Andersen–Tawil syndrome: A long QT syndrome with variable expression

de Vera McMullan, Paula; Corella Aznar, Elena; Granados Ruiz, Miguel Ángel

doi:10.1016/j.medcle.2023.10.021

array:24 ["pii" => "S2387020624000676" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.10.021" "estado" => "S300" "fechaPublicacion" => "2024-03-22" "aid" => "6475" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;162:309-11" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775323006711" "issn" => "00257753" "doi" => "10.1016/j.medcli.2023.10.021" "estado" => "S300" "fechaPublicacion" => "2024-03-22" "aid" => "6475" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;162:309-11" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "Carta al Editor" "titulo" => "Síndrome de Andersen-Tawil: un síndrome QT largo con expresividad variable" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "309" "paginaFinal" => "311" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Andersen–Tawil syndrome: A long QT syndrome with variable expression" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1763 "Ancho" => 3542 "Tamanyo" => 2184884 ] ] "descripcion" => array:1 [ "es" => "ECG basal del paciente 1 antes de la medicación betabloqueante. Ondas U prominentes con intervalo QT prolongado en todas las derivaciones." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Paula de Vera McMullan, Elena Corella Aznar, Miguel Ángel Granados Ruiz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Paula" "apellidos" => "de Vera McMullan" ] 1 => array:2 [ "nombre" => "Elena" "apellidos" => "Corella Aznar" ] 2 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "Granados Ruiz" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020624000676" "doi" => "10.1016/j.medcle.2023.10.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624000676?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323006711?idApp=UINPBA00004N" "url" => "/00257753/0000016200000006/v1_202403190527/S0025775323006711/v1_202403190527/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S238702062400069X" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.08.016" "estado" => "S300" "fechaPublicacion" => "2024-03-22" "aid" => "6432" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2024;162:312" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Image in medicine" "titulo" => "Fever of unknown origin in a solid organ transplant recipient" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "312" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fiebre de origen desconocido en un paciente con trasplante de órgano sólido" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 241 "Ancho" => 1005 "Tamanyo" => 73032 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Edwin U. Suárez, Carlos Soto, Elizabet Petkova Saiz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Edwin U." "apellidos" => "Suárez" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Soto" ] 2 => array:2 [ "nombre" => "Elizabet" "apellidos" => "Petkova Saiz" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062400069X?idApp=UINPBA00004N" "url" => "/23870206/0000016200000006/v2_202405200149/S238702062400069X/v2_202405200149/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2387020624000883" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.10.022" "estado" => "S300" "fechaPublicacion" => "2024-03-22" "aid" => "6473" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2024;162:308-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Hepatic and cardiac shear wave elastography in the assessment of hereditary transthyretin amyloidosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "308" "paginaFinal" => "309" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Elastografía por ondas de corte hepáticas y cardíacas en la evaluación de la amiloidosis hereditaria de transtiretina" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1969 "Ancho" => 3500 "Tamanyo" => 624679 ] ] "descripcion" => array:1 [ "en" => "Transthoracic echocardiogram and hepatic and cardiac elastography. (A and B) Parasternal long and short axis disclosing the classical cardiac amyloidosis features: increased myocardial thickness, pericardial effusion, valve thickening; (C) Bulls’ eye showing a very reduced global longitudinal strain (8.8%) with apical sparing (the worse deformation regions corresponding with basal ones); (D) Hepatic elastography, 78.9kPa in a segment at right hepatic lobe; (E) Cardiac elastography in the basal cardiac septum (2.36kPa); (F) Cardiac elastography in the apical region showing less stiffness comparing to basal regions (0.62kPa). AO: aorta; LA: left atrium; LV: left ventricle; RV: right ventricle. White arrows: regions of interest of the shear wave elastography technique; red arrow: mitral valve thickening; white asterisks: pericardial effusion; red asterisks: increased myocardial thickness." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Glaudir Donato, José Eymard Moraes de Medeiros Filho, Marcelo Melo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Glaudir" "apellidos" => "Donato" ] 1 => array:2 [ "nombre" => "José Eymard Moraes" "apellidos" => "de Medeiros Filho" ] 2 => array:2 [ "nombre" => "Marcelo" "apellidos" => "Melo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624000883?idApp=UINPBA00004N" "url" => "/23870206/0000016200000006/v2_202405200149/S2387020624000883/v2_202405200149/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Andersen–Tawil syndrome: A long QT syndrome with variable expression" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "309" "paginaFinal" => "311" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Paula de Vera McMullan, Elena Corella Aznar, Miguel Ángel Granados Ruiz" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Paula" "apellidos" => "de Vera McMullan" "email" => array:2 [ 0 => "paula.devera@gmail.com" 1 => "paula.vera@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Elena" "apellidos" => "Corella Aznar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Miguel Ángel" "apellidos" => "Granados Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital Universitario Infanta Cristina, Parla, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario Doce de Octubre, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Andersen-Tawil: un síndrome QT largo con expresividad variable" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1763 "Ancho" => 3542 "Tamanyo" => 2184884 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0295" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Baseline ECG of patient 1 before beta-blocker medication. Prominent U waves with prolonged QT interval in all leads." ] ] ] "textoCompleto" => "Andersen–Tawil syndrome (ATS) is a rare genetic disorder, secondary to mutations in the KCNJ2 gene, characterised by a triad of ventricular arrhythmias/QT-U interval prolongation, periodic muscle paralysis and skeletal dysmorphic features.We report two patients with different suspected ATS whose final diagnosis turned out to be genetic.The first patient, male, aged 17, presented with initial suspicion of metabolic myopathy after an episode of prolonged muscle paralysis with normal potassium levels. The ENG–EMG was normal, the baseline ECG with QTc interval was normal, while the U wave was prominent (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Holter showed occasional ventricular extrasystoles with some doublets without ventricular tachycardia; conventional exercise test with very prominent U waves but with normal QTc interval during tachycardia.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Suspecting ATS, genetic testing was performed, which confirmed the diagnosis –variant c.491A>G (p.Q164R) of the KCNJ2 mutation–. Treatment was started with bisoprolol.The second patient, female, aged 15, was initially assessed by the paediatric neurology department for dysmorphic syndrome of unknown aetiology with neurological-psychiatric comorbidity. A diagnosis of ATS was made after detecting the KCNJ2:p.Arg325His mutation in the exome. She had several dysmorphic features typical of ATS (low-set ears, hypertelorism and scoliosis). ECG was performed with a normal baseline QTc interval that was prolonged at maximum tachycardia in the standing test. Holter monitoring showed no extrasystoles or pathological tachycardias. Treatment with atenolol was started.ATS is a channelopathy inherited in an autosomal dominant fashion with an estimated prevalence of 1/1,000,000.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> It is characterised by periodic episodes of flaccid muscle paralysis, cardiac abnormalities (ventricular arrhythmias, QT prolongation/prominent U-waves) and skeletal dysmorphic features (low-set ears, hypertelorism, short stature, scoliosis, fifth finger clinodactyly and mandibular hypoplasia).<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>The initial diagnosis is clinical (2 of 3 parameters), but its confirmation is genetic, as was the case with our two patients. The typical clinical triad (present in 60%–80% of patients with KCNJ2 mutations<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>) is sometimes difficult to interpret, especially in patients with uncharacteristic dysmorphic features.This gene encodes the potassium channel Kir2.1, which stabilises the resting membrane potential (AP) and controls its duration in cardiac and skeletal myocytes, along with osteoblast function. Its mutation implies a loss of channel function, suppressing the potassium current responsible for the onset of its clinical manifestations.<a class="elsevierStyleCrossRefs" href="#bib0010">2–5</a> During paralysis, these levels are variable and may even be normal,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> as was the case in our first patient.In terms of the heart, this mutation prolongs the AP, which can cause spontaneous ventricular ectopy, as well as prolonging the QT-U interval, which favours the occurrence of ventricular tachyarrhythmias, classified as congenital long QT syndrome (LQTS) type 7.<a class="elsevierStyleCrossRefs" href="#bib0015">3–5</a>Although its electrocardiographic abnormalities are common, the presence of arrhythmic syncope or sudden cardiac death (SCD) is less common, in contrast to other types of LQTS. However, this discordance between high arrhythmic load and the apparent low incidence of SCD is under study as no correlation between this mutation and the prognosis of cardiac events (as opposed to the occurrence of skeletal dysmorphic features) has been reported. However, more and more articles argue in favour of an increased frequency for these episodes, and their prevalence is not negligible (up to 7.9% in some series). One theory could be the role of the U-wave in the prolongation of the QT interval.<a class="elsevierStyleCrossRefs" href="#bib0015">3–5</a>The indication for antiarrhythmic treatment (flecainide versus beta-blockers) is controversial due to its low prevalence and variability in cardiac expression. There are also few publications on the subject, most of which are isolated cases or small series.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a>We conclude that the diagnosis of ATS requires a high level of suspicion given the phenotypic and temporal variability of its clinical manifestations, as we have demonstrated in our 2 cases. Patients presenting with periodic muscle paralysis should undergo ECG for QT-U interval assessment, as findings compatible with ATS may help with the diagnosis of suspicion while awaiting genetic results. Likewise, in patients with dysmorphic (syndromic) features, it is essential to perform an ECG with measurement of the QT-U interval, as its prolongation/presence of a prominent U-wave could point to ATS in the differential diagnosis.Individualised assessment is essential to indicate the initiation and type of antiarrhythmic therapy, due to the possibility of arrhythmogenic syncope or SCD, although these episodes are rare.<a class="elsevierStyleCrossRefs" href="#bib0005">1,5</a>Ethical considerationsWe obtained both verbal and written informed consent from the 2 patients, and this was reflected in their medical records.FundingNo funding was provided for the preparation of this article.Conflict of interestNone of the authors have any conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1763 "Ancho" => 3542 "Tamanyo" => 2184884 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0295" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Baseline ECG of patient 1 before beta-blocker medication. Prominent U waves with prolonged QT interval in all leads." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Andersen-Tawil syndrome (ATS) — case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Olszewska" 1 => "J. Błaszczak" 2 => "M. Mielnik-Błaszczak" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pre Clin Clin Res" "fecha" => "2014" "volumen" => "8" "paginaInicial" => "123" "paginaFinal" => "126" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variable penetrance of Andersen-Tawil syndrome in a family with a rare missense KCNJ2 mutation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Deeb" 1 => "A. Veerapandiyan" 2 => "R. Tawil" 3 => "S. Treidler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/NXG.0000000000000284" "Revista" => array:5 [ "tituloSerie" => "Neurol Genet" "fecha" => "2018" "volumen" => "4" "paginaInicial" => "e284" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30533530" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Electrocardiographic features in Andersen-Tawil syndrome patients with KCNJ2 mutations: characteristic T-U-wave patterns predict the KCNJ2 genotype" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Zhang" 1 => "W. Benson" 2 => "M. Tristani-Firouzi" 3 => "L.J. Ptacek" 4 => "R. Tawil" 5 => "P.J. Schwartz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.104.472498" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2005" "volumen" => "111" "paginaInicial" => "2720" "paginaFinal" => "2726" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15911703" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Síndrome de Andersen-Tawil: una revisión del diagnóstico genético y clínico con énfasis en sus manifestaciones cardíacas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.F. Márquez" 1 => "A. Totomoch-Serra" 2 => "G. Vargas-Alarcón" 3 => "D. Cruz-Robles" 4 => "O.A. Pellizzon" 5 => "M. Cárdenas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acmx.2013.12.007" "Revista" => array:6 [ "tituloSerie" => "Arch Cardiol Mex" "fecha" => "2014" "volumen" => "84" "paginaInicial" => "278" "paginaFinal" => "285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25270337" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac characteristics and long-term outcome in Andersen-Tawil syndrome patients related to KCNJ2 mutation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Delannoy" 1 => "F. Sacher" 2 => "P. Maury" 3 => "P. Mabo" 4 => "J. Mansourati" 5 => "I. Magnin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/eut160" "Revista" => array:6 [ "tituloSerie" => "Europace" "fecha" => "2013" "volumen" => "15" "paginaInicial" => "1805" "paginaFinal" => "1811" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23867365" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016200000006/v2_202405200149/S2387020624000676/v2_202405200149/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016200000006/v2_202405200149/S2387020624000676/v2_202405200149/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624000676?idApp=UINPBA00004N"]

ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

See more Open Access Option

Indexed in:

Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, SciVerse ScienceDirect

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.6

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.1

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.371

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.511

View more metrics

Journal Information

Previous article | Next article

Vol. 162. Issue 6.