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Published in: Cardiovascular Diabetology 1/2015

Open Access 01-12-2015 | Original investigation

Diet-induced pre-diabetes slows cardiac conductance and promotes arrhythmogenesis

Authors: Lene Nygaard Axelsen, Kirstine Calloe, Thomas Hartig Braunstein, Mads Riemann, Johannes Pauli Hofgaard, Bo Liang, Christa Funch Jensen, Kristine Boisen Olsen, Emil D. Bartels, Ulrik Baandrup, Thomas Jespersen, Lars Bo Nielsen, Niels-Henrik Holstein-Rathlou, Morten Schak Nielsen

Published in: Cardiovascular Diabetology | Issue 1/2015

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Abstract

Background

Type 2 diabetes is associated with abnormal electrical conduction and sudden cardiac death, but the pathogenic mechanism remains unknown. This study describes electrophysiological alterations in a diet-induced pre-diabetic rat model and examines the underlying mechanism.

Methods

Sprague–Dawley rats were fed either high-fat diet and fructose water or normal chow and water for 6 weeks. The electrophysiological properties of the whole heart was analyzed by in vivo surface ECG recordings, as wells as ex vivo in Langendorff perfused hearts during baseline, ischemia and re-perfussion. Conduction velocity was examined in isolated tissue strips. Ion channel and gap junction conductances were analyzed by patch-clamp studies in isolated cardiomyocytes. Fibrosis was examined by Masson’s Trichrome staining and thin-layer chromatography was used to analyze cardiac lipid content. Connexin43 (Cx43) expression and distribution was examined by western blotting and immunofluorescence respectively.

Results

Following 6 weeks of feeding, fructose-fat fed rats (FFFRs) showed QRS prolongation compared to controls (16.1 ± 0.51 (n = 6) vs. 14.7 ± 0.32 ms (n = 4), p < 0.05). Conduction velocity was slowed in FFFRs vs. controls (0.62 ± 0.02 (n = 13) vs. 0.79 ± 0.06 m/s (n = 11), p < 0.05) and Langendorff perfused FFFR hearts were more prone to ventricular fibrillation during reperfusion following ischemia (p < 0.05). The patch-clamp studies revealed no changes in Na+ or K+ currents, cell capacitance or gap junctional coupling. Cx43 expression was also unaltered in FFFRs, but immunofluorescence demonstrated an increased fraction of Cx43 localized at the intercalated discs in FFFRs compared to controls (78 ± 3.3 (n = 5) vs. 60 ± 4.2 % (n = 6), p < 0.01). No fibrosis was detected but FFFRs showed a significant increase in cardiac triglyceride content (1.93 ± 0.19 (n = 12) vs. 0.77 ± 0.13 nmol/mg (n = 12), p < 0.0001).

Conclusion

Six weeks on a high fructose-fat diet cause electrophysiological changes, which leads to QRS prolongation, decreased conduction velocity and increased arrhythmogenesis during reperfusion. These alterations are not explained by altered gap junctional coupling, Na+, or K+ currents, differences in cell size or fibrosis.
Literature
1.
go back to reference Bergner DW, Goldberger JJ. Diabetes mellitus and sudden cardiac death: what are the data? Cardiol J. 2010;17:117–29.PubMed Bergner DW, Goldberger JJ. Diabetes mellitus and sudden cardiac death: what are the data? Cardiol J. 2010;17:117–29.PubMed
2.
go back to reference Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK, et al. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007;49:403–14.PubMedCrossRef Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK, et al. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007;49:403–14.PubMedCrossRef
3.
go back to reference Voulgari C, Tentolouris N, Papadogiannis D, Moyssakis I, Perrea D, Kyriaki D, et al. Increased left ventricular arrhythmogenicity in metabolic syndrome and relationship with myocardial performance, risk factors for atherosclerosis, and low-grade inflammation. Metabolism. 2010;59:159–65.PubMedCrossRef Voulgari C, Tentolouris N, Papadogiannis D, Moyssakis I, Perrea D, Kyriaki D, et al. Increased left ventricular arrhythmogenicity in metabolic syndrome and relationship with myocardial performance, risk factors for atherosclerosis, and low-grade inflammation. Metabolism. 2010;59:159–65.PubMedCrossRef
4.
go back to reference Bakth S, Arena J, Lee W, Torres R, Haider B, Patel BC, et al. Arrhythmia susceptibility and myocardial composition in diabetes. Influence of physical conditioning. J Clin Invest. 1986;77:382–95.PubMedCentralPubMedCrossRef Bakth S, Arena J, Lee W, Torres R, Haider B, Patel BC, et al. Arrhythmia susceptibility and myocardial composition in diabetes. Influence of physical conditioning. J Clin Invest. 1986;77:382–95.PubMedCentralPubMedCrossRef
5.
go back to reference Ghaly H, Boyle P, Vigmond E, Shimoni Y, Nygren A. Simulations of reduced conduction reserve in the diabetic rat heart: response to uncoupling and reduced excitability. Ann Biomed Eng. 2010;38:1415–25.PubMedCrossRef Ghaly H, Boyle P, Vigmond E, Shimoni Y, Nygren A. Simulations of reduced conduction reserve in the diabetic rat heart: response to uncoupling and reduced excitability. Ann Biomed Eng. 2010;38:1415–25.PubMedCrossRef
6.
go back to reference Nygren A, Olson ML, Chen KY, Emmett T, Kargacin G, Shimoni Y. Propagation of the cardiac impulse in the diabetic rat heart: reduced conduction reserve. J Physiol. 2007;580:543–60.PubMedCentralPubMedCrossRef Nygren A, Olson ML, Chen KY, Emmett T, Kargacin G, Shimoni Y. Propagation of the cardiac impulse in the diabetic rat heart: reduced conduction reserve. J Physiol. 2007;580:543–60.PubMedCentralPubMedCrossRef
7.
go back to reference Lin H, Ogawa K, Imanaga I, Tribulova N. Remodeling of connexin 43 in the diabetic rat heart. Mol Cell Biochem. 2006;290:69–78.PubMedCrossRef Lin H, Ogawa K, Imanaga I, Tribulova N. Remodeling of connexin 43 in the diabetic rat heart. Mol Cell Biochem. 2006;290:69–78.PubMedCrossRef
8.
go back to reference Stilli D, Lagrasta C, Berni R, Bocchi L, Savi M, Delucchi F, et al. Preservation of ventricular performance at early stages of diabetic cardiomyopathy involves changes in myocyte size, number and intercellular coupling. Basic Res Cardiol. 2007;102:488–99.PubMedCrossRef Stilli D, Lagrasta C, Berni R, Bocchi L, Savi M, Delucchi F, et al. Preservation of ventricular performance at early stages of diabetic cardiomyopathy involves changes in myocyte size, number and intercellular coupling. Basic Res Cardiol. 2007;102:488–99.PubMedCrossRef
9.
go back to reference Lin H, Mitasikova M, Dlugosova K, Okruhlicova L, Imanaga I, Ogawa K, et al. Thyroid hormones suppress epsilon-PKC signalling, down-regulate connexin-43 and increase lethal arrhythmia susceptibility in non-diabetic and diabetic rat hearts. J Physiol Pharmacol. 2008;59:271–85.PubMed Lin H, Mitasikova M, Dlugosova K, Okruhlicova L, Imanaga I, Ogawa K, et al. Thyroid hormones suppress epsilon-PKC signalling, down-regulate connexin-43 and increase lethal arrhythmia susceptibility in non-diabetic and diabetic rat hearts. J Physiol Pharmacol. 2008;59:271–85.PubMed
10.
go back to reference Apaijai N, Chinda K, Palee S, Chattipakorn S, Chattipakorn N. Combined vildagliptin and metformin exert better cardioprotection than monotherapy against ischemia-reperfusion injury in obese-insulin resistant rats. PLoS One. 2014;9, e102374.PubMedCentralPubMedCrossRef Apaijai N, Chinda K, Palee S, Chattipakorn S, Chattipakorn N. Combined vildagliptin and metformin exert better cardioprotection than monotherapy against ischemia-reperfusion injury in obese-insulin resistant rats. PLoS One. 2014;9, e102374.PubMedCentralPubMedCrossRef
11.
go back to reference Olsen KB, Axelsen LN, Braunstein TH, Sorensen CM, Andersen CB, Ploug T, et al. Myocardial impulse propagation is impaired in right ventricular tissue of Zucker Diabetic Fatty (ZDF) rats. Cardiovasc Diabetol. 2013;12:19.PubMedCentralPubMedCrossRef Olsen KB, Axelsen LN, Braunstein TH, Sorensen CM, Andersen CB, Ploug T, et al. Myocardial impulse propagation is impaired in right ventricular tissue of Zucker Diabetic Fatty (ZDF) rats. Cardiovasc Diabetol. 2013;12:19.PubMedCentralPubMedCrossRef
12.
go back to reference Axelsen LN, Lademann JB, Petersen JS, Holstein-Rathlou NH, Ploug T, Prats C, et al. Cardiac and metabolic changes in long-term high fructose-fat fed rats with severe obesity and extensive intramyocardial lipid accumulation. Am J Physiol Regul Integr Comp Physiol. 2010;298:R1560–70.PubMedCrossRef Axelsen LN, Lademann JB, Petersen JS, Holstein-Rathlou NH, Ploug T, Prats C, et al. Cardiac and metabolic changes in long-term high fructose-fat fed rats with severe obesity and extensive intramyocardial lipid accumulation. Am J Physiol Regul Integr Comp Physiol. 2010;298:R1560–70.PubMedCrossRef
13.
go back to reference Huang BW, Chiang MT, Yao HT, Chiang W. The effect of high-fat and high-fructose diets on glucose tolerance and plasma lipid and leptin levels in rats. Diabetes Obes Metab. 2004;6:120–6.PubMedCrossRef Huang BW, Chiang MT, Yao HT, Chiang W. The effect of high-fat and high-fructose diets on glucose tolerance and plasma lipid and leptin levels in rats. Diabetes Obes Metab. 2004;6:120–6.PubMedCrossRef
14.
go back to reference Kmecova J, Klimas J. Heart rate correction of the QT duration in rats. Eur J Pharmacol. 2010;641:187–92.PubMedCrossRef Kmecova J, Klimas J. Heart rate correction of the QT duration in rats. Eur J Pharmacol. 2010;641:187–92.PubMedCrossRef
15.
go back to reference Olsen KB, Braunstein TH, Sorensen CM, Axelsen LN, Holstein-Rathlou NH, Nielsen MS. Angiotensin II does not acutely regulate conduction velocity in rat atrial tissue. Scand J Clin Lab Invest. 2011;71:492–9.PubMedCrossRef Olsen KB, Braunstein TH, Sorensen CM, Axelsen LN, Holstein-Rathlou NH, Nielsen MS. Angiotensin II does not acutely regulate conduction velocity in rat atrial tissue. Scand J Clin Lab Invest. 2011;71:492–9.PubMedCrossRef
16.
go back to reference Kjolbye AL, Knudsen CB, Jepsen T, Larsen BD, Petersen JS. Pharmacological characterization of the new stable antiarrhythmic peptide analog Ac-D-Tyr-D-Pro-D-Hyp-Gly-D-Ala-Gly-NH2 (ZP123): in vivo and in vitro studies. J Pharmacol Exp Ther. 2003;306:1191–9.PubMedCrossRef Kjolbye AL, Knudsen CB, Jepsen T, Larsen BD, Petersen JS. Pharmacological characterization of the new stable antiarrhythmic peptide analog Ac-D-Tyr-D-Pro-D-Hyp-Gly-D-Ala-Gly-NH2 (ZP123): in vivo and in vitro studies. J Pharmacol Exp Ther. 2003;306:1191–9.PubMedCrossRef
17.
go back to reference Curtis MJ, Hancox JC, Farkas A, Wainwright CL, Stables CL, Saint DA, et al. The Lambeth Conventions (II): guidelines for the study of animal and human ventricular and supraventricular arrhythmias. Pharmacol Ther. 2013;139:213–48.PubMedCrossRef Curtis MJ, Hancox JC, Farkas A, Wainwright CL, Stables CL, Saint DA, et al. The Lambeth Conventions (II): guidelines for the study of animal and human ventricular and supraventricular arrhythmias. Pharmacol Ther. 2013;139:213–48.PubMedCrossRef
18.
go back to reference Procida K, Jorgensen L, Schmitt N, Delmar M, Taffet SM, Holstein-Rathlou NH, et al. Phosphorylation of connexin43 on serine 306 regulates electrical coupling. Heart Rhythm. 2009;6:1632–8.PubMedCentralPubMedCrossRef Procida K, Jorgensen L, Schmitt N, Delmar M, Taffet SM, Holstein-Rathlou NH, et al. Phosphorylation of connexin43 on serine 306 regulates electrical coupling. Heart Rhythm. 2009;6:1632–8.PubMedCentralPubMedCrossRef
19.
go back to reference Bartels ED, Lauritsen M, Nielsen LB. Hepatic expression of microsomal triglyceride transfer protein and in vivo secretion of triglyceride-rich lipoproteins are increased in obese diabetic mice. Diabetes. 2002;51:1233–9.PubMedCrossRef Bartels ED, Lauritsen M, Nielsen LB. Hepatic expression of microsomal triglyceride transfer protein and in vivo secretion of triglyceride-rich lipoproteins are increased in obese diabetic mice. Diabetes. 2002;51:1233–9.PubMedCrossRef
20.
go back to reference Axelsen LN, Stahlhut M, Mohammed S, Larsen BD, Nielsen MS, Holstein-Rathlou NH, et al. Identification of ischemia-regulated phosphorylation sites in connexin43: A possible target for the antiarrhythmic peptide analogue rotigaptide (ZP123). J Mol Cell Cardiol. 2006;40:790–8.PubMedCrossRef Axelsen LN, Stahlhut M, Mohammed S, Larsen BD, Nielsen MS, Holstein-Rathlou NH, et al. Identification of ischemia-regulated phosphorylation sites in connexin43: A possible target for the antiarrhythmic peptide analogue rotigaptide (ZP123). J Mol Cell Cardiol. 2006;40:790–8.PubMedCrossRef
21.
go back to reference Himmel HM, Wettwer E, Li Q, Ravens U. Four different components contribute to outward current in rat ventricular myocytes. Am J Physiol. 1999;277:H107–18.PubMed Himmel HM, Wettwer E, Li Q, Ravens U. Four different components contribute to outward current in rat ventricular myocytes. Am J Physiol. 1999;277:H107–18.PubMed
22.
go back to reference Grubb S, Speerschneider T, Occhipinti D, Fiset C, Olesen SP, Thomsen MB, et al. Loss of K+ currents in heart failure is accentuated in KChIP2 deficient mice. J Cardiovasc Electrophysiol. 2014;25:896–904.PubMedCrossRef Grubb S, Speerschneider T, Occhipinti D, Fiset C, Olesen SP, Thomsen MB, et al. Loss of K+ currents in heart failure is accentuated in KChIP2 deficient mice. J Cardiovasc Electrophysiol. 2014;25:896–904.PubMedCrossRef
23.
go back to reference Torres-Jacome J, Gallego M, Rodriguez-Robledo JM, Sanchez-Chapula JA, Casis O. Improvement of the metabolic status recovers cardiac potassium channel synthesis in experimental diabetes. Acta Physiol (Oxf). 2013;207:447–59.CrossRef Torres-Jacome J, Gallego M, Rodriguez-Robledo JM, Sanchez-Chapula JA, Casis O. Improvement of the metabolic status recovers cardiac potassium channel synthesis in experimental diabetes. Acta Physiol (Oxf). 2013;207:447–59.CrossRef
24.
go back to reference Siscovick D, Sotoodehnia N, Rea T, Raghunathan T, Jouven X, Lemaitre R. Type 2 diabetes mellitus and the risk of sudden cardiac arrest in the community. Rev Endocr Metab Disord. 2010;11:53–9.PubMedCentralPubMedCrossRef Siscovick D, Sotoodehnia N, Rea T, Raghunathan T, Jouven X, Lemaitre R. Type 2 diabetes mellitus and the risk of sudden cardiac arrest in the community. Rev Endocr Metab Disord. 2010;11:53–9.PubMedCentralPubMedCrossRef
25.
go back to reference Veglio M, Bruno G, Borra M, Macchia G, Bargero G, D’Errico N, et al. Prevalence of increased QT interval duration and dispersion in type 2 diabetic patients and its relationship with coronary heart disease: a population-based cohort. J Intern Med. 2002;251:317–24.PubMedCrossRef Veglio M, Bruno G, Borra M, Macchia G, Bargero G, D’Errico N, et al. Prevalence of increased QT interval duration and dispersion in type 2 diabetic patients and its relationship with coronary heart disease: a population-based cohort. J Intern Med. 2002;251:317–24.PubMedCrossRef
26.
go back to reference Ramirez AH, Schildcrout JS, Blakemore DL, Masys DR, Pulley JM, Basford MA, et al. Modulators of normal electrocardiographic intervals identified in a large electronic medical record. Heart Rhythm. 2011;8:271–7.PubMedCentralPubMedCrossRef Ramirez AH, Schildcrout JS, Blakemore DL, Masys DR, Pulley JM, Basford MA, et al. Modulators of normal electrocardiographic intervals identified in a large electronic medical record. Heart Rhythm. 2011;8:271–7.PubMedCentralPubMedCrossRef
27.
go back to reference Huang H, Amin V, Gurin M, Wan E, Thorp E, Homma S, et al. Diet-induced obesity causes long QT and reduces transcription of voltage-gated potassium channels. J Mol Cell Cardiol. 2013;59:151–8.PubMedCentralPubMedCrossRef Huang H, Amin V, Gurin M, Wan E, Thorp E, Homma S, et al. Diet-induced obesity causes long QT and reduces transcription of voltage-gated potassium channels. J Mol Cell Cardiol. 2013;59:151–8.PubMedCentralPubMedCrossRef
28.
go back to reference VanHoose L, Sawers Y, Loganathan R, Vacek JL, Stehno-Bittel L, Novikova L, et al. Electrocardiographic changes with the onset of diabetes and the impact of aerobic exercise training in the Zucker Diabetic Fatty (ZDF) rat. Cardiovasc Diabetol. 2010;9:56.PubMedCentralPubMedCrossRef VanHoose L, Sawers Y, Loganathan R, Vacek JL, Stehno-Bittel L, Novikova L, et al. Electrocardiographic changes with the onset of diabetes and the impact of aerobic exercise training in the Zucker Diabetic Fatty (ZDF) rat. Cardiovasc Diabetol. 2010;9:56.PubMedCentralPubMedCrossRef
29.
go back to reference Howarth FC, Jacobson M, Shafiullah M, Adeghate E. Long-term effects of type 2 diabetes mellitus on heart rhythm in the Goto-Kakizaki rat. Exp Physiol. 2008;93:362–9.PubMedCrossRef Howarth FC, Jacobson M, Shafiullah M, Adeghate E. Long-term effects of type 2 diabetes mellitus on heart rhythm in the Goto-Kakizaki rat. Exp Physiol. 2008;93:362–9.PubMedCrossRef
30.
go back to reference Yang Q, Kiyoshige K, Fujimoto T, Katayama M, Fujino K, Saito K, et al. Signal-averaging electrocardiogram in patients with diabetes mellitus. Jpn Heart J. 1990;31:25–33.PubMedCrossRef Yang Q, Kiyoshige K, Fujimoto T, Katayama M, Fujino K, Saito K, et al. Signal-averaging electrocardiogram in patients with diabetes mellitus. Jpn Heart J. 1990;31:25–33.PubMedCrossRef
31.
go back to reference Huisamen B, Genis A, Marais E, Lochner A. Pre-treatment with a DPP-4 inhibitor is infarct sparing in hearts from obese, pre-diabetic rats. Cardiovasc Drugs Ther. 2011;25:13–20.PubMedCrossRef Huisamen B, Genis A, Marais E, Lochner A. Pre-treatment with a DPP-4 inhibitor is infarct sparing in hearts from obese, pre-diabetic rats. Cardiovasc Drugs Ther. 2011;25:13–20.PubMedCrossRef
32.
go back to reference Howarth FC, Chandler NJ, Kharche S, Tellez JO, Greener ID, Yamanushi TT, et al. Effects of streptozotocin-induced diabetes on connexin43 mRNA and protein expression in ventricular muscle. Mol Cell Biochem. 2008;319:105–14.PubMedCrossRef Howarth FC, Chandler NJ, Kharche S, Tellez JO, Greener ID, Yamanushi TT, et al. Effects of streptozotocin-induced diabetes on connexin43 mRNA and protein expression in ventricular muscle. Mol Cell Biochem. 2008;319:105–14.PubMedCrossRef
33.
go back to reference Axelsen LN, Calloe K, Holstein-Rathlou NH, Nielsen MS. Managing the complexity of communication: regulation of gap junctions by post-translational modification. Front Pharmacol. 2013;4:130.PubMedCentralPubMedCrossRef Axelsen LN, Calloe K, Holstein-Rathlou NH, Nielsen MS. Managing the complexity of communication: regulation of gap junctions by post-translational modification. Front Pharmacol. 2013;4:130.PubMedCentralPubMedCrossRef
34.
go back to reference Stables CL, Musa H, Mitra A, Bhushal S, Deo M, Guerrero-Serna G, et al. Reduced Na(+) current density underlies impaired propagation in the diabetic rabbit ventricle. J Mol Cell Cardiol. 2014;69:24–31.PubMedCentralPubMedCrossRef Stables CL, Musa H, Mitra A, Bhushal S, Deo M, Guerrero-Serna G, et al. Reduced Na(+) current density underlies impaired propagation in the diabetic rabbit ventricle. J Mol Cell Cardiol. 2014;69:24–31.PubMedCentralPubMedCrossRef
35.
go back to reference Gallego M, Alday A, Urrutia J, Casis O. Transient outward potassium channel regulation in healthy and diabetic hearts. Can J Physiol Pharmacol. 2009;87:77–83.PubMedCrossRef Gallego M, Alday A, Urrutia J, Casis O. Transient outward potassium channel regulation in healthy and diabetic hearts. Can J Physiol Pharmacol. 2009;87:77–83.PubMedCrossRef
36.
go back to reference de Jong S, van Veen TA, van Rijen HV, de Bakker JM. Fibrosis and cardiac arrhythmias. J Cardiovasc Pharmacol. 2011;57:630–8.PubMedCrossRef de Jong S, van Veen TA, van Rijen HV, de Bakker JM. Fibrosis and cardiac arrhythmias. J Cardiovasc Pharmacol. 2011;57:630–8.PubMedCrossRef
37.
go back to reference van de Weijer T, Schrauwen-Hinderling VB, Schrauwen P. Lipotoxicity in type 2 diabetic cardiomyopathy. Cardiovasc Res. 2011;92:10–8.PubMedCrossRef van de Weijer T, Schrauwen-Hinderling VB, Schrauwen P. Lipotoxicity in type 2 diabetic cardiomyopathy. Cardiovasc Res. 2011;92:10–8.PubMedCrossRef
38.
go back to reference Elezaby A, Sverdlov AL, Tu VH, Soni K, Luptak I, Qin F, et al. Mitochondrial remodeling in mice with cardiomyocyte-specific lipid overload. J Mol Cell Cardiol. 2015;79:275–83.PubMedCrossRef Elezaby A, Sverdlov AL, Tu VH, Soni K, Luptak I, Qin F, et al. Mitochondrial remodeling in mice with cardiomyocyte-specific lipid overload. J Mol Cell Cardiol. 2015;79:275–83.PubMedCrossRef
39.
go back to reference Soltysinska E, Speerschneider T, Winther SV, Thomsen MB. Sinoatrial node dysfunction induces cardiac arrhythmias in diabetic mice. Cardiovasc Diabetol. 2014;13:122.PubMedCentralPubMedCrossRef Soltysinska E, Speerschneider T, Winther SV, Thomsen MB. Sinoatrial node dysfunction induces cardiac arrhythmias in diabetic mice. Cardiovasc Diabetol. 2014;13:122.PubMedCentralPubMedCrossRef
Metadata
Title
Diet-induced pre-diabetes slows cardiac conductance and promotes arrhythmogenesis
Authors
Lene Nygaard Axelsen
Kirstine Calloe
Thomas Hartig Braunstein
Mads Riemann
Johannes Pauli Hofgaard
Bo Liang
Christa Funch Jensen
Kristine Boisen Olsen
Emil D. Bartels
Ulrik Baandrup
Thomas Jespersen
Lars Bo Nielsen
Niels-Henrik Holstein-Rathlou
Morten Schak Nielsen
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Cardiovascular Diabetology / Issue 1/2015
Electronic ISSN: 1475-2840
DOI
https://doi.org/10.1186/s12933-015-0246-8

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