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Biomarkers of Hemodynamic Congestion in Heart Failure. 心力衰竭血流动力学充盈的生物标志物
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-09-19 DOI: 10.1007/s11897-024-00684-8
Alison Brann, Sean Selko, Ethan Krauspe, Kevin Shah

Purpose of review: The purpose of this review is to describe the evidence behind various blood and imaging-based biomarkers that can improve the identification of congestion when not clearly evident on routine examination.

Recent findings: The natriuretic peptides (NPs) BNP and NT-proBNP have been shown to closely correlate with intra-cardiac filling pressures, both at baseline and when trended following improvement in congestion. Additionally, NPs rise well before clinical congestion is apparent so can be used as a tool to help identify subclinical HF decompensation. Additional serum-based biomarkers including MR-proANP and CA-125 can be helpful in assisting with diagnostic certainty when BNP or NT-proBNP are in the "grey zone" or when factors are present which may confound NP levels. Additionally, the emerging use of ultrasound techniques may enhance our ability to fine-tune the assessment and treatment of congestion. Biomarkers, including the blood-based natriuretic peptides and markers on bedside point of care ultrasound, can be used as non-invasive indices of hemodynamic congestion. These biomarkers are particularly valuable to incorporate when the degree of a patient's congestion is not apparent on clinical exam, and they can provide important prognostic information and help guide clinical management.

综述目的:本综述旨在描述各种基于血液和成像的生物标志物背后的证据,这些生物标志物可以在常规检查不明显的情况下提高充血的识别率:最近的研究结果表明,无论是基线还是充血改善后的趋势,钠尿肽(NPs)BNP 和 NT-proBNP 都与心内充盈压密切相关。此外,NPs 早在临床充血明显之前就已升高,因此可作为帮助识别亚临床 HF 失代偿的工具。当 BNP 或 NT-proBNP 处于 "灰色区域 "或存在可能混淆 NP 水平的因素时,其他基于血清的生物标志物(包括 MR-proANP 和 CA-125)可帮助确定诊断。此外,超声技术的新兴应用可能会提高我们对充血评估和治疗进行微调的能力。生物标志物,包括血液中的钠尿肽和床旁护理点超声上的标志物,可用作血流动力学充血的无创指标。当患者的充血程度在临床检查中并不明显时,这些生物标志物就显得尤为重要,它们可以提供重要的预后信息,帮助指导临床治疗。
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引用次数: 0
Revisiting Biomarkers of Cardiac Allograft Vasculopathy: Addressing the Achilles Heel of Heart Transplantation. 重新审视心脏移植血管病变的生物标志物:解决心脏移植的致命弱点。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-10-17 DOI: 10.1007/s11897-024-00685-7
Patrick E O'Hara, Ananya Gorrai, Maryjane Farr, Matthias Peltz, Hadi Beaini, Yasbanoo Moayedi, Sharon Chih, Lauren K Truby

Nearly half of heart transplant recipients will be diagnosed with cardiac allograft vasculopathy (CAV) within five years after transplantation. Advanced CAV can lead to worsening heart failure as well as arrhythmias and sudden cardiac death. The only curative therapy for end-stage CAV is re-transplantation. Current diagnostic methods are invasive and limited by poor sensitivity in early disease. Despite its high prevalence in the post-transplantpopulation, the underlying pathophysiology of this condition has yet to be fully described. It is thought to be primarily related to endothelial dysfunction, immune activation, and cardiometabolic disease. Biomarkers reflecting these underlying processes, particularly endothelial injury and immune activation, have shown early promise in discriminating prevalent CAV. Next-generation sequencing technologies such as proteomic and transcriptomic profiling have also provided further insight into the pathophysiology of CAV through the identification of novel biomarkers. Ultimately, these biomarkers may have a role in not only diagnosing CAV but also highlighting potential targets for disease-specific therapies. In this article, we review the current data for biomarkers in CAV and discuss future directions for biomarker identification..

近一半的心脏移植受者会在移植后五年内被诊断出患有心脏同种异体移植血管病变(CAV)。晚期 CAV 可导致心力衰竭恶化、心律失常和心脏性猝死。对终末期 CAV 的唯一治疗方法是再次移植。目前的诊断方法都是侵入性的,对早期疾病的敏感性较低。尽管 CAV 在移植后人群中发病率很高,但其潜在的病理生理学尚未得到充分描述。人们认为它主要与内皮功能障碍、免疫激活和心脏代谢疾病有关。反映这些潜在过程(尤其是内皮损伤和免疫激活)的生物标志物在鉴别流行性 CAV 方面已初见成效。蛋白质组和转录组分析等下一代测序技术也通过鉴定新型生物标志物进一步深入了解了 CAV 的病理生理学。最终,这些生物标志物不仅可用于诊断 CAV,还能突出疾病特异性疗法的潜在靶点。在本文中,我们回顾了 CAV 生物标志物的现有数据,并讨论了生物标志物鉴定的未来方向。
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引用次数: 0
Screening for Heart Failure: Biomarkers to Detect Heightened Risk in the General Population. 心力衰竭筛查:检测普通人群高风险的生物标志物。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-09-17 DOI: 10.1007/s11897-024-00686-6
Leah B Kosyakovsky, Rudolf A de Boer, Jennifer E Ho

Purpose of review: Heart failure (HF) represents a growing global burden of morbidity and mortality. Identifying individuals at risk for HF development is increasingly important, particularly given the advent of disease-modifying therapies for HF as well as its major risk factors such as obesity actalnd diabetes. We aim to review the key circulating biomarkers associated with future HF which may contribute to HF risk prediction.

Recent findings: While current guidelines recommend the use of natriuretic peptides and cardiac troponins in HF risk stratification, there are a diverse array of other emerging protein, metabolic, transcriptomic, and genomic biomarkers of future HF development. These biomarkers not only lend insight into the underlying pathophysiology of HF, which spans inflammation to cardiac fibrosis, but also offer an opportunity to further refine HF risk in addition to established biomarkers. As evolving techniques in molecular biology enable an increased understanding of the complex biologic contributions to HF pathophysiology, there is an important opportunity to construct integrated clinical and multi-omic models to best capture HF risk. Moving forward, future studies should seek to understand the contributions of sex differences, underlying comorbidity burden, and HF subtypes to an individual's HF risk. Further studies are necessary to fully define the clinical utility of biomarker screening approaches to refine HF risk assessment, as well as to link risk assessment directly to preventive strategies for HF.

回顾的目的:心力衰竭(HF)是一个日益严重的全球性发病和死亡负担。鉴别心力衰竭高危人群的重要性与日俱增,特别是考虑到心力衰竭疾病修饰疗法的出现以及肥胖和糖尿病等主要风险因素。我们旨在回顾与未来心房颤动有关的主要循环生物标志物,这些标志物可能有助于心房颤动风险预测:尽管目前的指南建议在高血压风险分层中使用钠尿肽和心肌肌钙蛋白,但未来高血压发展的蛋白质、代谢、转录组和基因组生物标志物也多种多样。这些生物标志物不仅能帮助人们深入了解从炎症到心脏纤维化的心房颤动潜在病理生理学,还能在已有的生物标志物之外提供进一步完善心房颤动风险的机会。随着分子生物学技术的不断发展,人们对心房颤动病理生理学的复杂生物作用有了更多的了解,这为构建综合临床和多组学模型以最佳捕捉心房颤动风险提供了重要机会。展望未来,未来的研究应寻求了解性别差异、潜在合并症负担和高频亚型对个人高频风险的贡献。有必要开展进一步的研究,以充分确定生物标志物筛查方法在完善心房颤动风险评估方面的临床效用,并将风险评估与心房颤动的预防策略直接联系起来。
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引用次数: 0
Troponin Elevation in Asymptomatic Cancer Patients: Unveiling Connections and Clinical Implications. 无症状癌症患者肌钙蛋白升高:揭示联系与临床意义
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-09-10 DOI: 10.1007/s11897-024-00681-x
Sebastian W Romann, Evangelos Giannitsis, Norbert Frey, Lorenz H Lehmann

Purpose of the review: Elevated troponin levels are well established e.g., for the diagnosis of suspected acute coronary syndrome in symptomatic patients. In contrast, troponin elevations in asymptomatic cancer patients emerge as a complex phenomenon, challenging traditional perceptions of its association solely with cardiac events.

Recent findings: Recent data support the predictive value of cardiac biomarker for all-cause mortality and cardiotoxicity in cancer patients. This review gives an overview about the current literature about cardiac troponins in prediction and identification of high-risk cancer patients. The overview is focusing on diagnostic challenges, biomarker significance, and gaps of knowledge. Latest publications highlight the relevance of cardiac troponin in risk analysis before cancer treatment as well as a potential diagnostic gatekeeper for further cardiological diagnostics and therapy.

审查目的:肌钙蛋白水平升高已得到公认,如用于诊断有症状患者的疑似急性冠脉综合征。相比之下,无症状癌症患者的肌钙蛋白升高则是一个复杂的现象,它挑战了传统观念,即肌钙蛋白升高仅与心脏事件有关:最新研究结果:最新数据支持心脏生物标志物对癌症患者全因死亡率和心脏毒性的预测价值。本综述概述了目前有关心肌肌钙蛋白在预测和识别高危癌症患者方面的文献。综述的重点是诊断方面的挑战、生物标志物的意义和知识空白。最新出版物强调了心肌肌钙蛋白在癌症治疗前风险分析中的相关性,以及作为进一步心脏病诊断和治疗的潜在诊断守门员的作用。
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引用次数: 0
Cardiogenic Shock: Focus on Non-Cardiac Biomarkers. 心源性休克:关注非心脏生物标志物。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-07-30 DOI: 10.1007/s11897-024-00676-8
Hadi Beaini, Zainali Chunawala, Daniel Cheeran, Faris Araj, Christopher Wrobel, Lauren Truby, Amit Saha, Jennifer T Thibodeau, Maryjane Farr

Purpose of review: To examine the evolving multifaceted nature of cardiogenic shock (CS) in the context of non-cardiac biomarkers that may improve CS management and risk stratification.

Recent findings: There are increasing data highlighting the role of lactate, glucose, and other markers of inflammation and end-organ dysfunction in CS. These biomarkers provide a more comprehensive understanding of the concurrent hemo-metabolic and cellular disturbances observed in CS and offer insights beyond standard structural and functional cardiac assessments. Non-cardiac biomarkers both refine the diagnostic accuracy and improve the prognostic assessments in CS. Further studies revolving around novel biomarkers are warranted to support more targeted and effective therapeutic and management interventions in these high-risk patients.

综述的目的:结合可改善心源性休克管理和风险分层的非心脏生物标志物,研究心源性休克(CS)不断演变的多面性:越来越多的数据强调了乳酸、葡萄糖及其他炎症和内脏器官功能障碍标志物在 CS 中的作用。这些生物标志物能让人更全面地了解 CS 中并发的血液代谢和细胞紊乱,并提供超出标准心脏结构和功能评估的见解。非心脏生物标志物既能提高 CS 诊断的准确性,又能改善预后评估。我们有必要围绕新型生物标志物开展进一步研究,以支持对这些高危患者采取更有针对性、更有效的治疗和管理干预措施。
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引用次数: 0
Genetic Biomarkers in Heart Failure: From Gene Panels to Polygenic Risk Scores. 心力衰竭的遗传生物标志物:从基因面板到多基因风险评分。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-10-15 DOI: 10.1007/s11897-024-00687-5
Marta Figueiral, Alessia Paldino, Luca Fazzini, Naveen L Pereira

Purpose of review: This review aims to provide a comprehensive overview of the current understanding of genetic markers associated with heart failure (HF) and its underlying causative diseases, such as cardiomyopathies. It highlights the relevance of genetic biomarkers in diagnosing HF, predicting prognosis, potentially identifying its preclinical stages and identifying targets to enable the implementation of individualized medicine approaches.

Recent findings: The prevalence of HF is increasing due to an aging population but with greater access to disease-modifying therapies. Advanced diagnostic tools such as cardiac magnetic resonance, nuclear imaging, and AI-enabled diagnostic testing are now being utilized to further characterize HF patients. Additionally, the importance of genetic testing in HF diagnosis and management is increasingly being recognized. Genetic biomarkers, including single nucleotide polymorphisms (SNPs) and rare genetic variants, are emerging as crucial tools for diagnosing HF substrates, determining prognosis and increasingly directing therapy. These genetic insights are key to optimizing HF management and delivering personalized treatment tailored to individual patients. HF is a complex syndrome affecting millions globally, characterized by high mortality and significant economic burden. Understanding the underlying etiologies of HF is essential for improving management and clinical outcomes. Recent advances highlight the use of multimodal assessments, including AI-enabled diagnostics and genetic testing, to better characterize and manage HF. Genetic biomarkers are particularly promising in identifying preclinical HF stages and providing personalized treatment options. The genetic contribution to HF is heterogeneous, with both monogenic and polygenic bases playing a role. These developments underscore the shift towards personalized medicine in HF management.

综述的目的:本综述旨在全面概述目前对心力衰竭(HF)及其潜在致病疾病(如心肌病)相关遗传标记的认识。它强调了基因生物标志物在诊断心力衰竭、预测预后、潜在识别临床前阶段以及确定靶点以实施个体化医疗方法方面的相关性:由于人口老龄化,心房颤动的发病率正在上升,但获得疾病改变疗法的机会却越来越多。先进的诊断工具,如心脏磁共振、核成像和人工智能诊断检测,现在正被用来进一步描述心房颤动患者的特征。此外,基因检测在心房颤动诊断和管理中的重要性也日益得到认可。遗传生物标志物,包括单核苷酸多态性(SNP)和罕见遗传变异,正逐渐成为诊断心房颤动基质、确定预后和指导治疗的重要工具。这些遗传学见解是优化心房颤动管理和提供适合患者个体的个性化治疗的关键。心房颤动是一种复杂的综合征,影响着全球数百万人,具有死亡率高和经济负担重的特点。了解心房颤动的潜在病因对改善管理和临床疗效至关重要。最近的进展突出表明,多模式评估(包括人工智能诊断和基因检测)的使用能更好地描述和管理心房颤动。基因生物标志物在识别临床前高频阶段和提供个性化治疗方案方面尤其具有前景。心房颤动的遗传因素多种多样,单基因和多基因都在其中发挥作用。这些发展突显了在高血压管理中向个性化医疗的转变。
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引用次数: 0
Heart Failure in Rheumatoid Arthritis: Clinical Implications. 类风湿性关节炎的心力衰竭:临床意义。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-09-17 DOI: 10.1007/s11897-024-00682-w
Alexis Zambrano Zambrano, Hector Del Río Zanatta, Andrea González Espinoza, Brian Bernal Alferes, Kevin Zambrano Zambrano, Julio Martinez Salazar, Carlos Haroldo Ixcamparij Rosales

Purpose of review: This review focuses on the association between RA and heart failure, highlighting the role of inflammation and the prevalence of heart failure with preserved ejection fraction (HFpEF) in this population.

Recent findings: The incidence of heart failure in RA patients is two to three times higher than in the general population, with inflammation playing a significant role independent of traditional cardiovascular risk factors. HFpEF accounts for about half of heart failure cases and is increasingly recognized in RA patients, although it remains underdiagnosed. Atypical presentations and non-specific symptoms further complicate diagnosis. Early control of inflammation has been shown to reduce the risk of heart failure development and progression, improving both morbidity and mortality outcomes. Rheumatoid arthritis (RA) is a systemic inflammatory disease affecting approximately 1% of the population, with cardiovascular disease being the leading cause of premature death in these patients.

综述的目的:这篇综述重点探讨了RA与心力衰竭之间的关联,强调了炎症的作用以及射血分数保留型心力衰竭(HFpEF)在这一人群中的发病率:最近的研究结果:RA 患者心力衰竭的发病率是普通人群的两到三倍,炎症在传统的心血管风险因素之外发挥着重要作用。HFpEF约占心力衰竭病例的一半,在RA患者中的认知度越来越高,但仍未得到充分诊断。不典型的表现和非特异性症状使诊断更加复杂。研究表明,早期控制炎症可降低心衰发生和发展的风险,从而改善发病率和死亡率。类风湿性关节炎(RA)是一种全身性炎症性疾病,影响着约1%的人口,心血管疾病是这些患者过早死亡的主要原因。
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引用次数: 0
Emerging Biomarkers in Cardiac Sarcoidosis and Other Inflammatory Cardiomyopathies. 心脏肉样瘤病和其他炎症性心肌病的新生物标志物
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-10-04 DOI: 10.1007/s11897-024-00683-9
Joseph El Roumi, Ziad Taimeh

Purpose of review: Cardiac sarcoidosis and other inflammatory cardiomyopathies are disorders causing cardiac inflammation and leading to heart failure, arrythmias and cardiac arrest. Diagnosis of these entities remains challenging and multimodal. Thus, there is a growing need to develop reliable biomarkers that can aid in the diagnosis. This review aims to summarize and highlight recent findings in the field of biomarkers for cardiac sarcoidosis and inflammatory cardiomyopathy.

Recent findings: Multiple categories of biomarkers including novel molecules are being investigated with the latest evidence showing promising results. Some of these biomarkers are proven to be useful as diagnostic and prognostic aids in cardiac sarcoid and inflammatory cardiomyopathy. The identification of cost-effective and accurate biomarkers is useful not only for enhancing diagnostic accuracy but also for informing therapeutic decision-making processes. This advancement would facilitate the timely institution of immunosuppressive therapies, ultimately leading to improved patient outcomes.

综述的目的:心脏肉样瘤病和其他炎症性心肌病是引起心脏炎症的疾病,可导致心力衰竭、心律失常和心跳骤停。对这些疾病的诊断仍然具有挑战性,而且需要多种方式。因此,开发有助于诊断的可靠生物标志物的需求与日俱增。本综述旨在总结和强调心脏肉样瘤病和炎症性心肌病生物标志物领域的最新研究成果:包括新型分子在内的多类生物标志物正在接受研究,最新证据显示结果很有希望。其中一些生物标志物已被证明可作为心脏肉样瘤病和炎症性心肌病的诊断和预后辅助指标。鉴定具有成本效益和准确的生物标志物不仅有助于提高诊断的准确性,还能为治疗决策过程提供信息。这一进步将有助于及时采用免疫抑制疗法,最终改善患者的预后。
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引用次数: 0
Cancer Development and Progression in Patients with Heart Failure. 心力衰竭患者的癌症发展与恶化
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-12-01 Epub Date: 2024-09-28 DOI: 10.1007/s11897-024-00680-y
Katharina Seuthe, Felix Simon Ruben Picard, Holger Winkels, Roman Pfister

Purpose of review: The co-occurrence of heart failure (HF) and cancer represents a complex and multifaceted medical challenge. Patients with prevalent cardiovascular disease (CVD), particularly HF, exhibit an increased risk of cancer development, raising questions about the intricate interplay between these two prevalent conditions. This review aims to explore the evolving landscape of cancer development in patients with HF, shedding light on potential mechanisms, risk factors, and clinical implications.

Recent findings: Epidemiological data suggests higher cancer incidences and higher cancer mortality in HF patients, which are potentially more common in patients with HF with preserved ejection fraction due to related comorbidities. Moreover, recent preclinical data identified novel pathways and mediators including the protein SerpinA3 as potential drivers of cancer progression in HF patients, suggesting HF as an individual risk factor for cancer development. The review emphasizes preliminary evidence supporting cancer development in patients with HF, which offers several important clinical interventions such as cancer screening in HF patients, prevention addressing both HF and cancer, and molecular targets to treat cancer. However, there is need for more detailed understanding of molecular and cellular cross-talk between cancer and HF which can be derived from prospective assessments of cancer-related outcomes in CV trials and preclinical research of molecular mechanisms.

审查目的:心力衰竭(HF)与癌症并发是一项复杂而多方面的医学挑战。心血管疾病(CVD),尤其是心力衰竭(HF)患者罹患癌症的风险增加,从而引发了这两种常见疾病之间错综复杂的相互作用的问题。本综述旨在探讨心房颤动患者罹患癌症的演变情况,揭示潜在的机制、风险因素和临床影响:流行病学数据表明,心房颤动患者的癌症发病率和死亡率较高,而在射血分数保留的心房颤动患者中,由于相关合并症,癌症发病率和死亡率可能更高。此外,最近的临床前数据发现,包括蛋白 SerpinA3 在内的新型通路和介质是导致心房颤动患者癌症进展的潜在因素,这表明心房颤动是癌症发展的一个个体风险因素。综述强调了支持高血脂患者癌症发展的初步证据,这提供了一些重要的临床干预措施,如高血脂患者的癌症筛查、针对高血脂和癌症的预防以及治疗癌症的分子靶点。然而,还需要更详细地了解癌症与高血压之间的分子和细胞交叉作用,这可以从慢性病试验中癌症相关结果的前瞻性评估和分子机制的临床前研究中获得。
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引用次数: 0
Atrial Fibrillation in Heart Failure: Novel Insights, Challenges, and Treatment Opportunities. 心力衰竭中的心房颤动:新的见解、挑战和治疗机会。
IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-11-22 DOI: 10.1007/s11897-024-00691-9
Ghassan Bidaoui, Ala' Assaf, Nassir Marrouche

Purpose of review: Atrial fibrillation and heart failure frequently co-exist. This review discusses the comorbidity of atrial fibrillation and heart failure, the bi-directional link between them, and the recent advances in the management of these co-existing diseases.

Recent findings: Catheter ablation received a class 1 A recommendation for patients with AF and HF, after overwhelming evidence in heart failure with reduced ejection fraction and end-stage heart failure, while clinical trials are still lacking in patients with preserved ejection. Guideline-medical therapy of heart failure decreases the incidence of atrial fibrillation and the progression of atrial myopathy. Based on the current evidence, management of patients with both HF and AF should be include early optimization of comorbidity control, guideline-medical therapy for heart failure, and rhythm control preferentially through catheter ablation in properly selected patients.

回顾的目的:心房颤动和心力衰竭经常同时存在。本综述讨论了心房颤动和心力衰竭的并发症、两者之间的双向联系以及治疗这些并存疾病的最新进展:导管消融术在射血分数降低的心力衰竭和终末期心力衰竭患者中获得了大量证据,因此被列为心房颤动和心力衰竭患者的一级A类推荐治疗方案,而在射血分数保留的患者中仍缺乏临床试验。心力衰竭的指导性药物治疗可降低心房颤动的发生率和心房肌病的进展。根据目前的证据,对同时患有心房颤动和房颤的患者的治疗应包括早期优化合并症控制、心力衰竭的指导性药物治疗,以及在适当选择的患者中优先通过导管消融术控制心律。
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引用次数: 0
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Current Heart Failure Reports
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