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Sex differences in acute myocardial infarction. 急性心肌梗死的性别差异。
IF 2 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 Epub Date: 2024-06-02 DOI: 10.1080/14779072.2024.2362182
Elizabeth G Dieter, Aravinda Nanjundappa
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引用次数: 0
Targeting obesity for therapeutic intervention in heart failure patients. 针对肥胖症对心力衰竭患者进行治疗干预。
IF 2 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 Epub Date: 2024-06-13 DOI: 10.1080/14779072.2024.2363395
Ryosuke Sato, Stephan von Haehling

Introduction: Heart failure with preserved ejection fraction (HFpEF) is a highly heterogeneous syndrome, making it challenging to improve prognosis with pharmacotherapy. Obesity is one of the leading phenotypes of HFpEF, and its prevalence continues to grow worldwide. Consequently, obesity-targeted interventions have attracted attention as a novel treatment strategy for HFpEF.

Areas covered: The authors review the association between the pathogenesis of obesity and HFpEF and the potential for obesity-targeted pharmacotherapeutic strategies in HFpEF, together with the latest evidence. The literature search was conducted in PubMed up to April 2024.

Expert opinion: The STEP HFpEF (Semaglutide Treatment Effect in People with obesity and HFpEF) and SELECT (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity) trials recently demonstrated that the glucagon-like peptide 1 analogue, semaglutide, improves various aspects of clinical outcomes in obese HFpEF patients and significantly reduces cardiovascular and heart failure events in non-diabetic obese patients, along with a substantial weight loss. Future clinical trials with other incretin mimetics with more potent weight loss and sub-analyses of the SELECT trial may further emphasize the importance of the obesity phenotype-based approach in the treatment of HFpEF.

简介射血分数保留型心力衰竭(HFpEF)是一种高度异质性综合征,因此通过药物治疗改善预后具有挑战性。肥胖是 HFpEF 的主要表型之一,其患病率在全球范围内持续增长。因此,以肥胖为靶点的干预措施作为一种新型的高频心衰治疗策略备受关注:作者回顾了肥胖与 HFpEF 发病机制之间的关联,以及针对肥胖的药物治疗策略在 HFpEF 中的潜力,并提供了最新证据。文献检索在 PubMed 上进行,截至 2024 年 4 月:STEP HFpEF(塞马鲁肽对肥胖和HFpEF患者的治疗效果)和SELECT(塞马鲁肽对超重或肥胖患者心血管预后的影响)试验最近证明,胰高血糖素样肽1类似物塞马鲁肽可改善肥胖HFpEF患者各方面的临床预后,并显著减少非糖尿病肥胖患者的心血管和心衰事件,同时还能大幅减轻体重。未来使用其他增量素模拟药物进行的临床试验以及 SELECT 试验的子分析可能会进一步强调基于肥胖表型的方法在治疗 HFpEF 中的重要性。
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引用次数: 0
Evaluating current assessment techniques of cardiorespiratory fitness. 评估当前的心肺功能评估技术。
IF 2 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 Epub Date: 2024-06-10 DOI: 10.1080/14779072.2024.2363393
Amanda R Bonikowske, Jenna L Taylor, Kathryn F Larson, Joel Hardwick, Cemal Ozemek, Matthew P Harber, Lenny A Kaminsky, Ross Arena, Carl J Lavie

Introduction: Considerable and convincing global data from cohorts across the health spectrum (i.e. apparently healthy to known disease) indicate that cardiorespiratory fitness (CRF) is a major predictor of overall and cardiovascular disease (CVD)-survival, seemingly with greater prognostic resolution compared to other traditional CVD risk factors. Therefore, the assessment of CRF in research and clinical settings is of major importance.

Areas covered: In this manuscript, we review the technology of measuring CRF assessed by the 'gold standard,' cardiopulmonary exercise testing (CPET), as well as with various other methods (e.g. estimated metabolic equivalents, 6-minute walk tests, shuttle tests, and non-exercise equations that estimate CRF), all of which provide significant prognostic information for CVD- and all-cause survival. The literature through May 2024 has been cited.

Expert opinion: The promotion of physical activity in efforts to improve levels of CRF is needed throughout the world to improve lifespan and, more importantly, healthspan. The routine assessment of CRF should be considered a vital sign that is routinely assessed in clinical practice.

导言:来自不同健康人群(从表面健康到已知疾病)的大量令人信服的全球数据表明,心肺功能(CRF)是预测总体和心血管疾病(CVD)存活率的一个重要指标,与其他传统的心血管疾病风险因素相比,它似乎具有更高的预后分辨率。因此,在研究和临床环境中对 CRF 进行评估具有重要意义:在本手稿中,我们回顾了通过 "黄金标准 "心肺运动测试 (CPET) 以及其他各种方法(如估计代谢当量、6 分钟步行测试、穿梭测试和估计 CRF 的非运动方程)评估 CRF 的测量技术,所有这些方法都能为心血管疾病和全因生存提供重要的预后信息。截至 2024 年 5 月的文献已被引用:专家观点:全世界都需要促进体育锻炼,努力提高CRF水平,以延长寿命,更重要的是,延长健康寿命。CRF的常规评估应被视为临床实践中常规评估的生命体征。
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引用次数: 0
The role of gut microbiota in the development of salt-sensitive hypertension and the possible preventive effect of exercise. 肠道微生物群在盐敏感性高血压发病过程中的作用以及运动的可能预防效果。
IF 2 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 Epub Date: 2024-06-04 DOI: 10.1080/14779072.2024.2364031
Steven G Chrysant

Introduction: The aim of the present study is to analyze the data indicating an association between high salt intake and the gastrointestinal microbiota in the development of salt-sensitive hypertension in animals and men. It is also, to discuss the preventive effects of exercise on gut-induced hypertension by favorably modifying the composition of gut microbiota.

Areas covered: Salt sensitivity is quite common, accounting for 30%-60% in hypertensive subjects. Recently, a novel cause for salt-sensitive hypertension has been discovered through the action of gut microbiota by the secretion of several hormones and the action of short chain fatty acids (SCFAs). In addition, recent studies indicate that exercise might favorably modify the adverse effects of gut microbiota regarding their effects on BP. To identify the role of gut microbiota on the incidence of hypertension and CVD and the beneficial effect of exercise, a Medline search of the English literature was conducted between 2018 and 2023 and 42 pertinent papers were selected.

Expert opinion: The analysis of data from the selected papers disclosed that the gut microbiota contribute significantly to the development of salt-sensitive hypertension and that exercise modifies their gut composition and ameliorates their adverse effects on BP.

引言:本研究旨在分析表明高盐摄入量与胃肠道微生物群在动物和人类盐敏感性高血压发病过程中存在关联的数据。此外,本研究还探讨了运动通过改变肠道微生物群的组成对肠道诱发高血压的预防作用:盐敏感是一种相当常见的现象,在高血压患者中占 30%-60% 。最近,通过肠道微生物群分泌多种激素和短链脂肪酸(SCFAs)的作用,发现了盐敏感性高血压的新病因。此外,最近的研究表明,运动可能会有利地改变肠道微生物群对血压的不利影响。为了确定肠道微生物群对高血压和心血管疾病发病率的作用以及运动的有益影响,我们在2018年至2023年期间对英文文献进行了Medline检索,并选取了42篇相关论文:对所选论文的数据分析显示,肠道微生物群在盐敏感性高血压的发病中起着重要作用,而运动可改变其肠道组成,并改善其对血压的不利影响。
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引用次数: 0
Safety of cardiovascular disease drugs approved between 2014 and 2021 in the US: a pharmacovigilance analysis. 2014年至2021年间美国批准的心血管疾病药物的安全性:药物警戒分析。
IF 2 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 Epub Date: 2024-05-12 DOI: 10.1080/14779072.2024.2354255
Taehwan Park, Monica Hwang

Background: Recently FDA-approved drugs for cardiovascular disease (CVD) require robust post-marketing surveillance. The objective of this study was to assess their safety using a large pharmacovigilance database.

Research design and methods: We analyzed adverse event (AE) reports for 17 drugs approved from 2014 to 2021, utilizing the FDA Adverse Event Reporting System (FAERS). Descriptive and disproportionality analyses were conducted by estimating the reporting odds ratio (ROR) and its 95% confidence interval.

Results: Among the 43,664,773 AE reports 97,702 (0.22%) were related to newly approved CVD drugs. No AEs were reported for finerenone and evinacumab. The results from the disproportionality analyses revealed potential risks of acute kidney injury (ROR = 8.24, 95% CI: 6.05-11.22), cardiac failure (ROR = 4.80, 95% CI: 3.82-6.05), and hypotension (ROR = 3.98, 95% CI: 3.44-4.61) among sacubitril/valsartan users. Additionally, ivabradine was found to be associated with tachycardia (ROR = 11.94, 95% CI: 8.35-17.08), abnormal feeling (ROR = 4.40, 95% CI: 2.70-7.18), and dizziness (ROR = 2.56, 95% CI: 1.68-3.90).

Conclusions: This study identified specific safety concerns related to recently approved CVD drugs. Further research is required to understand the underlying mechanisms and clinical implications of these findings.

背景:最近获得 FDA 批准的心血管疾病(CVD)药物需要在上市后进行严格的监测。本研究的目的是利用大型药物警戒数据库评估这些药物的安全性:我们利用FDA不良事件报告系统(FAERS)分析了2014年至2021年期间批准的17种药物的不良事件(AE)报告。通过估计报告几率比(ROR)及其95%置信区间,进行了描述性分析和比例失调分析:在43,664,773份不良反应报告中,97,702份(0.22%)与新批准的心血管疾病药物有关。非格列奈和依维那单抗未报告任何不良反应。比例失调分析结果显示,在使用沙库比特利/缬沙坦的患者中存在急性肾损伤(ROR = 8.24,95% CI:6.05-11.22)、心力衰竭(ROR = 4.80,95% CI:3.82-6.05)和低血压(ROR = 3.98,95% CI:3.44-4.61)的潜在风险。此外,还发现伊伐布雷定与心动过速(ROR = 11.94,95% CI:8.35-17.08)、感觉异常(ROR = 4.40,95% CI:2.70-7.18)和头晕(ROR = 2.56,95% CI:1.68-3.90)有关:本研究发现了与近期批准的心血管疾病药物相关的特定安全性问题。结论:本研究发现了与最近批准的心血管疾病药物有关的特定安全性问题,需要进一步研究以了解这些发现的潜在机制和临床意义。
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引用次数: 0
Role of anticoagulation in non-ST-elevation myocardial infarction: a contemporary narrative review. 抗凝治疗在非 ST 段抬高型心肌梗死中的作用:当代叙述性综述。
IF 2 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 Epub Date: 2024-05-14 DOI: 10.1080/14779072.2024.2354243
Paul Jie Wen Tern, Khung Keong Yeo, Jack Wei Chieh Tan, Chee Tang Chin, Ru San Tan, Jonathan Yap

Introduction: Anticoagulants play a vital role as part of the antithrombotic therapy of myocardial infarction and are complementary to antiplatelet therapies. In the acute setting, the rationale for their use is to antagonize the ongoing clotting cascade including during percutaneous coronary intervention. Anticoagulation may be an important part of the longer-term antithrombotic strategy especially in patients who have other existing indications (e.g. atrial fibrillation) for their use.

Areas covered: In this narrative review, the authors provide a contemporary summary of the anticoagulation strategies of patients presenting with NSTEMI, both in terms of anticoagulation during the acute phase as well as suggested antithrombotic regimens for patients who require long-term anticoagulation for other indications.

Expert opinion: Patients presenting with non-ST-elevation myocardial infarction (NSTEMI) should be initiated on anticoagulation (e.g. heparin/low molecular weight heparin) for the initial hospitalization period for those medically managed or until percutaneous coronary intervention. Longer term management of NSTEMI for patients with an existing indication for long-term anticoagulation should comprise triple antithrombotic therapy of anticoagulant (preferably DOAC) with aspirin and clopidogrel for up to 1 month (typically 1 week or until hospital discharge), followed by DOAC plus clopidogrel for up to 1 year, and then DOAC monotherapy thereafter.

导言:抗凝剂在心肌梗塞的抗血栓治疗中发挥着重要作用,是抗血小板疗法的补充。在急性期,使用抗凝剂的理由是为了拮抗正在发生的凝血级联反应,包括在经皮冠状动脉介入治疗期间。抗凝可能是长期抗血栓策略的一个重要组成部分,尤其是对已有其他适应症(如心房颤动)的患者:在这篇叙述性综述中,作者对 NSTEMI 患者的抗凝策略进行了当代总结,既包括急性期的抗凝,也包括针对因其他适应症而需要长期抗凝的患者所建议的抗血栓治疗方案:专家意见:非 ST 段抬高型心肌梗死(NSTEMI)患者在住院初期应开始接受抗凝治疗(如肝素/低分子量肝素),接受药物治疗或直至经皮冠状动脉介入治疗。对于已有长期抗凝适应症的 NSTEMI 患者,其长期治疗应包括抗凝剂(最好是 DOAC)联合阿司匹林和氯吡格雷的三联抗血栓治疗,疗程最长为 1 个月(通常为 1 周或直至出院),然后是 DOAC 联合氯吡格雷,疗程最长为 1 年,之后再进行 DOAC 单药治疗。
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引用次数: 0
Managing chronic coronary syndrome: how do we achieve optimal patient outcomes? 管理慢性冠状动脉综合征:我们如何实现患者的最佳治疗效果?
IF 2 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 Epub Date: 2024-05-20 DOI: 10.1080/14779072.2024.2357344
Antonis A Manolis, Theodora A Manolis, Antonis S Manolis

Introduction: Chronic coronary syndrome (CCS) remains the leading cause of death worldwide with high admission/re-admission rates. Medical databases were searched on CCS & its management.

Areas covered: This review discusses phenotypes per stress-echocardiography, noninvasive/invasive testing (coronary computed-tomography angiography-CCTA; coronary artery calcium - CAC score; echocardiography assessing wall-motion, LV function, valvular disease; biomarkers), multidisciplinary management (risk factors/anti-inflammatory/anti-ischemic/antithrombotic therapies and revascularization), newer treatments (colchicine/ivabradine/ranolazine/melatonin), cardiac rehabilitation/exercise improving physical activity and quality-of-life, use of the implantable-defibrillator, and treatment with extracorporeal shockwave-revascularization for refractory symptoms.

Expert opinion: CCS is age-dependent, leading cause of death worldwide with high hospitalization rates. Stress-echocardiography defines phenotypes and guides prophylaxis and management. CAC is a surrogate for atherosclerosis burden, best for patients of intermediate/borderline risk. Higher CAC-scores indicate more severe coronary abnormalities. CCTA is preferred for noninvasive detection of CAC and atherosclerosis burden, determining stenosis' functional significance, and guiding management. Combining CAC score with CCTA improves diagnostic yield and assists prognosis. Echocardiography assesses LV wall-motion and function and valvular disease. Biomarkers guide diagnosis/prognosis. CCS management is multidisciplinary: risk-factor management, anti-inflammatory/anti-ischemic/antithrombotic therapies, and revascularization. Newer therapies comprise colchicine, ivabradine, ranolazine, melatonin, glucagon-like peptide-1-receptor antagonists. Cardiac rehabilitation/exercise improves physical activity and quality-of-life. An ICD protects from sudden death. Extracorporeal shockwave-revascularization treats refractory symptoms.

简介慢性冠状动脉综合征(CCS)仍是全球死亡的主要原因,其入院/再入院率很高。我们检索了有关慢性冠状动脉综合征及其管理的医学数据库:本综述讨论了应力超声心动图、无创/有创检测(冠状动脉计算机断层扫描血管造影-CCTA;冠状动脉钙化-CAC 评分;评估室壁运动、左心室功能、瓣膜病的超声心动图;生物标志物)、多学科管理(风险因素/抗炎/抗缺血/抗血栓治疗和血管再通)、新的治疗方法(秋水仙碱/伊伐布雷定/雷诺拉嗪/褪黑激素)、心脏康复/改善体力活动和生活质量的运动、植入式除颤器的使用以及针对难治性症状的体外冲击波血管再通治疗。专家意见:慢性心肌梗死与年龄有关,是全球的主要死因,住院率很高。负荷超声心动图可确定表型并指导预防和治疗。CAC 是动脉粥样硬化负担的代用指标,最适用于中等/边缘风险患者。CAC 分数越高,表明冠状动脉异常越严重。CCTA 是无创检测 CAC 和动脉粥样硬化负荷、确定狭窄的功能意义和指导治疗的首选。将 CAC 评分与 CCTA 结合使用可提高诊断率并有助于预后。超声心动图可评估左心室壁运动和功能以及瓣膜疾病。生物标志物可指导诊断/预后。CCS 的治疗是多学科的:风险因素管理、抗炎/抗缺血/抗血栓治疗和血管重建。新疗法包括秋水仙碱、伊伐布雷定、雷诺拉嗪、褪黑素、胰高血糖素样肽-1 受体拮抗剂。心脏康复/锻炼可改善体力活动和生活质量。ICD 可预防猝死。体外冲击波血管重建治疗难治性症状。
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引用次数: 0
The best of 'best buys': public health values of potassium-enriched salt substitute. 最实惠 "中的 "最实惠":富钾盐替代品的公共健康价值。
IF 2 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-04-30 DOI: 10.1080/14779072.2024.2349105
Yangfeng Wu, Yifang Yuan
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引用次数: 0
Cardiovascular disease and risk in COPD: a state of the art review. 慢性阻塞性肺病的心血管疾病和风险:最新研究综述。
IF 2 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-03-27 DOI: 10.1080/14779072.2024.2333786
Ricardo Polman, John R Hurst, Omer Faruk Uysal, Swapna Mandal, Dominik Linz, Sami Simons

Introduction: Chronic Obstructive Pulmonary Disease (COPD) and cardiovascular diseases (CVD) commonly co-exist. Outcomes of people living with both conditions are poor in terms of symptom burden, receiving evidence-based treatment and mortality. Increased understanding of the underlying mechanisms may help to identify treatments to relieve this disease burden. This narrative review covers the overlap of COPD and CVD with a focus on clinical presentation, mechanisms, and interventions. Literature up to December 2023 are cited.

Areas covered: 1. What is COPD 2. The co-existence of COPD and cardiovascular disease 3. Mechanisms of cardiovascular disease in COPD. 4. Populations with COPD are at risk of CVD 5. Complexity in the co-diagnosis of COPD in those with cardiovascular disease. 6. Therapy for COPD and implications for cardiovascular events and risk. 7. Cardiovascular risk and exacerbations of COPD. 8. Pro-active identification and management of CV risk in COPD.

Expert opinion: The prospective identification of co-morbid COPD in CVD patients and of CVD and CV risk in people with COPD is crucial for optimizing clinical outcomes. This includes the identification of novel treatment targets and the design of clinical trials specifically designed to reduce the cardiovascular burden and mortality associated with COPD. Databases searched: Pubmed, 2006-2023.

导言:慢性阻塞性肺病(COPD)和心血管疾病(CVD)通常同时存在。同时患有这两种疾病的患者在症状负担、接受循证治疗和死亡率方面都很糟糕。加深对其潜在机制的了解有助于找到减轻这种疾病负担的治疗方法。这篇叙述性综述涉及慢性阻塞性肺疾病和心血管疾病的重叠,重点关注临床表现、机制和干预措施。本文引用了截至 2023 年 12 月的文献。涵盖领域:1.什么是慢性阻塞性肺病 2.慢性阻塞性肺病与心血管疾病的共存 3.慢性阻塞性肺病与心血管疾病的机制慢性阻塞性肺病心血管疾病的机制。4.患有慢性阻塞性肺病的人群面临心血管疾病的风险 5. 合并诊断患有心血管疾病的慢性阻塞性肺病的复杂性 6.6.慢性阻塞性肺病的治疗及其对心血管事件和风险的影响 7.7.慢性阻塞性肺病的心血管风险和病情加重。8.积极识别和管理慢性阻塞性肺病的心血管风险:专家意见:前瞻性地识别心血管疾病患者合并慢性阻塞性肺疾病的情况以及慢性阻塞性肺疾病患者的心血管疾病和心血管风险对于优化临床结果至关重要。这包括确定新的治疗目标和设计专门用于降低慢性阻塞性肺病相关心血管负担和死亡率的临床试验。检索的数据库:Pubmed,2006-2024。
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引用次数: 0
Why selective screening for asymptomatic carotid stenosis is currently appropriate: a special report. 为什么目前适合对无症状颈动脉狭窄进行选择性筛查:特别报告。
IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 Epub Date: 2024-03-18 DOI: 10.1080/14779072.2024.2330660
Kosmas I Paraskevas, Alan Dardik, Marc L Schermerhorn, Christos D Liapis, Armando Mansilha, Brajesh K Lal, William A Gray, Martin M Brown, Piotr Myrcha, Carl J Lavie, Clark J Zeebregts, Eric A Secemsky, Luca Saba, Matthew Blecha, Victor Gurevich, Mauro Silvestrini, Ales Blinc, Alexei Svetlikov, Jose Fernandes E Fernandes, Peter A Schneider, Peter Gloviczki, Christopher J White, Ali F AbuRahma

Introduction: Two of the main reasons recent guidelines do not recommend routine population-wide screening programs for asymptomatic carotid artery stenosis (AsxCS) is that screening could lead to an increase of carotid revascularization procedures and that such mass screening programs may not be cost-effective. Nevertheless, selective screening for AsxCS could have several benefits. This article presents the rationale for such a program.

Areas covered: The benefits of selective screening for AsxCS include early recognition of AsxCS allowing timely initiation of preventive measures to reduce future myocardial infarction (MI), stroke, cardiac death and cardiovascular (CV) event rates.

Expert opinion: Mass screening programs for AsxCS are neither clinically effective nor cost-effective. Nevertheless, targeted screening of populations at high risk for AsxCS provides an opportunity to identify these individuals earlier rather than later and to initiate a number of lifestyle measures, risk factor modifications, and intensive medical therapy in order to prevent future strokes and CV events. For patients at 'higher risk of stroke' on best medical treatment, a prophylactic carotid intervention may be considered.

导言:最近的指南不建议对无症状颈动脉狭窄(AxCS)进行常规全民筛查,其中两个主要原因是筛查可能会导致颈动脉再血管化手术的增加,而且这种大规模筛查计划可能不具成本效益。然而,选择性筛查 AsxCS 可能会带来一些益处。本文介绍了开展此类计划的理由:选择性筛查 AsxCS 的益处包括:早期识别 AsxCS,及时启动预防措施,降低未来心肌梗死(MI)、中风、心源性死亡和心血管(CV)事件的发生率:专家意见:大规模的 AsxCS 筛查项目既无临床效果,也不具成本效益。然而,对 AsxCS 高危人群进行有针对性的筛查,可以及早发现这些人,并采取一系列生活方式措施、改变危险因素和强化医疗,以预防未来的脑卒中和心血管事件。对于接受最佳药物治疗的 "中风高危 "患者,可以考虑进行预防性颈动脉介入治疗。
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引用次数: 0
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Expert Review of Cardiovascular Therapy
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