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Mechanism of Action of Inotropic Agents in Heart Failure

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Acute Heart Failure

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 6))

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Abstract

In 1785 William Withering in his accounts of Foxglove, reported the beneficial effects of digitalis in dropsy [1]. Thus, the use of drugs with positive inotropic effects in the management of heart failure was introduced in the clinical practice. Catecholamines with positive inotropic effects appeared several decades after the introduction of digitalis and presently a large number of such catecholamines are available for the clinical use and a growing number of such agents are undergoing clinical investigation. Non-glycoside, non-catecholamine inotropic agents have also been developed and enthusiasm continues to introduce newer inotropic agents with novel modes of action in the management of both acute and chronic heart failure. The background for this increasing interest in developing inotropic agents is based on the fact that the inotropic agents have the potential to correct one important functional abnormality, that is, the reduced contractile function that frequently initiates heart failure. Although the principle goal for the use of inotropic agents is to enhance contractile function, it needs to be realized that the modes of action and the relative potencies of various inotropic agents are not similar and understanding the mechanism of action of these various inotropic agents and their hemodynamic effects has direct clinical relevance in their use in the management of patients with heart failure.

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References

  1. Withering W (1941) An account of the foxglove and some of its medical uses with practical remarks on dropsy and other diseases. In: Willius FA, Keys TE (eds) Classics of cardiology. Henry Schuman, New York, p 231

    Google Scholar 

  2. Wohlfahrt B, Noble MIM (1982) The cardiac excitation-contraction coupling. Pharmacol Ther 16: 1

    Article  Google Scholar 

  3. Chapman RA (1983) Control of cardiac contractility at the cellular level. Am J Physiol 245: H535

    PubMed  CAS  Google Scholar 

  4. Fabiato A, Fabiato F (1979) Calcium and cardiac excitation-contraction coupline. Annu Rev Physiol 41: 473

    Article  PubMed  CAS  Google Scholar 

  5. Colucci WS, Wright RF, Braunwald E (1986) New positive inotropic agents in the treatment of congestive heart failure. Mechanisms of action and recent clinical development. N Engl J Med 314: 290

    Article  PubMed  CAS  Google Scholar 

  6. Colucci WS, Wright RF, Braunwald E (1986) New positive inotropic agents in the treatment of congestive heart failure. Mechanisms of action and recent clinical developments. N Engl J Med 314: 349

    Article  PubMed  CAS  Google Scholar 

  7. Katz AM (1986) Discussion section. Article by Endoh M, Yanagisawa T, Taira N, Blinks JR: Effects of new inotropic agents on cyclic nucleotide metabolism and calcium transients in canine ventricular muscle. Circulation 73 (Suppl III): 117

    Google Scholar 

  8. Allen DG, Blinks JR (1978) Calcium transients in aquorin-injection frog cardiac muscle. Nature 273: 509

    Article  PubMed  CAS  Google Scholar 

  9. Smith TW, Antman EM, Friedman PL, et al (1984) Digitalis glycosides: Mechanisms and manifestations of toxicity. Prog Cardiovasc Dis 26: 413

    Article  PubMed  CAS  Google Scholar 

  10. Smith TW, Antman EM, Friedman PL, et al (1984) Digitalis glycosides: Mechanisms and manifestations of toxicity ( Part III ). Prog Cardiovasc Dis 27: 21

    Article  PubMed  CAS  Google Scholar 

  11. Braunwald E (1985) Effects of digitalis on the normal and failing heart. J Am Coll Cardiol 5: 51A

    Google Scholar 

  12. Sonnenblick EH, Williams JF Jr, Glick G, et al (1966) Studies on Digitalis XV: Effects of cardiac glycosides on myocardial force-velocity relations in the failing heart. Circulation 34: 532

    PubMed  CAS  Google Scholar 

  13. Spann JF Jr, Buccino RA, Sonnenblick EH, Braunwald E (1967) Contractile state of cardiac muscle obtained from cats with experimentally produced ventricular hypertrophy at heart failure. Circ Res 21: 341

    PubMed  Google Scholar 

  14. Mahler F, Karliner JS, O’Rourke RA (1974) Effects of chronic digoxin administration on left ventricular performance in the normal conscious dog. Circulation 50: 720

    PubMed  CAS  Google Scholar 

  15. Crawford MH, Karliner JS, O’Rourke RA, Amon KW (1976) Effects of chronic digoxin administration on left ventricular performance in normals subjects. Echocardiographic study. Am J Cardiol 38: 843

    Article  PubMed  CAS  Google Scholar 

  16. Mason DT, Braunwald E (1964) Studies on digitalis X. Effects of ouabain on forearm vascular resistance and venous tone in normal subjects and in patients in heart failure. J Clin Invest 43: 532

    Article  PubMed  CAS  Google Scholar 

  17. Shanbour LL, Jacobson ED (1972) Digitalis and the mesenteric circulation. Am J Dig Dis 17: 826

    Article  PubMed  CAS  Google Scholar 

  18. Ross J Jr, Braunwald E, Waldhausen JA (1960) Studies of digitalis II: Extracardiac effects on venous return and on the capacity of peripheral vascular bed. J Clin Invest 39: 936

    Google Scholar 

  19. Sugar KB, Hanson EC, Powell WJ (1977) Neurogenic vasoconstrictor effects during acute global ischemia in dogs. J Clin Invest 60: 1248

    Article  Google Scholar 

  20. DeMots H, Rahimtoola SH, McAnulty JH, Porter GA (1978) Effects of ouabain on coronary and systemic vascular resistance and myocardial oxygen consumption in patients without heart failure. Am J Cardiol 41: 88

    Article  PubMed  CAS  Google Scholar 

  21. Garan H, Smith TW, Powell WJ Jr (1974) The central nervous system as a site of action for the coronary vasoconstrictor effect of digoxin. J Clin Invest 54: 1365

    Article  PubMed  CAS  Google Scholar 

  22. Arnold SB, Byrd RC, Meister W, et al (1980) Long-term digitalis therapy improves left ventricular function in heart failure. N Engl J Med 303: 1443

    Article  PubMed  CAS  Google Scholar 

  23. Covit AB, Schaer GL, Sealy JE, et al (1983) Suppression of the renin-angiotensin by intravenous digoxin in chronic congestive heart failure. Am J Med 75: 445

    Article  PubMed  CAS  Google Scholar 

  24. Watanabe AM (1985) Digitalis and the autonomic nervous system. J Am Coll Cardiol 5: 35A

    Google Scholar 

  25. Nakamura M (1985) Digitalis induced augmentation of cardiopulmonary baroreflex control of forearm vascular resistance. Circulation 71: 11

    Article  PubMed  Google Scholar 

  26. Gillis RA, Quest JA (1980) The role of the nervous system in the cardiovascular effects of digitalis. Pharmacol Rev 31: 19

    Google Scholar 

  27. Ahlquist RP (1984) A study of adrenotropic receptors. Am J Physiol 153: 586

    Google Scholar 

  28. Watanabe AM (1983) Recent advances in knowledge about beta-adrenergic receptors: Application to clinical cardiology. J Am Coll Cardiol 1: 82

    Article  PubMed  CAS  Google Scholar 

  29. Colucci WS (1984) Alpha-adrenergic receptors in cardiovascular medicine. In: Karliner JS, Haft JI (eds) Receptor science in cardiology. Futura Publications Mt Kisco NY, p 43

    Google Scholar 

  30. Goldberg M, Robertson D (1984) Evidence for the existence of vascular alpha2-adrenoreceptors in humans. Hypertension 6: 551

    PubMed  CAS  Google Scholar 

  31. Langer SZ (1974) Presynaptic regulation of catecholamine release. Biochem Pharmacol 23: 1793

    Article  PubMed  CAS  Google Scholar 

  32. Bruckner R, Meyer W, Mugge A, et al (1984) Alpha-adrenoceptor mediated positive isotropic effect on phenylephrine in isolated human ventricular myocardium. Eur J Pharmacol 99: 345

    Article  PubMed  CAS  Google Scholar 

  33. Lefkowitz RJ, Stadel JM, Caron MG (1983) Adenylate cyclase-coupled beta adrenergic receptors: Structure and mechanisms of activation and desensitization. Annu Rev Biochem 52: 159

    Article  PubMed  CAS  Google Scholar 

  34. Francis GS (1983) The role of isotropic agents in the management of heart failure. In: Cohn JN (ed) Drug treatment of heart failure, Chap VII. York Medical Books, New York, p 125

    Google Scholar 

  35. Innes IR, Nickerson M (1975) Norepinephrine, epinephrine and the sympathomimetic amines. In: Goodman LS, Gilman A (eds) Pharmacological basis of therapeutics, 5th edn, Macmillan, New York, p 477

    Google Scholar 

  36. Goldberg LI, Rajfer SI (1985) Dopamine receptors. Applications in clinical cardiology. Circulation 72: 245

    Article  PubMed  CAS  Google Scholar 

  37. Goldberg LI (1972) Gardiovascular and renal actions of dopamine Potential applications. Pharmacol Rev 24: 1

    PubMed  CAS  Google Scholar 

  38. Goldberg LI, HGsieh YY, Resnekov L (1977) Newer catecholamines for treatment of heart failure and shock: An update on dopamine and a first look at dobutamine. Prog Cardiovasc Dis 4: 327

    Article  Google Scholar 

  39. Rajfer SI, Anton AH, Rossen J, Goldberg LI (1984) Beneficial hemodynamic effects of oral levodopa in heart failure: Relationship to the generation of dopamine. N Engl J Med 310: 1357

    Article  PubMed  CAS  Google Scholar 

  40. Daly PA, Chatterjee K, Viquerat CE, et al (1985) RO13–6438, a new inotrope-vasodilator: Systemic and coronary hemodynamic effects in congestive heart failure. Am J Cardiol 55: 1539

    Article  PubMed  CAS  Google Scholar 

  41. DeMarco T, Daly PA, Chatterjee K: Levodopa in chronic heart failure: Systemic and coronary hemodynamic and neurohumoral effects: Am J Cardiol (in press)

    Google Scholar 

  42. Brown RA, Dixon J, Farmer JB, et al (1985) Dopexamine: A novel agonist at peripheral dopamine receptors and beta2-adrenoreceptors. Br J Pharmacol 85: 599

    PubMed  CAS  Google Scholar 

  43. Dawson JR, Thompson DS, Signy M, et al (1985) Acute hemodynamic and metabolic effects of dopexamine, a new dopaminergic receptor agonist in patients with chronic heart failure. Br Heart J 54: 313

    Article  PubMed  CAS  Google Scholar 

  44. DeMarco T, Kwasman M, Lau D, Chatterjee K: Dopexamine hydrochloride in chronic heart failure: Improved cardiac performance without increased metabolic cost. Am J Cardiology (In press)

    Google Scholar 

  45. Fennell WH, Taylor AA, Young JB, et al (1983) Propylbutyldopamine: Hemodynamic effects in conscious dogs, normal human volunteers and patients with heart failure. Circulation 67: 829

    Article  PubMed  CAS  Google Scholar 

  46. Francis GS, Parks R, Cohn JN (1983) The effects of bromocriptine in patients with congestive heart failure. Am Heart J 106: 100

    Article  PubMed  CAS  Google Scholar 

  47. Leon CA, Suarez JM, Aranoff RD, et al (1984) Fenoldopam: Efficacy of a new orally active dopamine analog in heart failure. Circulation 70 (Suppl II): 307

    Google Scholar 

  48. Francis GS, Wilson BC, Rector TS (1988) Hemodynamic, renal, and neurohumoral effects of a selective oral DA, receptor agonist (fenoldopam) in patients with congestive heart failure. Am J Cardiol 116 (2): 473–479

    CAS  Google Scholar 

  49. Dei Gas L, Manca C, Bermardini B, et al (1982) Noninvasive evaluation of the effects of oral ibopamine (SB 7505) on cardiac and renal function in patients with congestive heart failure. J Cardiovasc Pharmacol 4: 436

    Article  Google Scholar 

  50. Dei Cas L, Bolognesi R, Cucchini F, et al (1983) Hemodynamic effects of ibopamine in patients with idiopathic congestive cardiomyopathy. J Cardiovasc Pharmacol 5: 249

    Article  Google Scholar 

  51. Rajfer SI, Rossen JD, Douglas FL, Goldberg LI, Karrison T (1986) Effects of long-term therapy with oral ibopamine on resting hemodynamics and exercise capacity in patients with heart failure: Relationship to the generation of N-methyldopamine and to plasma nor-epinephrine levels. Circulation 73: 740

    Article  PubMed  CAS  Google Scholar 

  52. Cantelli I, Lolli C, Bomba E, Brunelli D, Bracchetti D (1986) Sustained oral treatment with ibopamine in patients with chronic congestive heart failure. Current Ther Res 9: 900

    Google Scholar 

  53. Ruffolo RR Jr, Spradlin TA, Pollock GD, et al (1981) Alpha and beta adrenergic effects of the stereoisomers of dobutamine. J Pharmacol Exp Ther 219: 447

    PubMed  CAS  Google Scholar 

  54. Chatterjee J, Bendersky R, Parmley WW (1982) Dobutamine in heart failure. Eur Heart J 3: 107

    PubMed  Google Scholar 

  55. Liang G, Hood WB (1979) Dobutamine infusion in conscious dogs with and without autonomic nervous system inhibition: Effects on systemic hemodynamics, regional blood flows, and cardiac metabolism. J Pharmacol Exp Ther 211: 698–705

    PubMed  CAS  Google Scholar 

  56. Colucci WS, Wright RF, Jaski BE, Fifer MA, Braunwald E (1986) Milrinone and dobutamine in severe heart failure: Differing hemodynamic effects and individual patient responsiveness. Circulation 73 (Suppl III): 175

    Google Scholar 

  57. Bristow MR, Ginsburg R, Minobe W, et al (1982) Decreased catecholamine sensitivity and beta-adrenergic receptor density in failing human hearts. N Engl J Med 307: 205

    Article  PubMed  CAS  Google Scholar 

  58. Unverferth DV, Magorien RD, Altschuld R, et al (1983) The hemodynamic and metabolic advantages gained by a three-day infusion of dobutamine in patients with congestive cardiomyopathy. Am Heart J 106: 29

    Article  PubMed  CAS  Google Scholar 

  59. Bendersky R, Chatterjee K, Parmley WW, et al (1981) Dobutamine in chronic ischemic heart failure: Alterations in left ventricular function and coronary hemodynamics. Am J Cardiol 48: 554

    Article  PubMed  CAS  Google Scholar 

  60. Sharma B, Goodwin JF (1978) Beneficial effect of salbutamol on cardiac function in severe congestive cardiomyopathy: Effect on systolic and diastolic function of the left ventricle. Circulation 58: 449

    PubMed  CAS  Google Scholar 

  61. Bourdillon PDV, Dawson JR, Foale RA, et al (1982) Salbutamol in the treatment of heart failure. Br Heart J 43: 206

    Article  Google Scholar 

  62. Mifune J, Kuramoto K, Ueda K, et al (1982) Hemodynamic effects of salbutamol, an oral long-acting beta stimulant in patients with congestive heart failure. Am Heart J 104: 1011

    Article  PubMed  CAS  Google Scholar 

  63. Rude RE, Turi Z, Brown EJ, et al (1981) Acute effects of oral pirbuterol on congestive heart failure. Circulation 64: 139

    Article  PubMed  CAS  Google Scholar 

  64. Awan NA, Needham K, Evenson MK, et al (1981) Therapeutic efficacy of oral pirbuterol in severe chronic congestive heart failure. Acute hemodynamic and long-term ambulatory evaluation. Am Heart J 102: 555

    Article  PubMed  CAS  Google Scholar 

  65. Leier CV, Nelson S, Huss P, et al (1982) Intravenous pirbuterol. Clin Pharmacol Ther 31: 89

    Article  PubMed  CAS  Google Scholar 

  66. Colucci WS, Alexander RW, Williams GH, et al (1981) Decreased lymphocyte beta-adrenergic-receptor density in patients with heart failure and tolerance to the beta-adrenergic agonist, pirbuterol. N Engl J Med 305: 185

    Article  PubMed  CAS  Google Scholar 

  67. Manders WT, Watner SF, Braunwald E (1980) Cardio-selective beta adrenergic stimulation with prenalterol in the conscious dog. J Pharmacol Exp Ther 215: 266

    PubMed  CAS  Google Scholar 

  68. Kirlin PC, Pitt B (1981) Hemodynamic effects of intravenous prenalterol in severe heart failure. Am J Cardiol 47: 670

    Article  PubMed  CAS  Google Scholar 

  69. Wahr D, Swedberg K, Rabbino M, et al (1984) Intravenous and oral prenalterol in congestive heart failure. Effects on systemic and coronary hemodynamics and myocardial catecholamine balance. Am J Med 76: 999

    Article  PubMed  CAS  Google Scholar 

  70. Nuttal A, Snow HM (1982) The cardiovascular effects of ICI 118, 587: A beta-adrenoreceptor partial agonist. Br J Pharmacol 77: 381

    Google Scholar 

  71. Bhatia JSS, Swedberg K, Chatterjee K (1986) Acute hemodynamic and metabolic effects of ICI 118, 587 ( Corwin), a selective partial beta agonist, in patients with dilated cardiomyopathy. Am Heart J 111: 692

    Article  PubMed  CAS  Google Scholar 

  72. Kino M, Hirota Y, Yamamoto S, et al (1983) Cardiovascular effects of a newly synthesized cardiotonic agent (TA-064) on normal and diseased hearts. Am J Cardiol 51: 802

    Article  PubMed  CAS  Google Scholar 

  73. Ozaki N, Bito K, Kinoshita M, Kawakita S (1983) Effects of a cardiotonic agent, TA-064, on isolated canine cerebral, coronary, femoral, mesenteric and renal arteries. J Cardiovasc Pharmacol 5: 818

    Article  PubMed  CAS  Google Scholar 

  74. Nelson S, Leier CV (1981) Butopamine in normal human subjects. Curr Therap Res 30: 405

    Google Scholar 

  75. Thompson MJU, Huss P, Unverferth DV, et al (1980) Hemodynamic effects of intravenous butopamine in congestive heart failure. Clin Pharmacol Ther 28: 324

    Article  PubMed  CAS  Google Scholar 

  76. Goldstein RE, Skelton CL, Levey GS, et al (1971) Effects of chronic heart failure on the capacity of glucagon to enhance contractility and adenyl cyclase activity of human papillary muscles. Circulation 44: 638

    PubMed  CAS  Google Scholar 

  77. Daly JW (1984) Forskolin, adenylate cyclase, and cell physiology: An overview. Adv Cyclic Nucleotide Prot Phosphoryl Res 17: 81

    CAS  Google Scholar 

  78. Matsue S, Murakami E, Takekoshi N, et al (1983) Hemodynamic effects of dibutyryl cyclic AMP in congestive heart failure. Am J Cardiol 51: 1364

    Article  Google Scholar 

  79. Strada SJ, Thompson WJ (1984) Cyclic nucleotide phosphodiesterases. Adv Cyclic Nucleotide Prot Phosphoryl Res 16: 1

    Google Scholar 

  80. Still JA, Sullivan SF (1981) Aminophylline. Anesth Analg 60: 587

    Google Scholar 

  81. Mancini D, LeJemtel T, Sonnenblick E (1985) Intravenous use of amrinone for the treatment of the failing heart. Am J Cardiol 56: 8B

    Google Scholar 

  82. Benotti JR, Grossman W, Braunwald E, et al (1978) Hemodynamic assessment of amrinone: A new inotropic agent. N Engl J Med 299: 1373

    Article  PubMed  CAS  Google Scholar 

  83. Cody RJ, Muller FB, Kubo SH, et al (1986) Identification of the direct vasodilator effect of milrinone with an isolated limb preparation in patients with chronic congestive heart failure. Circulation 73: 124

    Article  PubMed  CAS  Google Scholar 

  84. Simonton CA, Chatrerjee K, Cody RJ, et al (1985) Milrinone in congestive heart failure: Acute and chronic hemodynamic and clinical evaluation. J Am Coll Cardiol 6: 453

    Article  PubMed  CAS  Google Scholar 

  85. Kubo SH, Cody RJ, Chatterjee K, et al (1985) Acute dose-range study of milrinone in congestive heart failure. Am J Cardiol 55: 726

    Article  PubMed  CAS  Google Scholar 

  86. Crawford MH, Richards KL, Sodums MT, Kennedy GT (1984) Positive inotropic and vasodilator effects of MDL 17043 in patients with reduced left ventricular performance. Am J Cardiol 53: 1051

    Article  PubMed  CAS  Google Scholar 

  87. Kereiakes D, Chatterjee K, Parmley WW, et al (1984) Intravenous and oral MDL 17043 (a new inotrope-vasodilator agent) in congestive heart failure: Hemodynamic and clinical evaluation in 38 patients. J Am Coll Cardiol 4: 884

    Article  PubMed  CAS  Google Scholar 

  88. Uretsky BF, Generalovich T, Reddy PS, et al (1984) Acute hemodynamic effect of oral MDL 17043 in severe congestive heart failure. Am J Cardiol 54: 357

    Article  PubMed  CAS  Google Scholar 

  89. Petein M, Levine B, Cohn JN (1984) Hemodynamic effects of a new inotropic agent, piroximone (MDL 19,205) in patients with chronic heart failure. J Am Coll Cardiol 4: 364

    Article  PubMed  CAS  Google Scholar 

  90. Dage RC, Roebel LE, Hsieh CP, Woodward JK (1984) Cardiovascular properties of a new cardiotonic agent, MDL 19, 205. J Cardiovasc Pharmacol 6: 35

    Article  PubMed  CAS  Google Scholar 

  91. Daly PA, Chatterjee K, Viquerat CE, et al (1985) RO13–6438, a new inotrope-vasodilator: Systemic and coronary hemodynamic effects in congestive heart failure. Am J Cardiol 55: 1539

    Article  PubMed  CAS  Google Scholar 

  92. Renard M, Jacobs P, Dechamps P, et al (1983) Hemodynamic and clinical response to three-day infusion of sulmazol (AR LI15BS) in severe congestive heart failure. Chest 84: 408

    Article  PubMed  CAS  Google Scholar 

  93. Mancini D, Sonnenblick EH, Latts JR, et al (1984) Hemodynamic and clinical benefits of CI-914, a new cardiotonic agent. Circulation 70 (Suppl II): 307

    Google Scholar 

  94. Endoh M, Yamashita S, Taira N (1982) Positive inotropic effect of amrinone in relation to cyclic nucleotide metabolism in the canine ventricular muscle. J Pharmacol Exp Ther 221: 775

    PubMed  CAS  Google Scholar 

  95. Ludmer PL, Wright RF, Arnold MO, et al (1986) Separation of the direct myocardial and vasodilator actions of milrinone administratered by an intracoronary infusion technique. Circulation 73: 130

    Article  PubMed  CAS  Google Scholar 

  96. Dage RC, Kariya T, Hsieh PC, et al (1987) Pharmacology of enoximone. Am J Cardiol 60: 10C

    Article  Google Scholar 

  97. Janicki JS, Shroff SG, Weber KT (1987) Physiologic response to the inotropic and vasodilator properties of enoximone. Am J Cardiol 60: 15C

    Google Scholar 

  98. Kereiakes DJ, Viquerat C, Lanzer P, et al (1984) Mechanisms of improved left ventricular function following intravenous MDL, 17093 in patients with severe chronic heart failure. Am Heart J 108: 1278

    Article  PubMed  CAS  Google Scholar 

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  1. K. Chatterjee
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Editors and Affiliations

  1. Department of Intensive Care, C. H. U. Vaudois, CH-1011, Lausanne, Switzerland

    Claude Perret (Director) (Director)

  2. Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean Louis Vincent (Assistant-Director) (Assistant-Director)

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Chatterjee, K. (1988). Mechanism of Action of Inotropic Agents in Heart Failure. In: Perret, C., Vincent, J.L. (eds) Acute Heart Failure. Update in Intensive Care and Emergency Medicine, vol 6. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-83453-0_15

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  • DOI: https://doi.org/10.1007/978-3-642-83453-0_15

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