGNED">Among 187 patients with confirmed COVID-19, 144 patients (77%) were discharged and 43 patients (23%) died. The mean (SD) age was 58.50 (14.66) years. Overall, 66 (35.3%) had underlying CVD including hypertension, coronary heart disease, and cardiomyopathy, and 52 (27.8%) exhibited myocardial injury as indicated by elevated TnT levels. The mortality during hospitalization was 7.62% (8 of 105) for patients without underlying CVD and normal TnT levels, 13.33% (4 of 30) for those with underlying CVD and normal TnT levels, 37.50% (6 of 16) for those without underlying CVD but elevated TnT levels, and 69.44% (25 of 36) for those with underlying CVD and elevated TnTs. Patients with underlying CVD were more likely to exhibit elevation of TnT levels compared with the patients without CVD (36 [54.5%] vs 16 [13.2%]). Plasma TnT levels demonstrated a high and significantly positive linear correlation with plasma high-sensitivity C-reactive protein levels (β = 0.530, P < .001) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (β = 0.613, P < .001). Plasma TnT and NT-proBNP levels during hospitalization (median [interquartile range (IQR)], 0.307 [0.094-0.600]; 1902.00 [728.35-8100.00]) and impending death (median [IQR], 0.141 [0.058-0.860]; 5375 [1179.50-25695.25]) increased significantly compared with admission values (median [IQR], 0.0355 [0.015-0.102]; 796.90 [401.93-1742.25]) in patients who died (P = .001; P < .001), while no significant dynamic changes of TnT (median [IQR], 0.010 [0.007-0.019]; 0.013 [0.007-0.022]; 0.011 [0.007-0.016]) and NT-proBNP (median [IQR], 352.20 [174.70-636.70]; 433.80 [155.80-1272.60]; 145.40 [63.4-526.50]) was observed in survivors (P = .96; P = .16). During hospitalization, patients with elevated TnT levels had more frequent malignant arrhythmias, and the use of glucocorticoid therapy (37 [71.2%] vs 69 [51.1%]) and mechanical ventilation (41 [59.6%] vs 14 [10.4%]) were higher compared with patients with normal TnT levels. The mortality rates of patients with and without use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 36.8% (7 of 19) and 25.6% (43 of 168).</AbstractText><AbstractText Label="Conclusions and Relevance" NlmCategory="UNASSIGNED">Myocardial injury is significantly associated with fatal outcome of COVID-19, while the prognosis of patients with underlying CVD but without myocardial injury is relatively favorable. Myocardial injury is associated with cardiac dysfunction and arrhythmias. Inflammation may be a potential mechanism for myocardial injury. Aggressive treatment may be considered for patients at high risk of myocardial injury.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Guo</LastName><ForeName>Tao</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Fan</LastName><ForeName>Yongzhen</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chen</LastName><ForeName>Ming</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wu</LastName><ForeName>Xiaoyan</ForeName><Initials>X</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zhang</LastName><ForeName>Lin</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>He</LastName><ForeName>Tao</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wang</LastName><ForeName>Hairong</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wan</LastName><ForeName>Jing</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wang</LastName><ForeName>Xinghuan</ForeName><Initials>X</Initials><AffiliationInfo><Affiliation>Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lu</LastName><ForeName>Zhibing</ForeName><Initials>Z</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>03</Month><Day>27</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>JAMA 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sortKey="Wan, Jing" sort="Wan, Jing" uniqKey="Wan J" first="Jing" last="Wan">Jing Wan</name><name sortKey="Wang, Hairong" sort="Wang, Hairong" uniqKey="Wang H" first="Hairong" last="Wang">Hairong Wang</name><name sortKey="Wang, Xinghuan" sort="Wang, Xinghuan" uniqKey="Wang X" first="Xinghuan" last="Wang">Xinghuan Wang</name><name sortKey="Wu, Xiaoyan" sort="Wu, Xiaoyan" uniqKey="Wu X" first="Xiaoyan" last="Wu">Xiaoyan Wu</name><name sortKey="Zhang, Lin" sort="Zhang, Lin" uniqKey="Zhang L" first="Lin" last="Zhang">Lin Zhang</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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