Nikolaus Marx

University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany

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Publications (284)1377.13 Total impact

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    ABSTRACT: Objective: Clinical assessment often cannot risk stratify patients hospitalized with chest pain and non-diagnostic electrocardiography (ECG) or myocardial enzymes. An inappropriate admission of patients with non-cardiac chest pain is an enormous cost factor. Methods: 2315 patients who presented in the chest pain unit (CPU) with symptoms suggestive of acute coronary syndrome (ACS) were screened. All patients with relevant changes in ECG or myocardial enzymes were excluded. 268 consecutive patients (mean 58 ± 7 years, 88 men) were prospectively included and underwent echocardiography for left ventricular ejection fraction (LVEF), wall motion score index (WMSI) and strain parameter and a coronary angiography (CA) within 2 ± 1 days after admission. Results: Anatomically obstructive coronary artery disease (CAD) (≥70 % diameter stenosis) was present in 110 patients (41 %). The incremental value of LVEF, WMSI, and strain parameters to relevant clinical variables was determined in nested Cox models. Baseline clinical data associated with relevant CAD were age [hazard ratio (HR) 1.31, p = 0.03], arterial hypertension (HR 1.39, p = 0.03) and diabetes (HR 1.46, p = 0.001). The addition of endocardial global circumferential strain (GCS) (HR 1.57, p < 0.001) caused the greatest increment in model power (χ (2) = 43.4, p < 0.001). Optimal cut-off value was calculated as -21.7 % for GCS (sensitivity 87 %, specificity 76 %) to differentiate between these patients. Conclusions: In patients with suspected ACS but without ECG changes or myocardial enzyme abnormalities, myocardial deformation imaging can identify patients at risk. This approach may be applied to improve decision guidance at the CPU for fast discharge of patients with non-cardiac chest pain or prompt cardiological allocation of patients with CAD. Clinical trial registration: NCT 02357641.
    Clinical Research in Cardiology 09/2015; DOI:10.1007/s00392-015-0916-2 · 4.56 Impact Factor
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    B. Gallwitz · S. Thiemann · H. Wörle · N. Marx
    Diabetologie und Stoffwechsel 09/2015; 10(04):189-196. DOI:10.1055/s-0035-1553589 · 0.33 Impact Factor
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    ABSTRACT: Experimental evidence suggests that soluble klotho (s-klotho), a co-receptor for fibroblast growth factor 23 (FGF23), may modulate cardiovascular risk through multiple mechanisms. However, the predictive value of s-klotho in patients remains unclear. Therefore, the present study examined in a large cohort of patients referred for coronary angiography whether s-klotho is associated with cardiovascular and total mortality. The longitudinal associations between baseline s-klotho and FGF23 concentrations and mortality were evaluated in 2948 participants of the Ludwigshafen Risk and Cardiovascular Health Study (LURIC), referred for coronary angiography. Mean age of participants was: 63 ± 10 years. Patients with diabetes mellitus (n = 1136) had elevated s-klotho: [440 (430-449) versus 414 (406-421) pg/mL, p < 0.001]. S-klotho decreased in parallel to glomerular filtration rate (GFR) and increased in parallel to FGF23. During a median follow-up of 9.9 years, 874 deaths (30%) occurred, 539 (18%) of which were cardiovascular. After adjustment for cardiovascular risk factors, the hazard ratios in the fourth quartile compared to the first quartile of s-klotho were 1.14 (95%CI, 0.94-1.38; p = 0.187) for all-cause mortality and 1.03 (95%CI, 0.80-1.31; p = 0.845) for cardiovascular mortality. Excess mortality prediction by high levels of baseline FGF23 was not modified by adjustment for baseline s-klotho levels. Klotho does not add predictive power to cardiovascular and mortality risk assessment in patients with normal renal function. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Atherosclerosis 08/2015; 242(2):483-489. DOI:10.1016/j.atherosclerosis.2015.08.017 · 3.99 Impact Factor
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    ABSTRACT: Epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD) in the general population. EAT is suggested to promote CAD by paracrine mechanisms and local inflammation. We evaluated whether in chronic hemodialysis (HD) patients EAT associates with CAD, how the amount of EAT develops over time, and if EAT independently predicts the mortality risk. Post-hoc analysis of a prospective study in 59 chronic HD patients who underwent non-enhanced multi-slice computed tomography (MSCT) at baseline. Thirty-seven patients underwent another MSCT after 24 ± 5 months. We measured EAT volume (cm³) and Agatston calcification scores of coronary arteries (CAC) and aortic valves (AVC). All-cause mortality was assessed after a follow-up of 88 months (IQR 52-105). Baseline EAT was 128.2 ± 60.8 cm³ and significantly higher than in a control group of non-renal patients (94 ± 46 cm³; p < 0.05). Median Agatston score for CAC was 329 (IQR 23-1181) and for AVC was 0 (IQR 0-25.3) in HD patients. We observed significant positive correlations between baseline EAT and age (r = 0.386; p = 0.003), BMI (r = 0.314; p = 0.016), CAC (r = 0.278; p = 0.03), and AVC (r = 0.282; p = 0.03). In multivariate analysis, age, BMI and AVC remained as significant predictors of EAT (p < 0.01). Calcification scores significantly increased over 2 years; in contrast EAT change was not significant (+11 %, IQR -10 to 24 %; p = 0.066). The limited patient number in the present study precludes analysis of the EAT impact upon survival. EAT correlated significantly with cardiovascular calcification in long-term HD patients. Mean EAT did not significantly change over 2 years.
    Journal of nephrology 08/2015; DOI:10.1007/s40620-015-0221-1 · 1.45 Impact Factor
  • Medizinische Klinik - Intensivmedizin und Notfallmedizin 08/2015; 110(6). DOI:10.1007/s00063-015-0059-2 · 0.56 Impact Factor
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    ABSTRACT: Autoantibodies have been identified as major predisposing factors for dilated cardiomyopathy (DCM). Patients with DCM show elevated serum levels of vascular endothelial growth factor (VEGF) whose source is unknown. Besides its well-investigated effects on angiogenesis, evidence is present that VEGF signaling is additionally involved in fibroblast proliferation and cardiomyocyte hypertrophy, hence in cardiac remodeling. Whether autoimmune effects in DCM impact cardiac VEGF signaling needs to be elucidated. Five DCM patients were treated by the immunoadsorption (IA) therapy on five consecutive days. The eluents from the IA columns were collected and prepared for cell culture. Cardiomyocytes from neonatal rats (NRCM) were incubated with increasing DCM-immunoglobulin-G (IgG) concentrations for 48 hours. Polyclonal IgG (Venimmun N), which was used to restore IgG plasma levels in DCM patients after the IA therapy was additionally used for control cell culture purposes. Elevated serum levels of VEGF decreased significantly after IA (Serum VEGF (ng/ml); DCM pre-IA: 45±9.1 vs. DCM post-IA: 29±6.7; P<0.05). In cell culture, pretreatment of NRCM by DCM-IgG induced VEGF expression in a time and dose dependent manner. Biologically active VEGF that was secreted by NRCM significantly increased BNP mRNA levels in control cardiomyocytes and induced cell-proliferation of cultured cardiac fibroblast (Fibroblast proliferation; NRCM medium/HC-IgG: 1±0.0 vs. NRCM medium/DCM-IgG 100 ng/ml: 5.6±0.9; P<0.05). The present study extends the knowledge about the possible link between autoimmune signaling in DCM and VEGF induction. Whether this observation plays a considerable role in cardiac remodeling during DCM development needs to be further elucidated. Copyright © 2015. Published by Elsevier Inc.
    Biochemical and Biophysical Research Communications 08/2015; 465(1). DOI:10.1016/j.bbrc.2015.07.143 · 2.30 Impact Factor
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    ABSTRACT: Heart rate monitoring is especially interesting in patients with atrial fibrillation (AF) and is routinely performed by ECG. A ballistocardiography (BCG) foil is an unobtrusive sensor for mechanical vibrations. We tested the correlation of heartbeat cycle length detection by a novel algorithm for a BCG foil to an ECG in AF and sinus rhythm (SR). Methods. In 22 patients we obtained BCG and synchronized ECG recordings before and after cardioversion and examined the correlation between heartbeat characteristics. Results. We analyzed a total of 4317 heartbeats during AF and 2445 during SR with a correlation between ECG and BCG during AF of r = 0.70 (95% CI 0.68–0.71, P < 0.0001 ) and r = 0.75 (95% CI 0.73–0.77, P < 0.0001 ) during SR. By adding a quality index, artifacts could be reduced and the correlation increased for AF to 0.76 (95% CI 0.74–0.77, P < 0.0001 , n = 3468 ) and for SR to 0.85 (95% CI 0.83–0.86, P < 0.0001 , n = 2176 ). Conclusion. Heartbeat cycle length measurement by our novel algorithm for BCG foil is feasible during SR and AF, offering new possibilities of unobtrusive heart rate monitoring. This trial is registered with IRB registration number EK205/11. This trial is registered with clinical trials registration number NCT01779674 .
    08/2015; 2015(19):1-10. DOI:10.1155/2015/840356
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    DMW - Deutsche Medizinische Wochenschrift 05/2015; 140(11):831-834. DOI:10.1055/s-0041-102194 · 0.54 Impact Factor
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    ABSTRACT: The cardiovascular (CV) safety of linagliptin was evaluated in subjects with type 2 diabetes (T2DM). Pre-specified patient-level pooled analysis of all available double-blind, randomized, controlled trials, ≥12 weeks' duration (19 trials, 9459 subjects) of linagliptin versus placebo/active treatment. Primary end point: composite of prospectively adjudicated CV death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization for unstable angina (4P-MACE). Hospitalization for congestive heart failure (CHF) was also evaluated; adjudication of CHF was introduced during the phase 3 program (8 trials; 3314 subjects). 4P-MACE was assessed in placebo-controlled trials (subgroup of 18 trials; 7746 subjects). Investigator-reported events suggestive of CHF from 24 placebo-controlled trials (including trials <12 weeks' duration, 8778 subjects) were also analyzed. 5847 patients received linagliptin (5 mg: 5687, 10 mg: 160) and 3612 comparator (glimepiride: 775, voglibose: 162, placebo: 2675); cumulative exposure, 4421.3 and 3254.7 patient-years, respectively. 4P-MACE incidence rates: 13.4 per 1000 patient-years, linagliptin (60 events), 18.9, total comparators (62 events); overall hazard ratio (HR), 0.78 (95% confidence interval [CI], 0.55-1.12). HR for adjudicated hospitalization for CHF (n = 21): 1.04 (0.43-2.47). For placebo-controlled trials, 4P-MACE incidence rates: 14.9 per 1000 patient-years, linagliptin (43 events), 16.4, total comparators (29 events); overall HR, 1.09 (95% CI, 0.68-1.75). Occurrence of investigator-reported events suggestive of CHF was low for linagliptin- (26 events, 0.5%; serious: 16 events, 0.3%) and placebo-treated (8 events, 0.2%; serious: 6 events, 0.2%) patients. Linagliptin is not associated with increased CV risk versus pooled active comparators or placebo in patients with T2DM.
    Cardiovascular Diabetology 05/2015; 14(1):57. DOI:10.1186/s12933-015-0215-2 · 4.02 Impact Factor
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    ABSTRACT: Insufficient stent expansion, vessel wall injury, and tissue prolapse, all frequently unrecognized by coronary angiography, are predictors of future major adverse cardiac event (MACE) after percutaneous coronary intervention (PCI). Optical coherence tomography (OCT) provides accurate visualization of these features of inadequate stent deployment, whereas reduced fractional flow reserve (FFR) values after PCI indicate functional significance of a residual intrastent stenosis. To investigate the relationship of OCT-derived intrastent lumen dimensions and FFR-derived hemodynamic relevance immediately after coronary stent implantation and to evaluate the clinical impact of these parameters at follow-up. In 66 stable patients with a coronary de novo lesion, treated by stent implantation, post-stenting FFR and OCT data were compared and related to MACE at follow-up. There was a significant correlation between remaining OCT-derived intrastent percent area stenosis (%AS) and post-stent FFR (r² = 0.491; P<.001). According to receiver operating characteristic (ROC) analysis, both final FFR and intrastent %AS predicted MACE at 20 months (FFR: area under the curve [AUC] = 0.768; 95% confidence interval [CI], 0.562-0.973; and optimal cut-off = 0.905; %AS: AUC = 0.807; 95%CI, 0.613-1.000; and optimal cut-off = 16.85%) with moderate diagnostic efficiency. Intrastent %AS (16.60 ± 4.75% vs 7.01 ± 3.49%; P<.001) and the 20-month cumulative incidence of MACE (35.9% vs 5.3%; P=.01) were significantly greater in patients with FFR ≤0.905 (n = 26; 39.4%) compared with FFR >0.905 (n = 40; 60.6%). OCT-derived residual intrastent %AS is associated with decreased FFR following stent implantation and both are predictors for clinical outcome at follow-up.
    The Journal of invasive cardiology 05/2015; 27(5):222-8. · 0.95 Impact Factor
  • European Heart Journal 04/2015; DOI:10.1093/eurheartj/ehv147 · 15.20 Impact Factor
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    ABSTRACT: Utilization of cardiac implants such as pacemakers and implantable cardioverter defibrillators is now commonplace among heart disease patients. The ever-increasing technological complexity of these devices is matched by the near omnipresent exposure to electric, magnetic, and electromagnetic fields (EMFs), both in everyday life and the occupational environment. Given that electromagnetic interferences (EMIs) are associated with potential risk in device patients, physicians are increasingly confronted with managing device patients with intermittent EMI and chronic occupational exposure. The current review aims to provide a contemporary overview of cardiovascular implantable electronic devices, their function and susceptibility of non-medical EMFs and provide recommendations for physicians caring for cardiac device patients presenting with EMI. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email:
    European Heart Journal 04/2015; 36(28). DOI:10.1093/eurheartj/ehv135 · 15.20 Impact Factor
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    ABSTRACT: Background: Bioelectrical impedance spectroscopy is applied to measure changes in tissue composition. The aim of this study was to evaluate its feasibility in measuring the fluid shift after thoracentesis in patients with pleural effusion. Methods: 45 participants (21 with pleural effusion and 24 healthy subjects) were included. Bioelectrical impedance was analyzed for "Transthoracic," "Foot to Foot," "Foot to Hand," and "Hand to Hand" vectors in low and high frequency domain before and after thoracentesis. Healthy subjects were measured at a single time point. Results: The mean volume of removed pleural effusion was 1169 ± 513 mL. The "Foot to Foot," "Hand to Hand," and "Foot to Hand" vector indicated a trend for increased bioelectrical impedance after thoracentesis. Values for the low frequency domain in the "Transthoracic" vector increased significantly (P < 0.001). A moderate correlation was observed between the amount of removed fluid and impedance change in the low frequency domain using the "Foot to Hand" vector (r = -0.7). Conclusion: Bioelectrical impedance changes in correlation with the thoracic fluid level. It was feasible to monitor significant fluid shifts and loss after thoracentesis in the "Transthoracic" vector by means of bioelectrical impedance spectroscopy. The trial is registered with Registration Numbers IRB EK206/11 and NCT01778270.
    04/2015; 2015:1-9. DOI:10.1155/2015/810797
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    ABSTRACT: Die 2013 veröffentlichten ESC (Europäische Gesellschaft für Kardiologie)-Leitlinien zur stabilen koronaren Herzerkrankung geben praktische Hinweise zum Einsatz diagnostischer Verfahren zur Erkennung einer hämodynamisch relevanten koronaren Herzerkrankung und zur langfristigen Verlaufskontrolle von mittlerweile asymptomatischen Patienten mit chronischer koronarer Herzkrankheit (KHK). Die Auswahl geeigneter diagnostischer Verfahren basiert auf der Vortestwahrscheinlichkeit, die eine zentrale Rolle im diagnostischen Algorithmus einnimmt. Nur bei Patienten mit schwerer Angina oder einem hohem Risiko für Tod oder Myokardinfarkt nach Risikostratifikation wird zu einem direkten invasiven Vorgehen geraten. Therapeutisch wird ein Schema zum Einsatz antianginöser und präventiver Medikamente vorgegeben, das neue Antianginosa einbezieht. Die Indikation zur perkutanen Koronarintervention (PCI) wird insbesondere für Patienten mit niedrigem SYNTAX-Score und Mehrgefäßerkrankung oder Hauptstammstenose erweitert. Abstract The 2013 guidelines of the European Society of Cardiology (ESC) on the management of stable coronary artery disease (CAD) give practical recommendations for the use of diagnostic tools to identify hemodynamically relevant coronary artery stenoses. Furthermore, they give advice for the management of previously symptomatic patients with known obstructive or non-obstructive CAD, who have become asymptomatic with treatment and need regular follow-up. The selection of appropriate diagnostic tests is based on the tabulated pretest probability of the patient, which plays a central role in the diagnostic algorithm. An invasive approach is recommended only for patients who either have severe angina or who are judged to be at high risk for adverse events based on clinical evidence or the results of diagnostic tests. The optimal use of preventive and antianginal medications is shown in a scheme which includes the new antianginal drugs. The guidelines recommend a percutaneous coronary intervention (PCI) as an alternative to bypass surgery in patients with multivessel disease or left main stem stenosis if the SYNTAX score is low.
    Der Kardiologe 04/2015; 9(2):159-164. DOI:10.1007/s12181-015-0652-x
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    ABSTRACT: -The renin-angiotensin-system and especially the angiotensin peptides play a cen-tral role in blood pressure regulation. Here, we hypothesize that a yet unknown peptide is in-volved in the action of Ang-II modulating the vasoregulatory effects as a cofactor. -The peptide with vasodilatory properties was isolated from adrenal glands chromatographically. The effects of this peptide were evaluated in-vitro and in-vivo, and the receptor affinity was analysed. The plasma concentration in humans was quantified in chronic kidney disease patients, heart failure patients and healthy controls. The amino acid se-quence of the peptide from bovine adrenal glands was HSSYEDELSEVL EKPNDQAE PKEVTEEVSSKDAAE, which is a degradation product of Chromogranin-A. The sequence of the peptide isolated from human plasma was HSGFEDELSEVLENQSSQAELKEAVEEPSSKDVME. Both peptides diminished significantly the vasoconstrictive effect of Ang-II in-vitro. Therefore, we named the peptide "vasoconstriction inhibiting factor" (VIF). The vasoregulatory effects of VIF are mediated by the AT2-receptor. VIF impairs Ang-II-induced phosphorylation of the p38MAPK-pathway but not of ERK1/2. The vasodilatory effects were confirmed in-vivo. The plasma concentration was significantly in-creased in renal and hear failure patients. -VIF is a vasoregulatory peptide which modulates the vasoconstrictive effects of Ang-II by acting on the AT2-receptor. It is likely that the increase in VIF may serve as a counter-regulatory effect to defend against hypertension. The identification of this target may help us to understand the pathophysiology of renal and heart failure and may form a basis for the develop-ment of new strategies for the prevention and treatment of cardiovascular disease.
    Circulation 03/2015; 131(16). DOI:10.1161/CIRCULATIONAHA.114.013168 · 14.43 Impact Factor
  • Circulation Cardiovascular Imaging 03/2015; 8(5). DOI:10.1161/CIRCIMAGING.114 · 5.32 Impact Factor
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    ABSTRACT: C-peptide has pro-atherogenic effects in animal models, and elevated C-peptide levels are associated with cardiovascular and all-cause mortality in patients undergoing coronary angiography. This cross-sectional study investigated the association between C-peptide serum levels and coronary artery calcification (CAC) in patients with rheumatoid arthritis (RA), a high-risk group for cardiovascular events. Fifty-four patients with RA were recruited from an arthritis outpatient department at the University Hospital in Aachen, Germany. CAC was measured by multi-slice CT scan, and blood samples were drawn from all patients for the analysis of C-peptide and other cardiovascular biomarkers. Mean serum levels of C-peptide (1.187 ± 0.771 vs 0.745 ± 0.481 nmol/L, p = 0.02), YKL-40, LDL cholesterol, and triglycerides were significantly higher in patients with CAC (n = 32, 59 %) compared to those without CAC (n = 22, 41 %). Univariate analysis revealed a significant association of C-peptide [OR 4.7, 95 % CI (1.1, 20.2)], YKL-40, triglycerides, hypertension, smoking, age, and male sex with the presence of CAC. After adjustment for body mass index, cholesterol, diabetes, adiponectin, calcium, and phosphate, C-peptide was still significantly associated with CAC in a multivariate logistic regression model. In conclusion, C-peptide serum levels are independently associated with the presence of CAC in patients with RA. These data suggest a potential role of C-peptide in cardiovascular disease in patients with RA.
    Rheumatology International 03/2015; 35(9). DOI:10.1007/s00296-015-3244-y · 1.52 Impact Factor
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    ABSTRACT: CARdiovascular Outcome Trial of LINAgliptin Versus Glimepiride in Type 2 Diabetes (NCT01243424) is an ongoing, randomized trial in subjects with early type 2 diabetes and increased cardiovascular risk or established complications that will determine the long-term cardiovascular impact of linagliptin versus the sulphonylurea glimepiride. Eligible patients were sulphonylurea-naïve with HbA1c 6.5%-8.5% or previously exposed to sulphonylurea (in monotherapy or in a combination regimen <5 years) with HbA1c 6.5%-7.5%. Primary outcome is time to first occurrence of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for unstable angina. A total of 631 patients with primary outcome events will be required to provide 91% power to demonstrate non-inferiority in cardiovascular safety by comparing the upper limit of the two-sided 95% confidence interval as being below 1.3 for a given hazard ratio. Hierarchical testing for superiority will follow, and the trial has 80% power to demonstrate a 20% relative cardiovascular risk reduction. A total of 6041 patients were treated with median type 2 diabetes duration 6.2 years, 40.0% female, mean HbA1c 7.2%, 66% on 1 and 24% on 2 glucose-lowering agents and 34.5% had previous cardiovascular complications. The results of CARdiovascular Outcome Trial of LINAgliptin Versus Glimepiride in Type 2 Diabetes may influence the decision-making process for selecting a second glucose-lowering agent after metformin in type 2 diabetes. © The Author(s) 2015.
    Diabetes & Vascular Disease Research 03/2015; 12(3). DOI:10.1177/1479164115570301 · 2.83 Impact Factor
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    ABSTRACT: Patients with chronic kidney disease (CKD) exhibit an increased cardiovascular risk. The high susceptibility to cardiovascular disease renders CKD patients 'vulnerable patients'. The overall cardiovascular risk of a vulnerable patient with CKD is determined by the components of the vulnerable myocardium, the vulnerable vessel and the vulnerable blood which in sum contribute to the increased morbidity and mortality risk in CKD patients. Future therapeutic strategies to reduce cardiovascular morbidity and mortality in this high-risk population should address all three aspects of vulnerability in CKD patients. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
    Nephrology Dialysis Transplantation 03/2015; DOI:10.1093/ndt/gfv041 · 3.58 Impact Factor
  • Journal of the American College of Cardiology 03/2015; 65(10):A2080. DOI:10.1016/S0735-1097(15)62080-0 · 16.50 Impact Factor

Publication Stats

8k Citations
1,377.13 Total Impact Points


  • 2010–2015
    • University Hospital RWTH Aachen
      • • Department of Neurology
      • • Clinic of Cardiology, Pneumology, Angiology and Internal Medicine Intensive Care (Internal Medicine I )
      • • Division of Internal Medicine
      Aachen, North Rhine-Westphalia, Germany
  • 2009–2015
    • RWTH Aachen University
      • Institute for Molecular Cardiovascular Research
      Aachen, North Rhine-Westphalia, Germany
  • 2012
    • Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin
      Aachen, North Rhine-Westphalia, Germany
  • 2001–2010
    • Universität Ulm
      • • Clinic of Internal Medicine II
      • • Department of Internal Medicine
      Ulm, Baden-Württemberg, Germany
  • 2006
    • Baylor College of Medicine
      • Department of Molecular & Cellular Biology
      Houston, TX, United States
  • 1998–2000
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
    • Ludwig-Maximilians-University of Munich
      München, Bavaria, Germany
    • Deutsches Herzzentrum München
      • Klinik für Herz- und Kreislauferkrankungen
      München, Bavaria, Germany
  • 1997
    • Technische Universität München
      • Medizinische Klinik und Poliklinik II
      München, Bavaria, Germany