Skip to main content
Top
Published in: Journal of Nuclear Cardiology 2/2010

01-04-2010 | Original Article

Alterations of pre- and postsynaptic noradrenergic signaling in a rat model of adriamycin-induced cardiotoxicity

Authors: Miran Kenk, BSc, James T. Thackeray, BSc, MSc, Stephanie L. Thorn, BSc, MSc, Karan Dhami, BSc, MD, Benjamin J. Chow, MD, FRCPC, FACC, FASNC, Kathy J. Ascah, MD, FRCPC, Jean N. DaSilva, PhD, Rob S. Beanlands, MD, FRCPC, FACC

Published in: Journal of Nuclear Cardiology | Issue 2/2010

Login to get access

Abstract

Background

Altered sympathetic nervous system signaling is known to play a role in the cardiotoxicity of the anthracycline chemotherapeutic agents, but the interaction of pre- and postsynaptic function is not well understood.

Methods and Results

Our aim was to study the noradrenergic signaling in an established rat model of adriamycin cardiotoxicity (15 mg/kg administered i.p. over 2 weeks) using radiotracers having potential applicability for imaging with positron emission tomography (PET). Ex vivo biodistribution was performed 1 and 3 weeks post-adriamycin treatment with the noradrenaline analogue [11C]meta-hydroxyephedrine ([11C]HED), β-adrenergic receptor antagonist [3H]CGP12177, and phosphodiesterase-4 inhibitor (R)-[11C]rolipram. Cardiac function (echocardiographic parameters) and heart/body weight ratio were not affected. Myocardial retention of [11C]HED, [3H]CGP12177, and (R)-[11C]rolipram were unchanged 1 week post-adriamycin. Compared to controls, 3 weeks post-treatment [3H]CGP12177 uptake decreased (left ventricle free wall and septum; P < 0.05), while [11C]HED and (R)-[11C]rolipram uptake were unaffected. Following acute increase in myocardial noradrenaline levels with desipramine treatment, (R)-[11C]rolipram retention increased in the left atrium, right ventricle, left ventricle free wall and septum (P < 0.05) in vehicle-, but not adriamycin-treated animals.

Conclusion

Our results suggest that adriamycin-induced toxicity exhibits no change in presynaptic noradrenaline uptake, but decreased β-adrenergic receptors in cardiac tissues, supporting a role for PET imaging of noradrenaline signaling in the study of anthracycline cardiotoxicity.
Literature
1.
go back to reference Minotti G, Menna P, Salvatorelli E, Cairo G, Gianni L. Anthracyclines: Molecular advances and pharmacologic developments in antitumor activity and cardiotoxicity. Pharmacol Rev 2004;56:185-229.CrossRefPubMed Minotti G, Menna P, Salvatorelli E, Cairo G, Gianni L. Anthracyclines: Molecular advances and pharmacologic developments in antitumor activity and cardiotoxicity. Pharmacol Rev 2004;56:185-229.CrossRefPubMed
2.
go back to reference Lefrak EA, Pitha J, Rosenheim S, Gottlieb JA. A clinicopathologic analysis of adriamycin cardiotoxicity. Cancer 1973;32:302-14.CrossRefPubMed Lefrak EA, Pitha J, Rosenheim S, Gottlieb JA. A clinicopathologic analysis of adriamycin cardiotoxicity. Cancer 1973;32:302-14.CrossRefPubMed
3.
go back to reference Singal PK, Deally CM, Weinberg LE. Subcellular effects of adriamycin in the heart: a concise review. J Mol Cell Cardiol 1987;19:817-28.CrossRefPubMed Singal PK, Deally CM, Weinberg LE. Subcellular effects of adriamycin in the heart: a concise review. J Mol Cell Cardiol 1987;19:817-28.CrossRefPubMed
4.
go back to reference Weinberg LE, Singal PK. Refractory heart failure and age-related differences in adriamycin-induced myocardial changes in rats. Can J Physiol Pharmacol 1987;65:1957-65.PubMed Weinberg LE, Singal PK. Refractory heart failure and age-related differences in adriamycin-induced myocardial changes in rats. Can J Physiol Pharmacol 1987;65:1957-65.PubMed
5.
go back to reference Bristow MR, Mason JW, Billingham ME, Daniels JR. Dose-effect and structure-function relationships in doxorubicin cardiomyopathy. Am Heart J 1981;102:709-18.CrossRefPubMed Bristow MR, Mason JW, Billingham ME, Daniels JR. Dose-effect and structure-function relationships in doxorubicin cardiomyopathy. Am Heart J 1981;102:709-18.CrossRefPubMed
6.
go back to reference Panjrath GS, Jain D. Monitoring chemotherapy-induced cardiotoxicity: Role of cardiac nuclear imaging. J Nucl Cardiol 2006;13:415-26.CrossRefPubMed Panjrath GS, Jain D. Monitoring chemotherapy-induced cardiotoxicity: Role of cardiac nuclear imaging. J Nucl Cardiol 2006;13:415-26.CrossRefPubMed
7.
go back to reference Dranitsaris G, Rayson D, Vincent M, Chang J, Gelmon K, Sandor D, et al. The development of a predictive model to estimate cardiotoxic risk for patients with metastatic breast cancer receiving anthracyclines. Breast Cancer Res Treat 2008;107:443-50.CrossRefPubMed Dranitsaris G, Rayson D, Vincent M, Chang J, Gelmon K, Sandor D, et al. The development of a predictive model to estimate cardiotoxic risk for patients with metastatic breast cancer receiving anthracyclines. Breast Cancer Res Treat 2008;107:443-50.CrossRefPubMed
8.
go back to reference Marchandise B, Schroeder E, Bosly A, Doyen C, Weynants P, Kremer R, et al. Early detection of doxorubicin cardiotoxicity: Interest of Doppler echocardiographic analysis of left ventricular filling dynamics. Am Heart J 1989;118:92-8.CrossRefPubMed Marchandise B, Schroeder E, Bosly A, Doyen C, Weynants P, Kremer R, et al. Early detection of doxorubicin cardiotoxicity: Interest of Doppler echocardiographic analysis of left ventricular filling dynamics. Am Heart J 1989;118:92-8.CrossRefPubMed
9.
go back to reference L’Ecuyer T, Sanjeev S, Thomas R, Novak R, Das L, Campbell W, et al. DNA damage is an early event in doxorubicin-induced cardiac myocyte death. Am J Physiol Heart Circ Physiol 2006;291:H1273-80.CrossRefPubMed L’Ecuyer T, Sanjeev S, Thomas R, Novak R, Das L, Campbell W, et al. DNA damage is an early event in doxorubicin-induced cardiac myocyte death. Am J Physiol Heart Circ Physiol 2006;291:H1273-80.CrossRefPubMed
10.
go back to reference Beanlands RS, Shaikh NA, Wen WH, Dawood F, Ugnat AM, McLaughlin PR, et al. Alterations in fatty acid metabolism in adriamycin cardiomyopathy. J Mol Cell Cardiol 1994;26:109-19.CrossRefPubMed Beanlands RS, Shaikh NA, Wen WH, Dawood F, Ugnat AM, McLaughlin PR, et al. Alterations in fatty acid metabolism in adriamycin cardiomyopathy. J Mol Cell Cardiol 1994;26:109-19.CrossRefPubMed
11.
go back to reference Tokarska-Schlattner M, Wallimann T, Schlattner U. Alterations in myocardial energy metabolism induced by the anti-cancer drug doxorubicin. C R Biol 2006;329:657-68.CrossRefPubMed Tokarska-Schlattner M, Wallimann T, Schlattner U. Alterations in myocardial energy metabolism induced by the anti-cancer drug doxorubicin. C R Biol 2006;329:657-68.CrossRefPubMed
12.
go back to reference Nousiainen T, Vanninen E, Jantunen E, Remes J, Ritanen E, Vuolteenaho O, et al. Neuroendocrine changes during the evolution of doxorubicin-induced left ventricular dysfunction in adult lymphoma patients. Clin Sci (Lond) 2001;101:601-7.CrossRef Nousiainen T, Vanninen E, Jantunen E, Remes J, Ritanen E, Vuolteenaho O, et al. Neuroendocrine changes during the evolution of doxorubicin-induced left ventricular dysfunction in adult lymphoma patients. Clin Sci (Lond) 2001;101:601-7.CrossRef
13.
go back to reference Tong J, Ganguly PK, Singal PK. Myocardial adrenergic changes at two stages of heart failure due to adriamycin treatment in rats. Am J Physiol 1991;260:H909-16.PubMed Tong J, Ganguly PK, Singal PK. Myocardial adrenergic changes at two stages of heart failure due to adriamycin treatment in rats. Am J Physiol 1991;260:H909-16.PubMed
14.
go back to reference Kawada T, Yamazaki T, Akiyama T, Sato T, Shishido T, Sugimachi M, et al. Chronic adriamycin treatment impairs myocardial interstitial neuronal release of norepinephrine and epinephrine. J Cardiovasc Pharmacol 2000;36(Suppl 2):S31-4.CrossRefPubMed Kawada T, Yamazaki T, Akiyama T, Sato T, Shishido T, Sugimachi M, et al. Chronic adriamycin treatment impairs myocardial interstitial neuronal release of norepinephrine and epinephrine. J Cardiovasc Pharmacol 2000;36(Suppl 2):S31-4.CrossRefPubMed
15.
go back to reference Yoshikawa T, Handa S, Suzuki M, Nagami K. Abnormalities in sympathoneuronal regulation are localized to failing myocardium in rabbit heart. J Am Coll Cardiol 1994;24:210-5.PubMedCrossRef Yoshikawa T, Handa S, Suzuki M, Nagami K. Abnormalities in sympathoneuronal regulation are localized to failing myocardium in rabbit heart. J Am Coll Cardiol 1994;24:210-5.PubMedCrossRef
16.
go back to reference Kizaki K, Akatsuka K, Momozaki M, Fujimori Y, Uchide T, Temma K, et al. Changes in myocardial beta1-adrenergic receptor and stimulatory G-protein gene expression after chronic treatment with doxorubicin in rat. J Vet Med Sci 2004;66:989-92.CrossRefPubMed Kizaki K, Akatsuka K, Momozaki M, Fujimori Y, Uchide T, Temma K, et al. Changes in myocardial beta1-adrenergic receptor and stimulatory G-protein gene expression after chronic treatment with doxorubicin in rat. J Vet Med Sci 2004;66:989-92.CrossRefPubMed
17.
go back to reference Lourenco CM, Kenk M, Beanlands RS, DaSilva JN. Increasing synaptic noradrenaline, serotonin and histamine enhances in vivo binding of phosphodiesterase-4 inhibitor (R)-[11C]rolipram in rat brain, lung and heart. Life Sci 2006;79:356-64.CrossRefPubMed Lourenco CM, Kenk M, Beanlands RS, DaSilva JN. Increasing synaptic noradrenaline, serotonin and histamine enhances in vivo binding of phosphodiesterase-4 inhibitor (R)-[11C]rolipram in rat brain, lung and heart. Life Sci 2006;79:356-64.CrossRefPubMed
18.
go back to reference Kenk M, Greene M, Thackeray J, Dekemp RA, Lortie M, Thorn S, et al. In vivo selective binding of (R)-[(11)C]rolipram to phosphodiesterase-4 provides the basis for studying intracellular cAMP signaling in the myocardium and other peripheral tissues. Nucl Med Biol 2007;34:71-7.CrossRefPubMed Kenk M, Greene M, Thackeray J, Dekemp RA, Lortie M, Thorn S, et al. In vivo selective binding of (R)-[(11)C]rolipram to phosphodiesterase-4 provides the basis for studying intracellular cAMP signaling in the myocardium and other peripheral tissues. Nucl Med Biol 2007;34:71-7.CrossRefPubMed
19.
go back to reference van Waarde A, Meeder JG, Blanksma PK, Bouwer J, Visser GM, Elsinga PH, et al. Suitability of CGP-12177 and CGP-26505 for quantitative imaging of beta-adrenoceptors. Int J Rad Appl Instrum B 1992;19:711-8.PubMed van Waarde A, Meeder JG, Blanksma PK, Bouwer J, Visser GM, Elsinga PH, et al. Suitability of CGP-12177 and CGP-26505 for quantitative imaging of beta-adrenoceptors. Int J Rad Appl Instrum B 1992;19:711-8.PubMed
20.
go back to reference Raffel D, Wieland D. Assessment of cardiac sympathetic nerve integrity with positron emission tomography. Nucl Med Biol 2001;28:541-59.CrossRefPubMed Raffel D, Wieland D. Assessment of cardiac sympathetic nerve integrity with positron emission tomography. Nucl Med Biol 2001;28:541-59.CrossRefPubMed
21.
go back to reference Tipre DN, Fox JJ, Holt DP, Green G, Yu J, Pomper M, et al. In vivo PET imaging of cardiac presynaptic sympathoneuronal mechanisms in the rat. J Nucl Med 2008;49:1189-95.CrossRefPubMed Tipre DN, Fox JJ, Holt DP, Green G, Yu J, Pomper M, et al. In vivo PET imaging of cardiac presynaptic sympathoneuronal mechanisms in the rat. J Nucl Med 2008;49:1189-95.CrossRefPubMed
22.
go back to reference deGrado TR, Hutchins G, Toorongian SA, Wieland DM, Schwaiger M. Myocardial kinetics of carbon-11-meta-hydroxyephedrine: Retention mechanisms and effects of norepinephrine. J Nucl Med 1993;34:1287-93.PubMed deGrado TR, Hutchins G, Toorongian SA, Wieland DM, Schwaiger M. Myocardial kinetics of carbon-11-meta-hydroxyephedrine: Retention mechanisms and effects of norepinephrine. J Nucl Med 1993;34:1287-93.PubMed
23.
go back to reference Thackeray JT, Beanlands RS, Dasilva JN. Presence of specific 11C-meta-hydroxyephedrine retention in heart, lung, pancreas, and brown adipose tissue. J Nucl Med 2007;48:1733-40.CrossRefPubMed Thackeray JT, Beanlands RS, Dasilva JN. Presence of specific 11C-meta-hydroxyephedrine retention in heart, lung, pancreas, and brown adipose tissue. J Nucl Med 2007;48:1733-40.CrossRefPubMed
24.
go back to reference Li T, Danelisen I, Bello-Klein A, Singal PK. Effects of probucol on changes of antioxidant enzymes in adriamycin-induced cardiomyopathy in rats. Cardiovasc Res 2000;46:523-30.CrossRefPubMed Li T, Danelisen I, Bello-Klein A, Singal PK. Effects of probucol on changes of antioxidant enzymes in adriamycin-induced cardiomyopathy in rats. Cardiovasc Res 2000;46:523-30.CrossRefPubMed
25.
go back to reference Ohkura K, Lee JD, Shimizu H, Nakano A, Uzui H, Horikoshi M, et al. Mitochondrials complex I activity is reduced in latent adriamycin-induced cardiomyopathy of rat. Mol Cell Biochem 2003;248:203-8.CrossRefPubMed Ohkura K, Lee JD, Shimizu H, Nakano A, Uzui H, Horikoshi M, et al. Mitochondrials complex I activity is reduced in latent adriamycin-induced cardiomyopathy of rat. Mol Cell Biochem 2003;248:203-8.CrossRefPubMed
26.
go back to reference Rosenspire KC, Haka MS, Van Dort ME, Jewett DM, Gildersleeve DL, Schwaiger M, et al. Synthesis and preliminary evaluation of carbon-11-meta-hydroxyephedrine: A false transmitter agent for heart neuronal imaging. J Nucl Med 1990;31:1328-34.PubMed Rosenspire KC, Haka MS, Van Dort ME, Jewett DM, Gildersleeve DL, Schwaiger M, et al. Synthesis and preliminary evaluation of carbon-11-meta-hydroxyephedrine: A false transmitter agent for heart neuronal imaging. J Nucl Med 1990;31:1328-34.PubMed
27.
go back to reference Link JM, Stratton JR, Levy W, Poole JE, Shoner SC, Stuetzle W, et al. PET measures of pre- and post-synaptic cardiac beta adrenergic function. Nucl Med Biol 2003;30:795-803.CrossRefPubMed Link JM, Stratton JR, Levy W, Poole JE, Shoner SC, Stuetzle W, et al. PET measures of pre- and post-synaptic cardiac beta adrenergic function. Nucl Med Biol 2003;30:795-803.CrossRefPubMed
28.
go back to reference DaSilva JN, Lourenco CM, Wilson AA, Houle S. Syntheses of the phosphodiesterase-4 inhibitors [11C]Ro 20-1724, R-, R/S- and S-[11C]rolipram. J Label Compd Radiopharm 2001;44:373-84.CrossRef DaSilva JN, Lourenco CM, Wilson AA, Houle S. Syntheses of the phosphodiesterase-4 inhibitors [11C]Ro 20-1724, R-, R/S- and S-[11C]rolipram. J Label Compd Radiopharm 2001;44:373-84.CrossRef
29.
go back to reference Thomas L, Bellmont S, Christen MO, La Roche B, Monassier L. Cardiovascular and survival effects of sympatho-inhibitors in adriamycin-induced cardiomyopathy in rats. Fundam Clin Pharmacol 2004;18:649-55.CrossRefPubMed Thomas L, Bellmont S, Christen MO, La Roche B, Monassier L. Cardiovascular and survival effects of sympatho-inhibitors in adriamycin-induced cardiomyopathy in rats. Fundam Clin Pharmacol 2004;18:649-55.CrossRefPubMed
30.
go back to reference Degrado TR, Zalutsky MR, Vaidyanathan G. Uptake mechanisms of meta-[123I]iodobenzylguanidine in isolated rat heart. Nucl Med Biol 1995;22:1-12.CrossRefPubMed Degrado TR, Zalutsky MR, Vaidyanathan G. Uptake mechanisms of meta-[123I]iodobenzylguanidine in isolated rat heart. Nucl Med Biol 1995;22:1-12.CrossRefPubMed
31.
go back to reference Wakasugi S, Wada A, Hasegawa Y, Nakano S, Shibata N. Detection of abnormal cardiac adrenergic neuron activity in adriamycin-induced cardiomyopathy with iodine-125-metaiodobenzylguanidine. J Nucl Med 1992;33:208-14.PubMed Wakasugi S, Wada A, Hasegawa Y, Nakano S, Shibata N. Detection of abnormal cardiac adrenergic neuron activity in adriamycin-induced cardiomyopathy with iodine-125-metaiodobenzylguanidine. J Nucl Med 1992;33:208-14.PubMed
32.
go back to reference Hausdorff WP, Caron MG, Lefkowitz RJ. Turning off the signal: Desensitization of beta-adrenergic receptor function. Faseb J 1990;4:2881-9.PubMed Hausdorff WP, Caron MG, Lefkowitz RJ. Turning off the signal: Desensitization of beta-adrenergic receptor function. Faseb J 1990;4:2881-9.PubMed
33.
go back to reference Bristow MR, Ginsburg R, Minobe W, Cubicciotti RS, Sageman WS, Lurie K, et al. Decreased catecholamine sensitivity and beta-adrenergic-receptor density in failing human hearts. N Engl J Med 1982;307:205-11.PubMed Bristow MR, Ginsburg R, Minobe W, Cubicciotti RS, Sageman WS, Lurie K, et al. Decreased catecholamine sensitivity and beta-adrenergic-receptor density in failing human hearts. N Engl J Med 1982;307:205-11.PubMed
34.
go back to reference Van Waarde A, Elsinga PH, Brodde O-E, Visser GM, Vaalburg W. Myocardial and pulmonary uptake of S-1’[18F]fluorocarazolol in intact rats reflects radioligand binding to ß-adrenoceptors. Eur J Pharmacol 1995;272:159-68.CrossRefPubMed Van Waarde A, Elsinga PH, Brodde O-E, Visser GM, Vaalburg W. Myocardial and pulmonary uptake of S-1’[18F]fluorocarazolol in intact rats reflects radioligand binding to ß-adrenoceptors. Eur J Pharmacol 1995;272:159-68.CrossRefPubMed
35.
go back to reference Engels P, Fichtel K, Lübbert H. Expression and regulation of human and rat phosphodiesterase type IV isogenes. FEBS Lett 1994;350:291-5.CrossRefPubMed Engels P, Fichtel K, Lübbert H. Expression and regulation of human and rat phosphodiesterase type IV isogenes. FEBS Lett 1994;350:291-5.CrossRefPubMed
36.
go back to reference Manning CD, McLaughlin MM, Livi GP, Cieslinski LB, Torphy TJ, Barnette MS. Prolonged beta adrenoceptor stimulation up-regulates cAMP phosphodiesterase activity in human monocytes by increasing mRNA and protein for phosphodiesterases 4A and 4B. J Pharmacol Exp Ther 1996;276:810-8.PubMed Manning CD, McLaughlin MM, Livi GP, Cieslinski LB, Torphy TJ, Barnette MS. Prolonged beta adrenoceptor stimulation up-regulates cAMP phosphodiesterase activity in human monocytes by increasing mRNA and protein for phosphodiesterases 4A and 4B. J Pharmacol Exp Ther 1996;276:810-8.PubMed
37.
go back to reference Sette C, Iona S, Conti M. The short-term activation of a rolipram-sensitive, cAMP-specific phosphodiesterase by thyroid-stimulating hormone in thyroid FRTL-5 cells is mediated by a cAMP-dependent phosphorylation. J Biol Chem 1994;269:9245-52.PubMed Sette C, Iona S, Conti M. The short-term activation of a rolipram-sensitive, cAMP-specific phosphodiesterase by thyroid-stimulating hormone in thyroid FRTL-5 cells is mediated by a cAMP-dependent phosphorylation. J Biol Chem 1994;269:9245-52.PubMed
38.
go back to reference Madelian V, La Vigne E. Rapid regulation of a cyclic AMP-specific phosphodiesterase (PDE IV) by forskolin and isoproterenol in LRM55 astroglial cells. Biochem Pharmacol 1996;51:1739-47.CrossRefPubMed Madelian V, La Vigne E. Rapid regulation of a cyclic AMP-specific phosphodiesterase (PDE IV) by forskolin and isoproterenol in LRM55 astroglial cells. Biochem Pharmacol 1996;51:1739-47.CrossRefPubMed
39.
go back to reference Calderone A, de Champlain J, Rouleau JL. Adriamycin-induced changes to the myocardial beta-adrenergic system in the rabbit. J Mol Cell Cardiol 1991;23:333-42.CrossRefPubMed Calderone A, de Champlain J, Rouleau JL. Adriamycin-induced changes to the myocardial beta-adrenergic system in the rabbit. J Mol Cell Cardiol 1991;23:333-42.CrossRefPubMed
40.
go back to reference Fu M, Matoba M, Liang QM, Sjogren KG, Hjalmarson A. Properties of G-protein modulated receptor-adenylyl cyclase system in myocardium of spontaneously hypertensive rats treated with adriamycin. Int J Cardiol 1994;44:9-18.CrossRefPubMed Fu M, Matoba M, Liang QM, Sjogren KG, Hjalmarson A. Properties of G-protein modulated receptor-adenylyl cyclase system in myocardium of spontaneously hypertensive rats treated with adriamycin. Int J Cardiol 1994;44:9-18.CrossRefPubMed
41.
go back to reference de Jong RM, Willemsen AT, Slart RH, Blanksma PK, van Waarde A, Cornel JH, et al. Myocardial beta-adrenoceptor downregulation in idiopathic dilated cardiomyopathy measured in vivo with PET using the new radioligand (S)-[11C]CGP12388. Eur J Nucl Med Mol Imaging 2005;32:443-7.CrossRefPubMed de Jong RM, Willemsen AT, Slart RH, Blanksma PK, van Waarde A, Cornel JH, et al. Myocardial beta-adrenoceptor downregulation in idiopathic dilated cardiomyopathy measured in vivo with PET using the new radioligand (S)-[11C]CGP12388. Eur J Nucl Med Mol Imaging 2005;32:443-7.CrossRefPubMed
42.
go back to reference Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: A retrospective analysis of three trials. Cancer 2003;97:2869-79.CrossRefPubMed Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: A retrospective analysis of three trials. Cancer 2003;97:2869-79.CrossRefPubMed
Metadata
Title
Alterations of pre- and postsynaptic noradrenergic signaling in a rat model of adriamycin-induced cardiotoxicity
Authors
Miran Kenk, BSc
James T. Thackeray, BSc, MSc
Stephanie L. Thorn, BSc, MSc
Karan Dhami, BSc, MD
Benjamin J. Chow, MD, FRCPC, FACC, FASNC
Kathy J. Ascah, MD, FRCPC
Jean N. DaSilva, PhD
Rob S. Beanlands, MD, FRCPC, FACC
Publication date
01-04-2010
Publisher
Springer-Verlag
Published in
Journal of Nuclear Cardiology / Issue 2/2010
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI
https://doi.org/10.1007/s12350-009-9190-x

Other articles of this Issue 2/2010

Journal of Nuclear Cardiology 2/2010 Go to the issue