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García-Mendívil L, Pérez-Zabalza M, Duwé S, Ordovás L, Pueyo E. Automatic quantification of myocardial remodeling features in human ventricular tissue from label-free microscopy. STAR Protoc 2023; 4:102730. [PMID: 37980568 PMCID: PMC10694586 DOI: 10.1016/j.xpro.2023.102730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/03/2023] [Accepted: 11/02/2023] [Indexed: 11/21/2023] Open
Abstract
The procedures used routinely for collagen and lipofuscin evaluation are, in many cases, qualitative, observer dependent, and disregard spatial distribution. Here, we present a protocol for automatic quantification and spatial characterization of collagen and lipofuscin from label-free microscopy images of human ventricular tissues. We describe the steps for sample collection, tissue processing, image acquisition, and quantification of collagen and lipofuscin. This protocol avoids discrepancies between observers and can be adapted to other tissues and species. For complete details on the use and execution of this protocol, please refer to García-Mendívil et al. (2022).1.
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Affiliation(s)
- Laura García-Mendívil
- Biomedical Signal Interpretation and Computational Simulation Group (BSICoS), Aragón Institute of Engineering Research, University of Zaragoza, 50018 Zaragoza, Spain; BSICoS, Instituto de Investigación Sanitaria Aragón (IISA), 50018 Zaragoza, Spain.
| | - María Pérez-Zabalza
- Biomedical Signal Interpretation and Computational Simulation Group (BSICoS), Aragón Institute of Engineering Research, University of Zaragoza, 50018 Zaragoza, Spain; BSICoS, Instituto de Investigación Sanitaria Aragón (IISA), 50018 Zaragoza, Spain; Defense University Centre (CUD), 50090 Zaragoza, Spain.
| | - Sam Duwé
- Advanced Optical Microscopy Centre, Biomedical Research Institute, Hasselt University, 3500 Diepenbeek, Belgium
| | - Laura Ordovás
- Biomedical Signal Interpretation and Computational Simulation Group (BSICoS), Aragón Institute of Engineering Research, University of Zaragoza, 50018 Zaragoza, Spain; BSICoS, Instituto de Investigación Sanitaria Aragón (IISA), 50018 Zaragoza, Spain; Fundación Agencia Aragonesa para la Investigación y el Desarrollo (ARAID), 50018 Zaragoza, Spain.
| | - Esther Pueyo
- Biomedical Signal Interpretation and Computational Simulation Group (BSICoS), Aragón Institute of Engineering Research, University of Zaragoza, 50018 Zaragoza, Spain; BSICoS, Instituto de Investigación Sanitaria Aragón (IISA), 50018 Zaragoza, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 50018 Zaragoza, Spain
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2
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García-Mendívil L, Pérez-Zabalza M, Oliver-Gelabert A, Vallejo-Gil JM, Fañanás-Mastral J, Vázquez-Sancho M, Bellido-Morales JA, Vaca-Núñez AS, Ballester-Cuenca C, Diez E, Ordovás L, Pueyo E. Interindividual Age-Independent Differences in Human CX43 Impact Ventricular Arrhythmic Risk. Research (Wash D C) 2023; 6:0254. [PMID: 38023417 PMCID: PMC10650968 DOI: 10.34133/research.0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023]
Abstract
Connexin 43 (CX43) is one of the major components of gap junctions, the structures responsible for the intercellular communication and transmission of the electrical impulse in the left ventricle. There is limited information on the histological changes of CX43 with age and their effect on electrophysiology, especially in humans. Here, we analyzed left ventricular biopsies from living donors starting at midlife to characterize age-related CX43 remodeling. We assessed its quantity, degree of lateralization, and spatial heterogeneity together with fibrotic deposition. We observed no significant age-related remodeling of CX43. Only spatial heterogeneity increased slightly with age, and this increase was better explained by biological age than by chronological age. Importantly, we found that CX43 features varied considerably among individuals in our population with no relevant relationship to age or fibrosis content, in contrast to animal species. We used our experimental results to feed computational models of human ventricular electrophysiology and to assess the effects of interindividual differences in specific features of CX43 and fibrosis on conduction velocity, action potential duration, and arrhythmogenicity. We found that larger amounts of fibrosis were associated with the highest arrhythmic risk, with this risk being increased when fibrosis deposition was combined with a reduction in CX43 amount and/or with an increase in CX43 spatial heterogeneity. These mechanisms underlying high arrhythmic risk in some individuals were not associated with age in our study population. In conclusion, our data rule out CX43 remodeling as an age-related arrhythmic substrate in the population beyond midlife, but highlight its potential as a proarrhythmic factor at the individual level, especially when combined with increased fibrosis.
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Affiliation(s)
- Laura García-Mendívil
- Biomedical Signal Interpretation and Computational Simulation group (BSICoS), Aragón Institute of Engineering Research,
University of Zaragoza, Zaragoza 50018, Spain
- BSICoS, Instituto de Investigación Sanitaria Aragón (IISA), Zaragoza 50018, Spain
| | - María Pérez-Zabalza
- Biomedical Signal Interpretation and Computational Simulation group (BSICoS), Aragón Institute of Engineering Research,
University of Zaragoza, Zaragoza 50018, Spain
- BSICoS, Instituto de Investigación Sanitaria Aragón (IISA), Zaragoza 50018, Spain
- Centro Universitario de la Defensa (CUD), Zaragoza 50090, Spain
| | - Antoni Oliver-Gelabert
- Biomedical Signal Interpretation and Computational Simulation group (BSICoS), Aragón Institute of Engineering Research,
University of Zaragoza, Zaragoza 50018, Spain
- BSICoS, Instituto de Investigación Sanitaria Aragón (IISA), Zaragoza 50018, Spain
| | - José María Vallejo-Gil
- Department of Cardiovascular Surgery,
University Hospital Miguel Servet, Zaragoza 50009, Spain
| | - Javier Fañanás-Mastral
- Department of Cardiovascular Surgery,
University Hospital Miguel Servet, Zaragoza 50009, Spain
| | - Manuel Vázquez-Sancho
- Department of Cardiovascular Surgery,
University Hospital Miguel Servet, Zaragoza 50009, Spain
| | | | | | - Carlos Ballester-Cuenca
- Department of Cardiovascular Surgery,
University Hospital Miguel Servet, Zaragoza 50009, Spain
| | - Emiliano Diez
- Institute of Experimental Medicine and Biology of Cuyo (IMBECU), CONICET, Mendoza 5500, Argentina
| | - Laura Ordovás
- Biomedical Signal Interpretation and Computational Simulation group (BSICoS), Aragón Institute of Engineering Research,
University of Zaragoza, Zaragoza 50018, Spain
- BSICoS, Instituto de Investigación Sanitaria Aragón (IISA), Zaragoza 50018, Spain
- Fundación Agencia Aragonesa para la Investigación y el Desarrollo (ARAID), Zaragoza 50018, Spain
| | - Esther Pueyo
- Biomedical Signal Interpretation and Computational Simulation group (BSICoS), Aragón Institute of Engineering Research,
University of Zaragoza, Zaragoza 50018, Spain
- BSICoS, Instituto de Investigación Sanitaria Aragón (IISA), Zaragoza 50018, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza 50018, Spain
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3
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García-Mendívil L, Pérez-Zabalza M, Mountris K, Duwé S, Smisdom N, Pérez M, Luján L, Wolfs E, Driesen RB, Vallejo-Gil JM, Fresneda-Roldán PC, Fañanás-Mastral J, Vázquez-Sancho M, Matamala-Adell M, Sorribas-Berjón JF, Bellido-Morales JA, Mancebón-Sierra FJ, Vaca-Núñez AS, Ballester-Cuenca C, Oliván-Viguera A, Diez E, Ordovás L, Pueyo E. Analysis of age-related left ventricular collagen remodeling in living donors: Implications in arrhythmogenesis. iScience 2022; 25:103822. [PMID: 35198884 PMCID: PMC8850748 DOI: 10.1016/j.isci.2022.103822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/14/2021] [Accepted: 01/25/2022] [Indexed: 12/18/2022] Open
Abstract
Age-related fibrosis in the left ventricle (LV) has been mainly studied in animals by assessing collagen content. Using second-harmonic generation microscopy and image processing, we evaluated amount, aggregation and spatial distribution of LV collagen in young to old pigs, and middle-age and elder living donors. All collagen features increased when comparing adult and old pigs with young ones, but not when comparing adult with old pigs or middle-age with elder individuals. Remarkably, all collagen parameters strongly correlated with lipofuscin, a biological age marker, in humans. By building patient-specific models of human ventricular tissue electrophysiology, we confirmed that amount and organization of fibrosis modulated arrhythmia vulnerability, and that distribution should be accounted for arrhythmia risk assessment. In conclusion, we characterize the age-associated changes in LV collagen and its potential implications for ventricular arrhythmia development. Consistency between pig and human results substantiate the pig as a relevant model of age-related LV collagen dynamics. Collagen remodeling traits change from youth to adulthood, not from midlife onwards In humans, collagen remodeling traits relate with the biological age-pigment lipofuscin Beyond collagen amount, its distribution also influences ventricular arrhythmogenesis Consistent age-related remodeling was observed amid healthy farm pigs and living donors
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Affiliation(s)
- Laura García-Mendívil
- Biomedical Signal Interpretation and Computational Simulation Group (BSICoS), Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza 50018, Spain.,BSICoS, IIS Aragón, Zaragoza 50018, Spain
| | - María Pérez-Zabalza
- Biomedical Signal Interpretation and Computational Simulation Group (BSICoS), Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza 50018, Spain.,BSICoS, IIS Aragón, Zaragoza 50018, Spain
| | - Konstantinos Mountris
- Biomedical Signal Interpretation and Computational Simulation Group (BSICoS), Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza 50018, Spain.,BSICoS, IIS Aragón, Zaragoza 50018, Spain
| | - Sam Duwé
- Advanced Optical Microscopy Centre, Biomedical Research Institute, Hasselt University, Diepenbeek 3500, Belgium
| | - Nick Smisdom
- Biomedical Research Institute, Hasselt University, Diepenbeek 3500, Belgium
| | - Marta Pérez
- Department of Anatomy, Embryology and Animal Genetics, University of Zaragoza, Zaragoza 50013, Spain.,Instituto Universitario de Investigación Mixto Agroalimentario de Aragón (IA2), University of Zaragoza, Zaragoza 50013, Spain
| | - Lluís Luján
- Instituto Universitario de Investigación Mixto Agroalimentario de Aragón (IA2), University of Zaragoza, Zaragoza 50013, Spain.,Department of Animal Pathology, University of Zaragoza, Zaragoza 50013, Spain
| | - Esther Wolfs
- Biomedical Research Institute, Hasselt University, Diepenbeek 3500, Belgium
| | - Ronald B Driesen
- Biomedical Research Institute, Hasselt University, Diepenbeek 3500, Belgium
| | - José María Vallejo-Gil
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, Zaragoza 50009, Spain
| | | | - Javier Fañanás-Mastral
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, Zaragoza 50009, Spain
| | - Manuel Vázquez-Sancho
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, Zaragoza 50009, Spain
| | - Marta Matamala-Adell
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, Zaragoza 50009, Spain
| | | | | | | | | | - Carlos Ballester-Cuenca
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, Zaragoza 50009, Spain
| | - Aida Oliván-Viguera
- Biomedical Signal Interpretation and Computational Simulation Group (BSICoS), Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza 50018, Spain.,BSICoS, IIS Aragón, Zaragoza 50018, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza 50018, Spain
| | - Emiliano Diez
- Institute of Experimental Medicine and Biology of Cuyo (IMBECU), CONICET, Mendoza 5500, Argentina
| | - Laura Ordovás
- Biomedical Signal Interpretation and Computational Simulation Group (BSICoS), Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza 50018, Spain.,BSICoS, IIS Aragón, Zaragoza 50018, Spain.,ARAID Foundation, Zaragoza 50018, Spain
| | - Esther Pueyo
- Biomedical Signal Interpretation and Computational Simulation Group (BSICoS), Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza 50018, Spain.,BSICoS, IIS Aragón, Zaragoza 50018, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza 50018, Spain
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4
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Oliván-Viguera A, Pérez-Zabalza M, García-Mendívil L, Mountris KA, Orós-Rodrigo S, Ramos-Marquès E, Vallejo-Gil JM, Fresneda-Roldán PC, Fañanás-Mastral J, Vázquez-Sancho M, Matamala-Adell M, Sorribas-Berjón F, Bellido-Morales JA, Mancebón-Sierra FJ, Vaca-Núñez AS, Ballester-Cuenca C, Marigil MÁ, Pastor C, Ordovás L, Köhler R, Diez E, Pueyo E. Minimally invasive system to reliably characterize ventricular electrophysiology from living donors. Sci Rep 2020; 10:19941. [PMID: 33203905 PMCID: PMC7673124 DOI: 10.1038/s41598-020-77076-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/03/2020] [Indexed: 01/03/2023] Open
Abstract
Cardiac tissue slices preserve the heterogeneous structure and multicellularity of the myocardium and allow its functional characterization. However, access to human ventricular samples is scarce. We aim to demonstrate that slices from small transmural core biopsies collected from living donors during routine cardiac surgery preserve structural and functional properties of larger myocardial specimens, allowing accurate electrophysiological characterization. In pigs, we compared left ventricular transmural core biopsies with transmural tissue blocks from the same ventricular region. In humans, we analyzed transmural biopsies and papillary muscles from living donors. All tissues were vibratome-sliced. By histological analysis of the transmural biopsies, we showed that tissue architecture and cellular organization were preserved. Enzymatic and vital staining methods verified viability. Optically mapped transmembrane potentials confirmed that action potential duration and morphology were similar in pig biopsies and tissue blocks. Action potential morphology and duration in human biopsies and papillary muscles agreed with published ranges. In both pigs and humans, responses to increasing pacing frequencies and β-adrenergic stimulation were similar in transmural biopsies and larger tissues. We show that it is possible to successfully collect and characterize tissue slices from human myocardial biopsies routinely extracted from living donors, whose behavior mimics that of larger myocardial preparations both structurally and electrophysiologically.
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Affiliation(s)
- Aida Oliván-Viguera
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragón, Institute of Engineering Research (I3A) and Instituto de Investigación Sanitaria (IIS) Aragón, University of Zaragoza, Edificio I+D+i, C/Mariano Esquillor s/n, 50018, Zaragoza, Spain.
| | - María Pérez-Zabalza
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragón, Institute of Engineering Research (I3A) and Instituto de Investigación Sanitaria (IIS) Aragón, University of Zaragoza, Edificio I+D+i, C/Mariano Esquillor s/n, 50018, Zaragoza, Spain
| | - Laura García-Mendívil
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragón, Institute of Engineering Research (I3A) and Instituto de Investigación Sanitaria (IIS) Aragón, University of Zaragoza, Edificio I+D+i, C/Mariano Esquillor s/n, 50018, Zaragoza, Spain
| | - Konstantinos A Mountris
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragón, Institute of Engineering Research (I3A) and Instituto de Investigación Sanitaria (IIS) Aragón, University of Zaragoza, Edificio I+D+i, C/Mariano Esquillor s/n, 50018, Zaragoza, Spain
| | - Sofía Orós-Rodrigo
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragón, Institute of Engineering Research (I3A) and Instituto de Investigación Sanitaria (IIS) Aragón, University of Zaragoza, Edificio I+D+i, C/Mariano Esquillor s/n, 50018, Zaragoza, Spain
| | - Estel Ramos-Marquès
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragón, Institute of Engineering Research (I3A) and Instituto de Investigación Sanitaria (IIS) Aragón, University of Zaragoza, Edificio I+D+i, C/Mariano Esquillor s/n, 50018, Zaragoza, Spain
| | - José María Vallejo-Gil
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, Zaragoza, Spain
| | | | - Javier Fañanás-Mastral
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, Zaragoza, Spain
| | - Manuel Vázquez-Sancho
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, Zaragoza, Spain
| | - Marta Matamala-Adell
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, Zaragoza, Spain
| | | | | | | | | | | | | | | | - Laura Ordovás
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragón, Institute of Engineering Research (I3A) and Instituto de Investigación Sanitaria (IIS) Aragón, University of Zaragoza, Edificio I+D+i, C/Mariano Esquillor s/n, 50018, Zaragoza, Spain.,Aragón Agency for Research and Development (ARAID), Zaragoza, Spain
| | - Ralf Köhler
- Aragón Institute of Health Sciences (IACS), Zaragoza, Spain.,Aragón Agency for Research and Development (ARAID), Zaragoza, Spain
| | - Emiliano Diez
- Institute of Experimental Medicine and Biology of Cuyo (IMBECU), CONICET, Mendoza, Argentina
| | - Esther Pueyo
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragón, Institute of Engineering Research (I3A) and Instituto de Investigación Sanitaria (IIS) Aragón, University of Zaragoza, Edificio I+D+i, C/Mariano Esquillor s/n, 50018, Zaragoza, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
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5
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Oliver-Gelabert A, García-Mendívil L, Vallejo-Gil JM, Fresneda-Roldán PC, Andelová K, Fañanás-Mastral J, Vázquez-Sancho M, Matamala-Adell M, Sorribas-Berjón F, Ballester-Cuenca C, Tribulova N, Ordovás L, Raúl Diez E, Pueyo E. Automatic Quantification of Cardiomyocyte Dimensions and Connexin 43 Lateralization in Fluorescence Images. Biomolecules 2020; 10:E1334. [PMID: 32957719 PMCID: PMC7565961 DOI: 10.3390/biom10091334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiomyocytes' geometry and connexin 43 (CX43) amount and distribution are structural features that play a pivotal role in electrical conduction. Their quantitative assessment is of high interest in the study of arrhythmias, but it is usually hampered by the lack of automatic tools. In this work, we propose a software algorithm (Myocyte Automatic Retrieval and Tissue Analyzer, MARTA) to automatically detect myocytes from fluorescent microscopy images of cardiac tissue, measure their morphological features and evaluate the expression of CX43 and its degree of lateralization. The proposed software is based on the generation of cell masks, contouring of individual cells, enclosing of cells in minimum area rectangles and splitting of these rectangles into end-to-end and middle compartments to estimate CX43 lateral-to-total ratio. Application to human ventricular tissue images shows that mean differences between automatic and manual methods in terms of cardiomyocyte length and width are below 4 μm. The percentage of lateral CX43 also agrees between automatic and manual evaluation, with the interquartile range approximately covering from 3% to 30% in both cases. MARTA is not limited by fiber orientation and has an optimized speed by using contour filtering, which makes it run hundreds of times faster than a trained expert. Developed for CX43 studies in the left ventricle, MARTA is a flexible tool applicable to morphometric and lateralization studies of other markers in any heart chamber or even skeletal muscle. This open-access software is available online.
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Affiliation(s)
- Antoni Oliver-Gelabert
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Institute of Engineering Research (I3A), University of Zaragoza & Instituto de Investigación Sanitaria (IIS), 50018 Zaragoza, Spain; (A.O.-G.); (L.G.-M.); (L.O.)
| | - Laura García-Mendívil
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Institute of Engineering Research (I3A), University of Zaragoza & Instituto de Investigación Sanitaria (IIS), 50018 Zaragoza, Spain; (A.O.-G.); (L.G.-M.); (L.O.)
| | - José María Vallejo-Gil
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, 50018 Zaragoza, Spain; (J.M.V.-G.); (P.C.F.-R.); (J.F.-M.); (M.V.-S.); (M.M.-A.); (F.S.-B.); (C.B.-C.)
| | - Pedro Carlos Fresneda-Roldán
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, 50018 Zaragoza, Spain; (J.M.V.-G.); (P.C.F.-R.); (J.F.-M.); (M.V.-S.); (M.M.-A.); (F.S.-B.); (C.B.-C.)
| | - Katarína Andelová
- Centre of Experimental Medicine, SAS, 84104 Bratislava, Slovakia; (K.A.); (N.T.)
| | - Javier Fañanás-Mastral
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, 50018 Zaragoza, Spain; (J.M.V.-G.); (P.C.F.-R.); (J.F.-M.); (M.V.-S.); (M.M.-A.); (F.S.-B.); (C.B.-C.)
| | - Manuel Vázquez-Sancho
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, 50018 Zaragoza, Spain; (J.M.V.-G.); (P.C.F.-R.); (J.F.-M.); (M.V.-S.); (M.M.-A.); (F.S.-B.); (C.B.-C.)
| | - Marta Matamala-Adell
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, 50018 Zaragoza, Spain; (J.M.V.-G.); (P.C.F.-R.); (J.F.-M.); (M.V.-S.); (M.M.-A.); (F.S.-B.); (C.B.-C.)
| | - Fernando Sorribas-Berjón
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, 50018 Zaragoza, Spain; (J.M.V.-G.); (P.C.F.-R.); (J.F.-M.); (M.V.-S.); (M.M.-A.); (F.S.-B.); (C.B.-C.)
| | - Carlos Ballester-Cuenca
- Department of Cardiovascular Surgery, University Hospital Miguel Servet, 50018 Zaragoza, Spain; (J.M.V.-G.); (P.C.F.-R.); (J.F.-M.); (M.V.-S.); (M.M.-A.); (F.S.-B.); (C.B.-C.)
| | - Narcisa Tribulova
- Centre of Experimental Medicine, SAS, 84104 Bratislava, Slovakia; (K.A.); (N.T.)
| | - Laura Ordovás
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Institute of Engineering Research (I3A), University of Zaragoza & Instituto de Investigación Sanitaria (IIS), 50018 Zaragoza, Spain; (A.O.-G.); (L.G.-M.); (L.O.)
- Aragon Agency for Research and Development (ARAID), 50018 Zaragoza, Spain
| | - Emiliano Raúl Diez
- Institute of Experimental Medicine and Biology of Cuyo (IMBECU), CONICET, 855 5500 Mendoza, Argentina
| | - Esther Pueyo
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Institute of Engineering Research (I3A), University of Zaragoza & Instituto de Investigación Sanitaria (IIS), 50018 Zaragoza, Spain; (A.O.-G.); (L.G.-M.); (L.O.)
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 50018 Zaragoza, Spain
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