Skip to main content
Top
Published in: Heart and Vessels 1/2017

01-01-2017 | Original Article

Characterization of gut microbiota profiles in coronary artery disease patients using data mining analysis of terminal restriction fragment length polymorphism: gut microbiota could be a diagnostic marker of coronary artery disease

Authors: Takuo Emoto, Tomoya Yamashita, Toshio Kobayashi, Naoto Sasaki, Yushi Hirota, Tomohiro Hayashi, Anna So, Kazuyuki Kasahara, Keiko Yodoi, Takuya Matsumoto, Taiji Mizoguchi, Wataru Ogawa, Ken-ichi Hirata

Published in: Heart and Vessels | Issue 1/2017

Login to get access

Abstract

The association between atherosclerosis and gut microbiota has been attracting increased attention. We previously demonstrated a possible link between gut microbiota and coronary artery disease. Our aim of this study was to clarify the gut microbiota profiles in coronary artery disease patients using data mining analysis of terminal restriction fragment length polymorphism (T-RFLP). This study included 39 coronary artery disease (CAD) patients and 30 age- and sex- matched no-CAD controls (Ctrls) with coronary risk factors. Bacterial DNA was extracted from their fecal samples and analyzed by T-RFLP and data mining analysis using the classification and regression algorithm. Five additional CAD patients were newly recruited to confirm the reliability of this analysis. Data mining analysis could divide the composition of gut microbiota into 2 characteristic nodes. The CAD group was classified into 4 CAD pattern nodes (35/39 = 90 %), while the Ctrl group was classified into 3 Ctrl pattern nodes (28/30 = 93 %). Five additional CAD samples were applied to the same dividing model, which could validate the accuracy to predict the risk of CAD by data mining analysis. We could demonstrate that operational taxonomic unit 853 (OTU853), OTU657, and OTU990 were determined important both by the data mining method and by the usual statistical comparison. We classified the gut microbiota profiles in coronary artery disease patients using data mining analysis of T-RFLP data and demonstrated the possibility that gut microbiota is a diagnostic marker of suffering from CAD.
Literature
1.
go back to reference Qin J, Li R, Raes J, Arumugam M, Burgdorf KS, Manichanh C, Nielsen T, Pons N, Levenez F, Yamada T, Mende DR, Li J, Xu J, Li S, Li D, Cao J, Wang B, Liang H, Zheng H, Xie Y, Tap J, Lepage P, Bertalan M, Batto JM, Hansen T, Le Paslier D, Linneberg A, Nielsen HB, Pelletier E, Renault P, Sicheritz-Ponten T, Turner K, Zhu H, Yu C, Li S, Jian M, Zhou Y, Li Y, Zhang X, Li S, Qin N, Yang H, Wang J, Brunak S, Dore J, Guarner F, Kristiansen K, Pedersen O, Parkhill J, Weissenbach J, Meta HITC, Bork P, Ehrlich SD, Wang J (2010) A human gut microbial gene catalogue established by metagenomic sequencing. Nature 464:59–65CrossRefPubMedPubMedCentral Qin J, Li R, Raes J, Arumugam M, Burgdorf KS, Manichanh C, Nielsen T, Pons N, Levenez F, Yamada T, Mende DR, Li J, Xu J, Li S, Li D, Cao J, Wang B, Liang H, Zheng H, Xie Y, Tap J, Lepage P, Bertalan M, Batto JM, Hansen T, Le Paslier D, Linneberg A, Nielsen HB, Pelletier E, Renault P, Sicheritz-Ponten T, Turner K, Zhu H, Yu C, Li S, Jian M, Zhou Y, Li Y, Zhang X, Li S, Qin N, Yang H, Wang J, Brunak S, Dore J, Guarner F, Kristiansen K, Pedersen O, Parkhill J, Weissenbach J, Meta HITC, Bork P, Ehrlich SD, Wang J (2010) A human gut microbial gene catalogue established by metagenomic sequencing. Nature 464:59–65CrossRefPubMedPubMedCentral
2.
go back to reference Wang Z, Klipfell E, Bennett BJ, Koeth R, Levison BS, Dugar B, Feldstein AE, Britt EB, Fu X, Chung YM, Wu Y, Schauer P, Smith JD, Allayee H, Tang WH, DiDonato JA, Lusis AJ, Hazen SL (2011) Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature 472:57–63CrossRefPubMedPubMedCentral Wang Z, Klipfell E, Bennett BJ, Koeth R, Levison BS, Dugar B, Feldstein AE, Britt EB, Fu X, Chung YM, Wu Y, Schauer P, Smith JD, Allayee H, Tang WH, DiDonato JA, Lusis AJ, Hazen SL (2011) Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature 472:57–63CrossRefPubMedPubMedCentral
3.
go back to reference Koeth RA, Wang Z, Levison BS, Buffa JA, Org E, Sheehy BT, Britt EB, Fu X, Wu Y, Li L, Smith JD, DiDonato JA, Chen J, Li H, Wu GD, Lewis JD, Warrier M, Brown JM, Krauss RM, Tang WH, Bushman FD, Lusis AJ, Hazen SL (2013) Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med 19:576–585CrossRefPubMedPubMedCentral Koeth RA, Wang Z, Levison BS, Buffa JA, Org E, Sheehy BT, Britt EB, Fu X, Wu Y, Li L, Smith JD, DiDonato JA, Chen J, Li H, Wu GD, Lewis JD, Warrier M, Brown JM, Krauss RM, Tang WH, Bushman FD, Lusis AJ, Hazen SL (2013) Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med 19:576–585CrossRefPubMedPubMedCentral
4.
go back to reference Tang WH, Wang Z, Levison BS, Koeth RA, Britt EB, Fu X, Wu Y, Hazen SL (2013) Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. N Engl J Med 368:1575–1584CrossRefPubMedPubMedCentral Tang WH, Wang Z, Levison BS, Koeth RA, Britt EB, Fu X, Wu Y, Hazen SL (2013) Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. N Engl J Med 368:1575–1584CrossRefPubMedPubMedCentral
5.
go back to reference Atarashi K, Tanoue T, Shima T, Imaoka A, Kuwahara T, Momose Y, Cheng G, Yamasaki S, Saito T, Ohba Y, Taniguchi T, Takeda K, Hori S, Ivanov II, Umesaki Y, Itoh K, Honda K (2011) Induction of colonic regulatory T cells by indigenous Clostridium species. Science 331:337–341CrossRefPubMed Atarashi K, Tanoue T, Shima T, Imaoka A, Kuwahara T, Momose Y, Cheng G, Yamasaki S, Saito T, Ohba Y, Taniguchi T, Takeda K, Hori S, Ivanov II, Umesaki Y, Itoh K, Honda K (2011) Induction of colonic regulatory T cells by indigenous Clostridium species. Science 331:337–341CrossRefPubMed
7.
go back to reference Atarashi K, Tanoue T, Oshima K, Suda W, Nagano Y, Nishikawa H, Fukuda S, Saito T, Narushima S, Hase K, Kim S, Fritz JV, Wilmes P, Ueha S, Matsushima K, Ohno H, Olle B, Sakaguchi S, Taniguchi T, Morita H, Hattori M, Honda K (2013) Treg induction by a rationally selected mixture of Clostridia strains from the human microbiota. Nature 500:232–236CrossRefPubMed Atarashi K, Tanoue T, Oshima K, Suda W, Nagano Y, Nishikawa H, Fukuda S, Saito T, Narushima S, Hase K, Kim S, Fritz JV, Wilmes P, Ueha S, Matsushima K, Ohno H, Olle B, Sakaguchi S, Taniguchi T, Morita H, Hattori M, Honda K (2013) Treg induction by a rationally selected mixture of Clostridia strains from the human microbiota. Nature 500:232–236CrossRefPubMed
8.
go back to reference Ketelhuth DF, Hansson GK (2016) Adaptive response of T and B cells in atherosclerosis. Circ Res 118:668–678CrossRefPubMed Ketelhuth DF, Hansson GK (2016) Adaptive response of T and B cells in atherosclerosis. Circ Res 118:668–678CrossRefPubMed
9.
go back to reference Satoh S, Yada R, Inoue H, Omura S, Ejima E, Mori T, Takenaka K, Kawamura N, Numaguchi K, Mori E, Asoh A, Nakamura T, Hiyamuta K (2016) Toll-like receptor-4 is upregulated in plaque debris of patients with acute coronary syndrome more than Toll-like receptor-2. Heart Vessels 31:1–5CrossRefPubMed Satoh S, Yada R, Inoue H, Omura S, Ejima E, Mori T, Takenaka K, Kawamura N, Numaguchi K, Mori E, Asoh A, Nakamura T, Hiyamuta K (2016) Toll-like receptor-4 is upregulated in plaque debris of patients with acute coronary syndrome more than Toll-like receptor-2. Heart Vessels 31:1–5CrossRefPubMed
10.
go back to reference Kobayashi N, Suzuki J, Ogawa M, Aoyama N, Komuro I, Izumi Y, Isobe M (2014) Porphyromonas gingivalis promotes neointimal formation after arterial injury through toll-like receptor 2 signaling. Heart Vessels 29:542–549CrossRefPubMed Kobayashi N, Suzuki J, Ogawa M, Aoyama N, Komuro I, Izumi Y, Isobe M (2014) Porphyromonas gingivalis promotes neointimal formation after arterial injury through toll-like receptor 2 signaling. Heart Vessels 29:542–549CrossRefPubMed
11.
go back to reference Takeda M, Yamashita T, Sasaki N, Nakajima K, Kita T, Shinohara M, Ishida T, Hirata K (2010) Oral administration of an active form of vitamin D3 (calcitriol) decreases atherosclerosis in mice by inducing regulatory T cells and immature dendritic cells with tolerogenic functions. Arterioscler Thromb Vasc Biol 30:2495–2503CrossRefPubMed Takeda M, Yamashita T, Sasaki N, Nakajima K, Kita T, Shinohara M, Ishida T, Hirata K (2010) Oral administration of an active form of vitamin D3 (calcitriol) decreases atherosclerosis in mice by inducing regulatory T cells and immature dendritic cells with tolerogenic functions. Arterioscler Thromb Vasc Biol 30:2495–2503CrossRefPubMed
12.
go back to reference Sasaki N, Yamashita T, Takeda M, Shinohara M, Nakajima K, Tawa H, Usui T, Hirata K (2009) Oral anti-CD3 antibody treatment induces regulatory T cells and inhibits the development of atherosclerosis in mice. Circulation 120:1996–2005CrossRefPubMed Sasaki N, Yamashita T, Takeda M, Shinohara M, Nakajima K, Tawa H, Usui T, Hirata K (2009) Oral anti-CD3 antibody treatment induces regulatory T cells and inhibits the development of atherosclerosis in mice. Circulation 120:1996–2005CrossRefPubMed
13.
go back to reference Emoto T, Sasaki N, Yamashita T, Kasahara K, Yodoi K, Sasaki Y, Matsumoto T, Mizoguchi T, Hirata K (2014) Regulatory/effector T-cell ratio is reduced in coronary artery disease. Circ J 78:2935–2941CrossRefPubMed Emoto T, Sasaki N, Yamashita T, Kasahara K, Yodoi K, Sasaki Y, Matsumoto T, Mizoguchi T, Hirata K (2014) Regulatory/effector T-cell ratio is reduced in coronary artery disease. Circ J 78:2935–2941CrossRefPubMed
14.
go back to reference Yamashita T, Kasahara K, Emoto T, Matsumoto T, Mizoguchi T, Kitano N, Sasaki N, Hirata K (2015) Intestinal immunity and gut microbiota as therapeutic targets for preventing atherosclerotic cardiovascular diseases. Circ J 79:1882–1890CrossRefPubMed Yamashita T, Kasahara K, Emoto T, Matsumoto T, Mizoguchi T, Kitano N, Sasaki N, Hirata K (2015) Intestinal immunity and gut microbiota as therapeutic targets for preventing atherosclerotic cardiovascular diseases. Circ J 79:1882–1890CrossRefPubMed
15.
go back to reference Karlsson FH, Fak F, Nookaew I, Tremaroli V, Fagerberg B, Petranovic D, Backhed F, Nielsen J (2012) Symptomatic atherosclerosis is associated with an altered gut metagenome. Nat Commun 3:1245CrossRefPubMedPubMedCentral Karlsson FH, Fak F, Nookaew I, Tremaroli V, Fagerberg B, Petranovic D, Backhed F, Nielsen J (2012) Symptomatic atherosclerosis is associated with an altered gut metagenome. Nat Commun 3:1245CrossRefPubMedPubMedCentral
16.
go back to reference Yin J, Liao SX, He Y, Wang S, Xia GH, Liu FT, Zhu JJ, You C, Chen Q, Zhou L, Pan SY, Zhou HW (2015) Dysbiosis of gut microbiota with reduced trimethylamine-N-oxide level in patients with large-artery atherosclerotic stroke or transient ischemic attack. J Am Heart Assoc 4(11):e002699. doi:10.1161/JAHA.115.002699 CrossRefPubMedPubMedCentral Yin J, Liao SX, He Y, Wang S, Xia GH, Liu FT, Zhu JJ, You C, Chen Q, Zhou L, Pan SY, Zhou HW (2015) Dysbiosis of gut microbiota with reduced trimethylamine-N-oxide level in patients with large-artery atherosclerotic stroke or transient ischemic attack. J Am Heart Assoc 4(11):e002699. doi:10.​1161/​JAHA.​115.​002699 CrossRefPubMedPubMedCentral
17.
go back to reference Fu J, Bonder MJ, Cenit MC, Tigchelaar EF, Maatman A, Dekens JA, Brandsma E, Marczynska J, Imhann F, Weersma RK, Franke L, Poon TW, Xavier RJ, Gevers D, Hofker MH, Wijmenga C, Zhernakova A (2015) The gut microbiome contributes to a substantial proportion of the variation in blood lipids. Circ Res 117:817–824CrossRefPubMedPubMedCentral Fu J, Bonder MJ, Cenit MC, Tigchelaar EF, Maatman A, Dekens JA, Brandsma E, Marczynska J, Imhann F, Weersma RK, Franke L, Poon TW, Xavier RJ, Gevers D, Hofker MH, Wijmenga C, Zhernakova A (2015) The gut microbiome contributes to a substantial proportion of the variation in blood lipids. Circ Res 117:817–824CrossRefPubMedPubMedCentral
18.
go back to reference Emoto T, Yamashita T, Sasaki N, Hirota Y, Hayashi T, So A, Kasahara K, Yodoi K, Matsumoto T, Mizoguchi T, Ogawa W, Hirata KI (2016) Analysis of gut microbiota in coronary artery disease patients: a possible link between gut microbiota and coronary artery disease. J Atheroscler Thromb [epub ahead of print] Emoto T, Yamashita T, Sasaki N, Hirota Y, Hayashi T, So A, Kasahara K, Yodoi K, Matsumoto T, Mizoguchi T, Ogawa W, Hirata KI (2016) Analysis of gut microbiota in coronary artery disease patients: a possible link between gut microbiota and coronary artery disease. J Atheroscler Thromb [epub ahead of print]
19.
go back to reference Osborn AM, Moore ER, Timmis KN (2000) An evaluation of terminal-restriction fragment length polymorphism (T-RFLP) analysis for the study of microbial community structure and dynamics. Environ Microbiol 2:39–50CrossRefPubMed Osborn AM, Moore ER, Timmis KN (2000) An evaluation of terminal-restriction fragment length polymorphism (T-RFLP) analysis for the study of microbial community structure and dynamics. Environ Microbiol 2:39–50CrossRefPubMed
20.
go back to reference Andoh A, Kobayashi T, Kuzuoka H, Suzuki Y, Matsui T, Nakamura S, Matsumoto T, Fujiyama Y, Bamba T (2013) Data mining analysis of terminal restriction fragment length polymorphism shows geographical differences in the human gut microbiota. Biomed Rep 1:559–562PubMedPubMedCentral Andoh A, Kobayashi T, Kuzuoka H, Suzuki Y, Matsui T, Nakamura S, Matsumoto T, Fujiyama Y, Bamba T (2013) Data mining analysis of terminal restriction fragment length polymorphism shows geographical differences in the human gut microbiota. Biomed Rep 1:559–562PubMedPubMedCentral
21.
go back to reference Kobayashi T, Fujiwara K (2013) Comparison of the accuracy and mechanism of data mining identification of the intestinal microbiota with 7 restriction enzymes. Biosci Microbiota Food Health 32:139–148CrossRefPubMedPubMedCentral Kobayashi T, Fujiwara K (2013) Comparison of the accuracy and mechanism of data mining identification of the intestinal microbiota with 7 restriction enzymes. Biosci Microbiota Food Health 32:139–148CrossRefPubMedPubMedCentral
22.
go back to reference Kobayashi T, Fujiwara K (2013) Identification of heavy smokers through their intestinal microbiota by data mining analysis. Biosci Microbiota Food Health 32:77–80CrossRefPubMedPubMedCentral Kobayashi T, Fujiwara K (2013) Identification of heavy smokers through their intestinal microbiota by data mining analysis. Biosci Microbiota Food Health 32:77–80CrossRefPubMedPubMedCentral
23.
go back to reference Kobayashi T, Jin JS, Kibe R, Touyama M, Tanaka Y, Benno Y, Fujiwara K, Shimakawa M, Maruo T, Toda T, Matsuda I, Tagami H, Matsumoto M, Seo G, Sato N, Chounan O, Benno Y (2013) Identification of human intestinal microbiota of 92 men by data mining for 5 characteristics, i.e., age, BMI, smoking habit, cessation period of previous smokers and drinking habit. Biosci Microbiota Food Health 32:129–137CrossRefPubMedPubMedCentral Kobayashi T, Jin JS, Kibe R, Touyama M, Tanaka Y, Benno Y, Fujiwara K, Shimakawa M, Maruo T, Toda T, Matsuda I, Tagami H, Matsumoto M, Seo G, Sato N, Chounan O, Benno Y (2013) Identification of human intestinal microbiota of 92 men by data mining for 5 characteristics, i.e., age, BMI, smoking habit, cessation period of previous smokers and drinking habit. Biosci Microbiota Food Health 32:129–137CrossRefPubMedPubMedCentral
24.
go back to reference Andoh A, Kobayashi T, Kuzuoka H, Tsujikawa T, Suzuki Y, Hirai F, Matsui T, Nakamura S, Matsumoto T, Fujiyama Y (2014) Characterization of gut microbiota profiles by disease activity in patients with Crohn’s disease using data mining analysis of terminal restriction fragment length polymorphisms. Biomed Rep 2:370–373PubMedPubMedCentral Andoh A, Kobayashi T, Kuzuoka H, Tsujikawa T, Suzuki Y, Hirai F, Matsui T, Nakamura S, Matsumoto T, Fujiyama Y (2014) Characterization of gut microbiota profiles by disease activity in patients with Crohn’s disease using data mining analysis of terminal restriction fragment length polymorphisms. Biomed Rep 2:370–373PubMedPubMedCentral
25.
go back to reference Kobayashi T, Fujiwara K (2014) Technical aspects of nominal partitions on accuracy of data mining classification of intestinal microbiota—comparison between 7 restriction enzymes. Biosci Microbiota Food Health 33:129–138CrossRefPubMedPubMedCentral Kobayashi T, Fujiwara K (2014) Technical aspects of nominal partitions on accuracy of data mining classification of intestinal microbiota—comparison between 7 restriction enzymes. Biosci Microbiota Food Health 33:129–138CrossRefPubMedPubMedCentral
26.
go back to reference Kobayashi T, Osaki T, Oikawa S (2014) Applying data mining to classify age by intestinal microbiota in 92 healthy men using a combination of several restriction enzymes for T-RFLP experiments. Biosci Microbiota Food Health 33:65–78CrossRefPubMedPubMedCentral Kobayashi T, Osaki T, Oikawa S (2014) Applying data mining to classify age by intestinal microbiota in 92 healthy men using a combination of several restriction enzymes for T-RFLP experiments. Biosci Microbiota Food Health 33:65–78CrossRefPubMedPubMedCentral
27.
go back to reference Jin JS, Touyama M, Kibe R, Tanaka Y, Benno Y, Kobayashi T, Shimakawa M, Maruo T, Toda T, Matsuda I, Tagami H, Matsumoto M, Seo G, Chonan O, Benno Y (2013) Analysis of the human intestinal microbiota from 92 volunteers after ingestion of identical meals. Benef Microbes 4:187–193CrossRefPubMed Jin JS, Touyama M, Kibe R, Tanaka Y, Benno Y, Kobayashi T, Shimakawa M, Maruo T, Toda T, Matsuda I, Tagami H, Matsumoto M, Seo G, Chonan O, Benno Y (2013) Analysis of the human intestinal microbiota from 92 volunteers after ingestion of identical meals. Benef Microbes 4:187–193CrossRefPubMed
28.
go back to reference Kobayashi T, Osaki T, Oikawa S (2015) Use of T-RFLP and seven restriction enzymes to compare the faecal microbiota of obese and lean Japanese healthy men. Benef Microbes 6:735–745CrossRefPubMed Kobayashi T, Osaki T, Oikawa S (2015) Use of T-RFLP and seven restriction enzymes to compare the faecal microbiota of obese and lean Japanese healthy men. Benef Microbes 6:735–745CrossRefPubMed
29.
go back to reference Faith JJ, Guruge JL, Charbonneau M, Subramanian S, Seedorf H, Goodman AL, Clemente JC, Knight R, Heath AC, Leibel RL, Rosenbaum M, Gordon JI (2013) The long-term stability of the human gut microbiota. Science 341:1237439CrossRefPubMedPubMedCentral Faith JJ, Guruge JL, Charbonneau M, Subramanian S, Seedorf H, Goodman AL, Clemente JC, Knight R, Heath AC, Leibel RL, Rosenbaum M, Gordon JI (2013) The long-term stability of the human gut microbiota. Science 341:1237439CrossRefPubMedPubMedCentral
30.
go back to reference Nagashima K, Hisada T, Sato M, Mochizuki J (2003) Application of new primer-enzyme combinations to terminal restriction fragment length polymorphism profiling of bacterial populations in human feces. Appl Environ Microbiol 69:1251–1262CrossRefPubMedPubMedCentral Nagashima K, Hisada T, Sato M, Mochizuki J (2003) Application of new primer-enzyme combinations to terminal restriction fragment length polymorphism profiling of bacterial populations in human feces. Appl Environ Microbiol 69:1251–1262CrossRefPubMedPubMedCentral
31.
go back to reference Nagashima K, Mochizuki J, Hisada T, Suzuki S, Shimomura S (2006) Phylogenetic analysis of 16S ribosomal RNA gene sequences from human fecal microbiota and lmproved utility of terminal restriction fragment length polymorphism profiling. Bioscience Microflora 25:99–107CrossRef Nagashima K, Mochizuki J, Hisada T, Suzuki S, Shimomura S (2006) Phylogenetic analysis of 16S ribosomal RNA gene sequences from human fecal microbiota and lmproved utility of terminal restriction fragment length polymorphism profiling. Bioscience Microflora 25:99–107CrossRef
32.
go back to reference Wu GD, Chen J, Hoffmann C, Bittinger K, Chen YY, Keilbaugh SA, Bewtra M, Knights D, Walters WA, Knight R, Sinha R, Gilroy E, Gupta K, Baldassano R, Nessel L, Li H, Bushman FD, Lewis JD (2011) Linking long-term dietary patterns with gut microbial enterotypes. Science 334:105–108CrossRefPubMedPubMedCentral Wu GD, Chen J, Hoffmann C, Bittinger K, Chen YY, Keilbaugh SA, Bewtra M, Knights D, Walters WA, Knight R, Sinha R, Gilroy E, Gupta K, Baldassano R, Nessel L, Li H, Bushman FD, Lewis JD (2011) Linking long-term dietary patterns with gut microbial enterotypes. Science 334:105–108CrossRefPubMedPubMedCentral
Metadata
Title
Characterization of gut microbiota profiles in coronary artery disease patients using data mining analysis of terminal restriction fragment length polymorphism: gut microbiota could be a diagnostic marker of coronary artery disease
Authors
Takuo Emoto
Tomoya Yamashita
Toshio Kobayashi
Naoto Sasaki
Yushi Hirota
Tomohiro Hayashi
Anna So
Kazuyuki Kasahara
Keiko Yodoi
Takuya Matsumoto
Taiji Mizoguchi
Wataru Ogawa
Ken-ichi Hirata
Publication date
01-01-2017
Publisher
Springer Japan
Published in
Heart and Vessels / Issue 1/2017
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-016-0841-y

Other articles of this Issue 1/2017

Heart and Vessels 1/2017 Go to the issue