{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T21:53:44Z","timestamp":1771710824038,"version":"3.50.1"},"reference-count":55,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T00:00:00Z","timestamp":1643587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Chronic Chagas cardiomyopathy (CCM) is ranked among heart failure etiologies with the highest mortality rates. CCM is characterized by alterations in left ventricular function with a typical and unique pattern of myocardial involvement. Left ventricle longitudinal speckle tracking strain is emerging as an important additive method for evaluating left ventricular function and risk of future cardiovascular events. This systematic review aimed to characterize the left ventricle (LV) longitudinal strain by speckle tracking patterns in the different stages of Chagas disease, compared to healthy controls. Methods: Searches in Medline, EMBASE, and LILACS databases (from inception to 20 May 2021) were performed. Articles written in any language that assessed patients with Chagas disease and reported any measures derived from the left ventricular strain by speckle tracking were included. Two reviewers independently selected the studies, extracted the data, and assessed the quality of evidence. Standardized mean differences (SMD) were pooled using random-effects meta-analyses. Results: Of 1044 references, ten studies, including a total of 1222 participants (CCM: 477; indeterminate form: 444; healthy controls: 301), fulfilled the selection criteria and were included in the final analysis. Patients with CCM had a significantly higher mean global longitudinal strain (GLS) value than indeterminate form (IF) patients (SMD 1.253; 95% CI 0.53, 1.98. I2 = 94%), while no significant difference was observed between IF patients and healthy controls (SMD 0.197; 95% CI \u22120.19, 0.59. I2 = 80%). Segmental strain analyses revealed that patients with the IF form of CD had significantly worse strain values in the basal-inferoseptal (SMD 0.49; 95% CI 0.24, 0.74. I2: 24%), and mid-inferoseptal (SMD 0.28; 95% CI 0.05, 0.50. I2: 10%) segments compared to healthy controls. Conclusions: Our results suggest different levels of functional derangements in myocardial function across different stages of Chagas disease. Further research is needed to assess the prognostic role of LV longitudinal strain and other measures derived from speckle tracking in CD patients regarding progression to cardiomyopathy and clinical outcomes prediction.<\/jats:p>","DOI":"10.3390\/jcm11030769","type":"journal-article","created":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T08:20:29Z","timestamp":1643617229000},"page":"769","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Longitudinal Speckle Tracking Strain Abnormalities in Chagas Disease: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"11","author":[{"given":"Sergio Alejandro","family":"G\u00f3mez-Ochoa","sequence":"first","affiliation":[{"name":"Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lyda Z.","family":"Rojas","sequence":"additional","affiliation":[{"name":"Research Group and Development of Nursing Knowledge (GIDCEN-FCV), Research Center, Fundaci\u00f3n Cardiovascular de Colombia, Floridablanca 680004, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliana Alexandra","family":"Hern\u00e1ndez-Vargas","sequence":"additional","affiliation":[{"name":"Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Bogot\u00e1 111711, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Largo","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Universidad Militar Nueva Granada, Bogot\u00e1 110010, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taulant","family":"Muka","sequence":"additional","affiliation":[{"name":"Institute of Social and Preventive Medicine (ISPM), University of Bern, 3012 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis E.","family":"Echeverr\u00eda","sequence":"additional","affiliation":[{"name":"Heart Failure and Heart Transplant Clinic, Fundaci\u00f3n Cardiovascular de Colombia, Floridablanca 680004, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.idc.2018.10.015","article-title":"American Trypanosomiasis (Chagas Disease)","volume":"33","author":"Echeverria","year":"2019","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Requena-M\u00e9ndez, A., Aldasoro, E., De Lazzari, E., Sicuri, E., Brown, M., Moore, D.A.J., Gascon, J., and Mu\u00f1oz, J. (2015). Prevalence of Chagas Disease in Latin-American Migrants Living in Europe: A Systematic Review and Meta-analysis. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0003540"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e00023-19","DOI":"10.1128\/CMR.00023-19","article-title":"Chagas Disease in the United States: A Public Health Approach","volume":"33","author":"Bern","year":"2019","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Manne-Goehler, J., Umeh, C., Montgomery, S.P., and Wirtz, V.J. (2016). Estimating the Burden of Chagas Disease in the United States. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0005033"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00392-013-0613-y","article-title":"Epidemiology of Chagas disease in Europe: Many calculations, little knowledge","volume":"103","author":"Strasen","year":"2013","journal-title":"Clin. Res. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"165642","DOI":"10.1016\/j.bbadis.2019.165642","article-title":"Immune-neuroendocrine and metabolic disorders in human and experimental T. cruzi infection: New clues for understanding Chagas disease pathology","volume":"1866","author":"Villar","year":"2020","journal-title":"Biochim. Biophys. Acta BBA Mol. Basis Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e169","DOI":"10.1161\/CIR.0000000000000599","article-title":"Chagas Cardiomyopathy: An Update of Current Clinical Knowledge and Management: A Scientific Statement From the American Heart Association","volume":"138","author":"Nunes","year":"2018","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"26","DOI":"10.5334\/gh.484","article-title":"WHF IASC Roadmap on Chagas Disease","volume":"15","author":"Marcus","year":"2020","journal-title":"Glob. Hear."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e02542021","DOI":"10.1590\/0037-8682-0254-2021","article-title":"Indeterminate form of Chagas disease: Historical, conceptual, clinical, and prognostic aspects","volume":"54","author":"Xavier","year":"2021","journal-title":"Rev. Soc. Bras. Med. Trop."},{"key":"ref_10","first-page":"111","article-title":"The Indeterminate Form of Chagas Disease","volume":"110","author":"Issa","year":"2018","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1146\/annurev-pathol-020117-043711","article-title":"Pathology and Pathogenesis of Chagas Heart Disease","volume":"14","author":"Bonney","year":"2019","journal-title":"Annu. Rev. Pathol. Mech. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.echo.2017.10.019","article-title":"Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DIC-SBC)","volume":"31","author":"Acquatella","year":"2018","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_13","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_14","first-page":"245","article-title":"Echocardiographic parameters and survival in Chagas heart disease with severe systolic dysfunction","volume":"102","author":"Rassi","year":"2014","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1111\/echo.14603","article-title":"Echocardiographic parameters, speckle tracking, and brain natriuretic peptide levels as indicators of progression of indeterminate stage to Chagas cardiomyopathy","volume":"37","author":"Rojas","year":"2020","journal-title":"Echocardiography"},{"key":"ref_16","first-page":"1673","article-title":"Prognostic implications of global LV dysfunction: A systematic review and meta-analysis of global longitudinal strain and ejection fraction","volume":"100","author":"Kalam","year":"2014","journal-title":"Heart Br. Card. Soc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1007\/s11255-020-02492-0","article-title":"Prognostic value of left ventricular global longitudinal strain in chronic kidney disease patients: A systematic review and meta-analysis","volume":"52","author":"Zhang","year":"2020","journal-title":"Int. Urol. Nephrol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jchf.2021.08.007","article-title":"Prognostic Value of Global Longitudinal Strain in Patients With Heart Failure With Improved Ejection Fraction","volume":"10","author":"Janwanishstaporn","year":"2021","journal-title":"JACC Hear. Fail."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e5338","DOI":"10.1097\/MD.0000000000005338","article-title":"Global longitudinal strain predicts incident atrial fibrillation and stroke occurrence after acute myocardial infarction","volume":"95","author":"Olsen","year":"2016","journal-title":"Medicine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2956","DOI":"10.1002\/ehf2.12910","article-title":"Global longitudinal strain for prediction of ventricular arrhythmia in patients with heart failure","volume":"7","author":"Nikoo","year":"2020","journal-title":"ESC Hear. Fail."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Romano MM, D., Moreira, H.T., Marin-Neto, J.A., Baccelli, P.E., Alenezi, F., Klem, I., Maciel, B.C., Kisslo, J., Schmidt, A., and Velazquez, E.J. (2020). Early impairment of myocardial deformation assessed by regional speckle-tracking echocardiography in the indeterminate form of Chagas disease without fibrosis detected by cardiac magnetic resonance. PLoS Negl. Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0008795"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1016\/j.echo.2013.08.018","article-title":"Left Atrial and Left Ventricular Diastolic Function in Chronic Chagas Disease","volume":"26","author":"Nascimento","year":"2013","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s10654-019-00576-5","article-title":"A 24-step guide on how to design, conduct, and successfully publish a systematic review and meta-analysis in medical research","volume":"35","author":"Muka","year":"2019","journal-title":"Eur. J. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur. J. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Hozo, S.P., Djulbegovic, B., and Hozo, I. (2005). Estimating the mean and variance from the median, range, and the size of a sample. BMC Med. Res. Methodol., 5.","DOI":"10.1186\/1471-2288-5-13"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1016\/j.cardfail.2011.08.007","article-title":"Myocardial Deformation Analysis in Chagas Heart Disease With the Use of Speckle Tracking Echocardiography","volume":"17","author":"Sitges","year":"2011","journal-title":"J. Card. Fail."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1111\/echo.12426","article-title":"Early Detection of Left Ventricular Contractility Abnormalities by Two-Dimensional Speckle Tracking Strain in Chagas\u2019 Disease","volume":"31","author":"Barbosa","year":"2013","journal-title":"Echocardiography"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.echo.2016.03.007","article-title":"Analysis of Regional Left Ventricular Strain in Patients with Chagas Disease and Normal Left Ventricular Systolic Function","volume":"29","author":"Gomes","year":"2016","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12947-016-0062-7","article-title":"Comprehensive left ventricular mechanics analysis by speckle tracking echocardiography in Chagas disease","volume":"14","author":"Lima","year":"2015","journal-title":"Cardiovasc. Ultrasound"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s12574-016-0305-5","article-title":"Indeterminate form of Chagas disease: Is left ventricular torsional mechanics a clue to subclinical myocardial abnormalities?","volume":"15","author":"Voos","year":"2017","journal-title":"J. Echocardiogr."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Santos Junior, O.R., da Costa Rocha, M.O., Rodrigues de Almeida, F., Sales da Cunha, P.F., Souza, S.C.S., Saad, G.P., Santos, T.A.D.Q., Ferreira, A.M., Tan, T.C., and Nunes, M.C.P. (2019). Speckle tracking echocardiographic deformation indices in Chagas and idiopathic dilated cardiomyopathy: Incremental prognostic value of longitudinal strain. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0221028"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/echo.14917","article-title":"Speckle tracking echocardiography in the indeterminate form of Chagas disease","volume":"38","author":"Cianciulli","year":"2020","journal-title":"Echocardiography"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"348","DOI":"10.4269\/ajtmh.1993.48.348","article-title":"Amplification of a Trypanosoma Cruzi DNA Sequence from Inflammatory Lesions in Human Chagasic Cardiomyopathy","volume":"48","author":"Jones","year":"1993","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/1054-8807(93)90021-S","article-title":"Correlation between Trypanosoma cruzi parasitism and myocardial inflammatory infiltrate in human chronic chagasic myocarditis: Light microscopy and immunohistochemical findings","volume":"2","author":"Barbosa","year":"1993","journal-title":"Cardiovasc. Pathol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/S0002-8703(96)90358-0","article-title":"In vivo detection of Trypanosoma cruzi antigens in hearts of patients with chronic Chagas\u2019 heart disease","volume":"131","author":"Bellotti","year":"1996","journal-title":"Am. Heart J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/S0002-9149(00)01133-4","article-title":"Relation of regional sympathetic denervation and myocardial perfusion disturbance to wall motion impairment in Chagas\u2019 cardiomyopathy","volume":"86","author":"Pintya","year":"2000","journal-title":"Am. J. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/0002-9149(92)90505-S","article-title":"Myocardial perfusion abnormalities in chronic Chagas\u2019 disease as detected by thallium-201 scintigraphy","volume":"69","author":"Marzullo","year":"1992","journal-title":"Am. J. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1007\/s12350-018-1290-z","article-title":"Relationship between microvascular changes, autonomic denervation, and myocardial fibrosis in Chagas cardiomyopathy: Evaluation by MRI and SPECT imaging","volume":"27","author":"Barizon","year":"2020","journal-title":"J. Nucl. Cardiol."},{"key":"ref_39","first-page":"6420364","article-title":"Cardiovascular Magnetic Resonance Imaging Evidence of Edema in Chronic Chagasic Cardiomyopathy","volume":"2019","author":"Diaz","year":"2019","journal-title":"Cardiol. Res. Pr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1007\/s10554-020-01925-2","article-title":"Cardiac magnetic resonance imaging in Chagas\u2019 disease: A parallel with electrophysiologic studies","volume":"36","author":"Rojas","year":"2020","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"618.e1","DOI":"10.1016\/j.crad.2016.02.015","article-title":"Value of cardiac MRI for evaluation of chronic Chagas disease cardiomyopathy","volume":"71","author":"Thomas","year":"2016","journal-title":"Clin. Radiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1136\/hrt.82.3.279","article-title":"Different microcirculatory and interstitial matrix patterns in idiopathic dilated cardiomyopathy and Chagas\u2019 disease: A three dimensional confocal microscopy study","volume":"82","author":"Higuchi","year":"1999","journal-title":"Heart"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.vetpar.2009.03.053","article-title":"Trypanosoma cruzi: Dehydroepiandrosterone (DHEA) and immune response during the chronic phase of the experimental Chagas\u2019 disease","volume":"163","author":"Caetano","year":"2009","journal-title":"Vet. Parasitol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"334","DOI":"10.3389\/fendo.2018.00334","article-title":"Role of Hormonal Circuitry Upon T Cell Development in Chagas Disease: Possible Implications on T Cell Dysfunctions","volume":"9","author":"Morrot","year":"2018","journal-title":"Front. Endocrinol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"787","DOI":"10.12688\/f1000research.7228.1","article-title":"Recent advances in echocardiography: Strain and strain rate imaging","volume":"5","author":"Mirea","year":"2016","journal-title":"F1000Research"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1111\/echo.13878","article-title":"Echocardiographic advances in hypertrophic cardiomyopathy: Three-dimensional and strain imaging echocardiography","volume":"35","author":"Inciardi","year":"2018","journal-title":"Echocardiography"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1093\/ehjci\/jes026","article-title":"Correlates of global area strain in native hypertensive patients: A three-dimensional speckle-tracking echocardiography study","volume":"13","author":"Galderisi","year":"2012","journal-title":"Eur. Hear. J. Cardiovasc. Imaging"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e004661","DOI":"10.1161\/CIRCIMAGING.116.004661","article-title":"Additive Prognostic Value of Left Ventricular Systolic Dysfunction in a Population-Based Cohort","volume":"9","author":"Kuznetsova","year":"2016","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1007\/s10741-020-09945-9","article-title":"The prognostic role of speckle tracking echocardiography in clinical practice: Evidence and reference values from the literature","volume":"26","author":"Pastore","year":"2020","journal-title":"Hear. Fail. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1097\/CRD.0000000000000172","article-title":"The Prognostic Implications of Two-Dimensional Speckle Tracking Echocardiography in Hypertrophic Cardiomyopathy: Current and Future Perspectives","volume":"26","author":"Zegkos","year":"2018","journal-title":"Cardiol. Rev."},{"key":"ref_51","first-page":"124","article-title":"The Presence and Extension of Myocardial Fibrosis in the Undetermined Form of Chagas\u2019 Disease: A Study Using Magnetic Resonance","volume":"110","author":"Macedo","year":"2018","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"726","DOI":"10.4269\/ajtmh.1999.60.726","article-title":"Myocardial parasite persistence in chronic chagasic patients","volume":"60","author":"Carrasco","year":"1999","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"328","DOI":"10.4269\/ajtmh.1997.57.328","article-title":"The indeterminate phase of Chagas\u2019 disease: Ultrastructural characterization of cardiac changes in the canine model","volume":"57","author":"Andrade","year":"1997","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_54","first-page":"623","article-title":"[Indeterminate form of Chagas\u2019 disease. Proposal of new diagnostic criteria and perspectives for early treatment of cardiomyopathy]","volume":"79","author":"Maciel","year":"2002","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1590\/S0100-879X2006000400008","article-title":"Minor segmental wall motion abnormalities detected in patients with Chagas\u2019 disease have adverse prognostic implications","volume":"39","author":"Romano","year":"2006","journal-title":"Braz. J. Med Biol. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/769\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:11:44Z","timestamp":1760134304000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/769"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,31]]},"references-count":55,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["jcm11030769"],"URL":"https:\/\/doi.org\/10.3390\/jcm11030769","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,31]]}}}