{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T13:47:53Z","timestamp":1779889673432,"version":"3.53.1"},"reference-count":46,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T00:00:00Z","timestamp":1701388800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union","award":["RRF-2.3.1-21-2022-00003"],"award-info":[{"award-number":["RRF-2.3.1-21-2022-00003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Background: Ventricular tachycardia (VT) recurrence after catheter ablation remains a concern, emphasizing the need for precise risk assessment. We aimed to use machine learning (ML) to predict 1-month and 1-year VT recurrence following VT ablation. Methods: For 337 patients undergoing VT ablation, we collected 31 parameters including medical history, echocardiography, and procedural data. 17 relevant features were included in the ML-based feature selection, which yielded six and five optimal features for 1-month and 1-year recurrence, respectively. We trained several supervised machine learning models using 10-fold cross-validation for each endpoint. Results: We observed 1-month VT recurrence was observed in 60 (18%) cases and accurately predicted using our model with an area under the receiver operating curve (AUC) of 0.73. Input features used were hemodynamic instability, incessant VT, ICD shock, left ventricular ejection fraction, TAPSE, and non-inducibility of the clinical VT at the end of the procedure. A separate model was trained for 1-year VT recurrence (observed in 117 (35%) cases) with a mean AUC of 0.71. Selected features were hemodynamic instability, the number of inducible VT morphologies, left ventricular systolic diameter, mitral regurgitation, and ICD shock. For both endpoints, a random forest model displayed the highest performance. Conclusions: Our ML models effectively predict VT recurrence post-ablation, aiding in identifying high-risk patients and tailoring follow-up strategies.<\/jats:p>","DOI":"10.3390\/bioengineering10121386","type":"journal-article","created":{"date-parts":[[2023,12,2]],"date-time":"2023-12-02T13:45:41Z","timestamp":1701524741000},"page":"1386","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Machine-Learning-Based Prediction of 1-Year Arrhythmia Recurrence after Ventricular Tachycardia Ablation in Patients with Structural Heart Disease"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3260-2471","authenticated-orcid":false,"given":"Ferenc","family":"Koml\u00f3si","sequence":"first","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrik","family":"T\u00f3th","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gyula","family":"Bohus","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"V\u00e1mosi","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3036-4131","authenticated-orcid":false,"given":"M\u00e1rton","family":"Tokodi","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N\u00e1ndor","family":"Szegedi","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zolt\u00e1n","family":"Sall\u00f3","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1428-3588","authenticated-orcid":false,"given":"Katalin","family":"Piros","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"Perge","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8209-990X","authenticated-orcid":false,"given":"Istv\u00e1n","family":"Osztheimer","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5645-9855","authenticated-orcid":false,"given":"P\u00e1l","family":"\u00c1brah\u00e1m","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00e1bor","family":"Sz\u00e9plaki","sequence":"additional","affiliation":[{"name":"Mater Private Hospital, 69 Eccles St., D07 WKW8 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e9la","family":"Merkely","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00e1szl\u00f3","family":"Gell\u00e9r","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaudia","family":"Nagy","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, V\u00e1rosmajor u. 68, 1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1161\/01.CIR.0000022692.49934.E3","article-title":"Sustained Ventricular Arrhythmias among Patients with Acute Coronary Syndromes with No ST-Segment Elevation: Incidence, Predictors, and Outcomes","volume":"106","author":"Granger","year":"2002","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1056\/NEJM199612263352601","article-title":"Improved Survival with an Implanted Defibrillator in Patients with Coronary Disease at High Risk for Ventricular Arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators","volume":"335","author":"Moss","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1056\/NEJMoa071098","article-title":"Prognostic Importance of Defibrillator Shocks in Patients with Heart Failure","volume":"359","author":"Poole","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1097\/JCN.0000000000000610","article-title":"Implantable Cardioverter Defibrillator Shocks and Psychological Distress: Examining the Mediating Roles of Implantable Cardioverter Defibrillator-Related Concerns and Perceived Control","volume":"35","author":"Lee","year":"2020","journal-title":"J. Cardiovasc. Nurs."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/S0140-6736(96)08171-8","article-title":"Randomised Trial of Outcome after Myocardial Infarction in Patients with Frequent or Repetitive Ventricular Premature Depolarisations: CAMIAT","volume":"349","author":"Cairns","year":"1997","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1056\/NEJMoa1513614","article-title":"Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs","volume":"375","author":"Sapp","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1016\/j.hrthm.2016.03.004","article-title":"Comparative Effectiveness of Antiarrhythmic Drugs and Catheter Ablation for the Prevention of Recurrent Ventricular Tachycardia in Patients with Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"13","author":"Santangeli","year":"2016","journal-title":"Heart Rhythm"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1007\/s10840-023-01471-6","article-title":"Treatment of Ventricular Tachycardia with Catheter Ablation versus Anti-Arrhythmic Drug Titration: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"66","author":"Ahmed","year":"2023","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s11886-016-0742-9","article-title":"Outcomes of Catheter Ablation of Ventricular Tachycardia in the Setting of Structural Heart Disease","volume":"18","author":"Betensky","year":"2016","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1007\/s00392-015-0813-8","article-title":"Successful Emergency Ablation of Ventricular Tachycardia in the Early Postoperative Period after Left Ventricular Assist Device Implantation","volume":"104","author":"Szegedi","year":"2015","journal-title":"Clin. Res. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1016\/j.hrthm.2015.05.036","article-title":"Freedom from Recurrent Ventricular Tachycardia after Catheter Ablation Is Associated with Improved Survival in Patients with Structural Heart Disease: An International VT Ablation Center Collaborative Group Study","volume":"12","author":"Tung","year":"2015","journal-title":"Heart Rhythm"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/j.jacc.2022.06.035","article-title":"Clinical Outcomes in Patients with Dilated Cardiomyopathy and Ventricular Tachycardia","volume":"80","author":"Zeppenfeld","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"179","DOI":"10.47487\/apcyccv.v3i4.236","article-title":"Acute and long-term success of ventricular tachycardia ablation in patients with ischemic heart disease in a Mexican center","volume":"3","author":"Levinstein","year":"2022","journal-title":"Arch. Peru Cardiol. Cirug\u00eda Cardiovasc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1061471","DOI":"10.3389\/fcvm.2022.1061471","article-title":"Sex Differences in One-Year Recurrence and All-Cause Mortality Following Catheter Ablation of Ventricular Tachycardia in Structural Heart Disease","volume":"9","author":"Szegedi","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e006730","DOI":"10.1161\/CIRCEP.118.006730","article-title":"Predictive Score for Identifying Survival and Recurrence Risk Profiles in Patients Undergoing Ventricular Tachycardia Ablation: The I-VT Score","volume":"11","author":"Vergara","year":"2018","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_16","first-page":"1601","article-title":"2015 ESC Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)","volume":"17","author":"Priori","year":"2015","journal-title":"Europace"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1093\/europace\/euz132","article-title":"2019 HRS\/EHRA\/APHRS\/LAHRS Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias","volume":"21","author":"Cronin","year":"2019","journal-title":"Europace"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","article-title":"2019 ESC Guidelines for the Diagnosis and Management of Chronic Coronary Syndromes","volume":"41","author":"Knuuti","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1093\/eurheartj\/ehac262","article-title":"2022 ESC Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death","volume":"43","author":"Zeppenfeld","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.echo.2016.01.011","article-title":"Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"29","author":"Nagueh","year":"2016","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/s41592-019-0686-2","article-title":"SciPy 1.0: Fundamental Algorithms for Scientific Computing in Python","volume":"17","author":"Virtanen","year":"2020","journal-title":"Nat. Methods"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.21105\/joss.01317","article-title":"Lifelines: Survival Analysis in Python","volume":"4","year":"2019","journal-title":"J. Open Source Softw."},{"key":"ref_23","unstructured":"van Rossum, G. (1995). Python Reference Manual, Centrum Voor Wiskunde en Informatica."},{"key":"ref_24","first-page":"2825","article-title":"Scikit-Learn: Machine Learning in Python","volume":"12","author":"Pedregosa","year":"2011","journal-title":"J. Mach. Learn. Res."},{"key":"ref_25","first-page":"559","article-title":"Imbalanced-Learn: A Python Toolbox to Tackle the Curse of Imbalanced Datasets in Machine Learning","volume":"18","author":"Nogueira","year":"2017","journal-title":"J. Mach. Learn. Res."},{"key":"ref_26","first-page":"4768","article-title":"A Unified Approach to Interpreting Model Predictions","volume":"30","author":"Lundberg","year":"2017","journal-title":"Adv. Neural Inf. Process. Syst."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Benhar, H., Idri, A., and Fern\u00e1ndez-Alem\u00e1n, J.L. (2020). Data Preprocessing for Heart Disease Classification: A Systematic Literature Review. Comput. Methods Programs Biomed., 195.","DOI":"10.1016\/j.cmpb.2020.105635"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s10115-022-01772-8","article-title":"Imbalanced Data Preprocessing Techniques for Machine Learning: A Systematic Mapping Study","volume":"65","year":"2023","journal-title":"Knowl. Inf. Syst."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1093\/bioinformatics\/btq134","article-title":"Permutation Importance: A Corrected Feature Importance Measure","volume":"26","author":"Altmann","year":"2010","journal-title":"Bioinformatics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/978-3-030-85292-4_3","article-title":"Foundations of Machine Learning-Based Clinical Prediction Modeling: Part II-Generalization and Overfitting","volume":"134","author":"Kernbach","year":"2022","journal-title":"Acta Neurochir. Suppl."},{"key":"ref_31","unstructured":"Shreffler, J., and Huecker, M.R. (2023). Diagnostic Testing Accuracy: Sensitivity, Specificity, Predictive Values and Likelihood Ratios, StatPearls Publishing."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.1016\/S1574-0005(02)03016-3","article-title":"Chapter 53 The Shapley Value","volume":"Volume 3","author":"Winter","year":"2002","journal-title":"Handbook of Game Theory with Economic Applications"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Robin, X., Turck, N., Hainard, A., Tiberti, N., Lisacek, F., Sanchez, J.-C., and M\u00fcller, M. (2011). PROC: An Open-Source Package for R and S+ to Analyze and Compare ROC Curves. BMC Bioinform., 12.","DOI":"10.1186\/1471-2105-12-77"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.jacc.2012.07.059","article-title":"Reasons for Recurrent Ventricular Tachycardia after Catheter Ablation of Post-Infarction Ventricular Tachycardia","volume":"61","author":"Yokokawa","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.cjca.2022.12.004","article-title":"Catheter Ablation of Ventricular Arrhythmia in Patients with an Implantable Cardioverter-Defibrillator: A Systematic Review and Meta-Analysis","volume":"39","author":"Fong","year":"2022","journal-title":"Can. J. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.amjcard.2012.10.031","article-title":"Safety, Long-Term Results, and Predictors of Recurrence after Complete Endocardial Ventricular Tachycardia Substrate Ablation in Patients with Previous Myocardial Infarction","volume":"111","author":"Arenal","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1161\/CIRCEP.114.001461","article-title":"Correlates and Prognosis of Early Recurrence after Catheter Ablation for Ventricular Tachycardia Due to Structural Heart Disease","volume":"7","author":"Nagashima","year":"2014","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1016\/j.hrthm.2017.03.008","article-title":"Outcomes after Repeat Ablation of Ventricular Tachycardia in Structural Heart Disease: An Analysis from the International VT Ablation Center Collaborative Group","volume":"14","author":"Tzou","year":"2017","journal-title":"Heart Rhythm"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2054","DOI":"10.1016\/j.hrthm.2022.07.005","article-title":"Impact of Early Ventricular Tachycardia Ablation in Patients with an Implantable Cardioverter-Defibrillator: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"19","author":"Prasitlumkum","year":"2022","journal-title":"Heart Rhythm"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1161\/CIRCULATIONAHA.119.043400","article-title":"Preventive or Deferred Ablation of Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy and Implantable Defibrillator (BERLIN VT): A Multicenter Randomized Trial","volume":"141","author":"Willems","year":"2020","journal-title":"Circulation"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e004422","DOI":"10.1161\/CIRCEP.116.004422","article-title":"Impact of Substrate Modification by Catheter Ablation on Implantable Cardioverter-Defibrillator Interventions in Patients with Unstable Ventricular Arrhythmias and Coronary Artery Disease: Results from the Multicenter Randomized Controlled SMS (Substrate Modification Study): Results from the Multicenter Randomized Controlled SMS (Substrate Modification Study)","volume":"10","author":"Kuck","year":"2017","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1111\/j.1540-8167.2009.01705.x","article-title":"SMASH-VT Investigators Influence of Clinical and Procedural Predictors on Ventricular Tachycardia Ablation Outcomes: An Analysis from the Substrate Mapping and Ablation in Sinus Rhythm to Halt Ventricular Tachycardia Trial (SMASH-VT)","volume":"21","author":"Tung","year":"2010","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1016\/j.jacc.2012.01.026","article-title":"Noninvasive Programmed Ventricular Stimulation Early after Ventricular Tachycardia Ablation to Predict Risk of Late Recurrence","volume":"59","author":"Frankel","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1080\/14017431.2019.1601253","article-title":"Long-Term Outcome of Catheter Ablation in Post-Infarction Recurrent Ventricular Tachycardia","volume":"53","author":"Haanschoten","year":"2019","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e009476","DOI":"10.1161\/JAHA.118.009476","article-title":"Machine Learning Outperforms ACC\/AHA CVD Risk Calculator in MESA","volume":"7","author":"Kakadiaris","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s10741-020-10007-3","article-title":"Machine Learning versus Conventional Clinical Methods in Guiding Management of Heart Failure Patients-a Systematic Review","volume":"26","author":"Bazoukis","year":"2021","journal-title":"Heart Fail. Rev."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/12\/1386\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:36:25Z","timestamp":1760132185000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/12\/1386"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,1]]},"references-count":46,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["bioengineering10121386"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering10121386","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,1]]}}}