Background: Heart failure with preserved ejection fraction (HFpEF) remains underdiagnosed in primary care settings, where echocardiography is not available. This study aimed to develop and validate a scoring system that does not include echocardiographic variables for HFpEF screening among patients with shortness of breath.
Methods: A total of 622 consecutive patients referred for exercise stress echocardiography were evaluated (283 HFpEF and 339 controls). Diagnosis of HFpEF was determined by the HFA-PEFF algorithm Steps 2-3.
Results: Multivariable logistic regression analysis identified age ≥ 65 years, coronary artery disease, elevated natriuretic peptide levels, anemia, cardiomegaly on chest radiography, and left ventricular high-voltage on electrocardiogram as independent predictors of having HFpEF. A weighted score, including the six predictors and atrial fibrillation, was created (BREATH2 score). The BREATH2 score accurately discriminated HFpEF from controls [area under the curve (AUC) 0.84, p < 0.0001], with a superior diagnostic ability to the H2FPEF score. The diagnostic accuracy was confirmed in an external validation cohort (n = 105, AUC 0.78, p < 0.0001) and in patients whose diagnosis was determined by exercise right heart catheterization (n = 79, AUC 0.75, p = 0.0001). The BREATH2 score classified each patient into different risk categories of having HFpEF, ranging from 4 % to 93 %.
Conclusions: The BREATH2 score can be an effective screening tool in primary care settings to help refer patients to a secondary hospital for further evaluation.
背景：保留射血分数的心力衰竭（HFpEF）在没有超声心动图的初级保健机构中仍未得到充分诊断。本研究旨在开发和验证一种评分系统，该系统不包括超声心动图变量，用于呼吸短促患者的HFpEF筛查。方法：对622例连续接受运动应激超声心动图检查的患者（283例HFpEF和339例对照）进行评估。通过HFA-PEFF算法步骤2-3确定HFpEF的诊断。结果：多变量logistic回归分析确定年龄 ≥ 65 岁、冠状动脉疾病、利钠肽水平升高、贫血、胸片上的心脏肥大和心电图上的左室高电压是HFpEF的独立预测因素。创建一个加权评分，包括6个预测因子和房颤（BREATH2评分）。BREATH2评分准确区分了HFpEF和对照组[曲线下面积（AUC） 0.84， p 2FPEF评分。外部验证队列（n = 105,AUC 0.78， p 2评分）证实了诊断的准确性，将每个患者分为不同的HFpEF风险类别，范围为4 %至93 %。结论：在初级保健机构中，BREATH2评分可以作为一种有效的筛查工具，帮助患者转诊到二级医院进行进一步评估。
{"title":"An evidence-based tool for screening for heart failure with preserved ejection fraction in primary care: The BREATH<sub>2</sub> score.","authors":"Yuki Saito, Nobuyuki Kagiyama, Tomonari Harada, Tomohiro Kaneko, Kazuki Kagami, Taishi Dotare, Naoki Yuasa, Eiichiro Sato, Hidemi Sorimachi, Azusa Murata, Masashi Kawagoshi, Yoichi Nishiya, Atsutaka Yasui, Yasuo Okumura, Tohru Minamino, Hideki Ishii, Masaru Obokata","doi":"10.1016/j.jjcc.2025.03.018","DOIUrl":"https://doi.org/10.1016/j.jjcc.2025.03.018","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) remains underdiagnosed in primary care settings, where echocardiography is not available. This study aimed to develop and validate a scoring system that does not include echocardiographic variables for HFpEF screening among patients with shortness of breath.</p><p><strong>Methods: </strong>A total of 622 consecutive patients referred for exercise stress echocardiography were evaluated (283 HFpEF and 339 controls). Diagnosis of HFpEF was determined by the HFA-PEFF algorithm Steps 2-3.</p><p><strong>Results: </strong>Multivariable logistic regression analysis identified age ≥ 65 years, coronary artery disease, elevated natriuretic peptide levels, anemia, cardiomegaly on chest radiography, and left ventricular high-voltage on electrocardiogram as independent predictors of having HFpEF. A weighted score, including the six predictors and atrial fibrillation, was created (BREATH<sub>2</sub> score). The BREATH<sub>2</sub> score accurately discriminated HFpEF from controls [area under the curve (AUC) 0.84, p < 0.0001], with a superior diagnostic ability to the H<sub>2</sub>FPEF score. The diagnostic accuracy was confirmed in an external validation cohort (n = 105, AUC 0.78, p < 0.0001) and in patients whose diagnosis was determined by exercise right heart catheterization (n = 79, AUC 0.75, p = 0.0001). The BREATH<sub>2</sub> score classified each patient into different risk categories of having HFpEF, ranging from 4 % to 93 %.</p><p><strong>Conclusions: </strong>The BREATH<sub>2</sub> score can be an effective screening tool in primary care settings to help refer patients to a secondary hospital for further evaluation.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Preclinical studies have suggested that Annexin A1 and Annexin A2 act as anti-inflammatory agents, slowing the progression of atherosclerosis and further potentially reducing the risk of ischemic stroke. Since the causality of Annexins and ischemic stroke remains uncertain, this study aimed to investigate the causal effects of both using a two-sample Mendelian randomization (MR) method.
Methods: The genetic instruments associated with Annexin A1 and Annexin A2 originated from a European-descent genome-wide association study (GWAS) of 50,000 participants from the INTERVAL study. Summary statistics for ischemic stroke and ischemic stroke subtypes were derived from the MEGASTROKE consortium's GWAS dataset, involving 40,585 cases and 406,111 controls of European ancestry. The inverse-variance weighted method was utilized in the main analysis, followed by a series of sensitivity analyses for robustness validation.
Results: In the primary analysis, genetically predicted high Annexin A1 levels were associated with decreased risks of ischemic stroke (OR = 0.96; 95 % CI = 0.93-0.99; p = 0.023) and large artery stroke (OR = 0.88; 95 % CI = 0.81-0.96; p = 0.004). Similarly, genetically predicted high Annexin A2 levels also had significant associations with decreased risks of ischemic stroke (OR = 0.97; 95 % CI = 0.95-1.00; p = 0.019) and large artery stroke (OR = 0.90; 95 % CI = 0.85-0.96; p = 0.001).
Conclusion: In this two-sample MR study, we found that Annexins had causal protective effects against ischemic stroke, especially large artery stroke. Further basic mechanistic studies should be conducted to investigate the biological roles of these genes.
{"title":"Causal effects of Annexin A1 and Annexin A2 on ischemic stroke and its subtypes: A two-sample Mendelian randomization study.","authors":"Minglan Jiang, Lulu Sun, Yiming Jia, Xiao Ren, Longyang Han, Zhengbao Zhu, Xiaowei Zheng","doi":"10.1016/j.jjcc.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.jjcc.2025.03.019","url":null,"abstract":"<p><strong>Background: </strong>Preclinical studies have suggested that Annexin A1 and Annexin A2 act as anti-inflammatory agents, slowing the progression of atherosclerosis and further potentially reducing the risk of ischemic stroke. Since the causality of Annexins and ischemic stroke remains uncertain, this study aimed to investigate the causal effects of both using a two-sample Mendelian randomization (MR) method.</p><p><strong>Methods: </strong>The genetic instruments associated with Annexin A1 and Annexin A2 originated from a European-descent genome-wide association study (GWAS) of 50,000 participants from the INTERVAL study. Summary statistics for ischemic stroke and ischemic stroke subtypes were derived from the MEGASTROKE consortium's GWAS dataset, involving 40,585 cases and 406,111 controls of European ancestry. The inverse-variance weighted method was utilized in the main analysis, followed by a series of sensitivity analyses for robustness validation.</p><p><strong>Results: </strong>In the primary analysis, genetically predicted high Annexin A1 levels were associated with decreased risks of ischemic stroke (OR = 0.96; 95 % CI = 0.93-0.99; p = 0.023) and large artery stroke (OR = 0.88; 95 % CI = 0.81-0.96; p = 0.004). Similarly, genetically predicted high Annexin A2 levels also had significant associations with decreased risks of ischemic stroke (OR = 0.97; 95 % CI = 0.95-1.00; p = 0.019) and large artery stroke (OR = 0.90; 95 % CI = 0.85-0.96; p = 0.001).</p><p><strong>Conclusion: </strong>In this two-sample MR study, we found that Annexins had causal protective effects against ischemic stroke, especially large artery stroke. Further basic mechanistic studies should be conducted to investigate the biological roles of these genes.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The prognosis for patients with low-flow low-gradient (LFLG) aortic valve stenosis (AS) remains controversial. In general, atrial fibrillation (AF) is one factor determining the LF status in patients with severe AS (SAS). However, the association between concomitant AF in LFLG AS and the risk of heart failure (HF) remains unclear.
Methods: This study evaluated 278 consecutive patients with SAS (indexed aortic valve area < 0.6 cm2/m2). Among them, we enrolled patients with high-gradient (HG) SAS [mean pressure gradient (mPG) ≥40 mmHg] and LFLG AS (stroke volume index ≤35 ml/m2, mPG <40 mmHg). The two groups were further categorized into four subgroups following the presence or absence of AF as HG SAS with AF (n = 27), HG SAS without AF (n = 68), LFLG AS with AF (n = 30), and LFLG AS without AF (n = 67). The primary endpoint was worsening HF that required unplanned hospitalization or HF drug therapy.
Results: We observed worsening HF in 65 patients. The Kaplan-Meier curve revealed a higher rate of worsening HF in LFLG AS with AF than that in HG SAS without AF (log-rank p < 0.001) without any significant difference compared to HG SAS with AF. The Cox hazard analysis among LFLG AS patients identified the presence of AF as an independent predictor for worsening HF [hazard ratio (HR): 2.79; 95 % confidence interval (CI): 1.17-6.96; p = 0.021]. In addition, the Kaplan-Meier analysis curve revealed a higher risk of worsening HF in patients with LFLG AS and paroxysmal AF (PAF) or chronic AF (CAF) than in those without AF (PAF: HR: 4.71, 95 % CI: 1.79-11.9, p = 0.0024; CAF: HR: 3.22, 95 % CI: 1.29-7.83, p = 0.013, respectively).
Conclusions: Patients with LFLG AS and concomitant AF exhibited an unfavorable prognosis for HF, with no significantly different rate of worsening HF compared with patients with HG SAS and conc.
背景：低流量低梯度（LFLG）主动脉瓣狭窄（AS）患者的预后仍有争议。一般来说，心房颤动（AF）是决定严重AS （SAS）患者LF状态的因素之一。然而，LFLG AS合并房颤与心力衰竭（HF）风险之间的关系尚不清楚。方法：本研究评估278例SAS（主动脉瓣指数面积 2/m2）患者。其中，我们纳入了高梯度（HG） SAS[平均压力梯度(mPG)≥40 mmHg]和LFLG AS（脑卒中容积指数≤35 ml/m2， mPG）患者。结果：65例患者HF恶化。Kaplan-Meier曲线显示，LFLG AS合并房颤的HF恶化率高于不合并房颤的HG SAS （log-rank p ）。结论：LFLG AS合并房颤的患者HF预后不良，与HG SAS合并房颤的患者相比，HF恶化率无显著差异。
{"title":"Prognosis of low-flow low-gradient aortic valve stenosis with atrial fibrillation.","authors":"Ryo Nishinarita, Jun Oikawa, Kenshiro Arao, Kenichi Sugisaki, Takahiro Yamashita, Ayane Yozawa, Yae Ota, Hisashi Sato, Uiri Ooki, Yusuke Tamanaha, Taku Kasahara, Takaaki Mase, Akira Satoh, Junya Ako","doi":"10.1016/j.jjcc.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.jjcc.2025.03.017","url":null,"abstract":"<p><strong>Background: </strong>The prognosis for patients with low-flow low-gradient (LFLG) aortic valve stenosis (AS) remains controversial. In general, atrial fibrillation (AF) is one factor determining the LF status in patients with severe AS (SAS). However, the association between concomitant AF in LFLG AS and the risk of heart failure (HF) remains unclear.</p><p><strong>Methods: </strong>This study evaluated 278 consecutive patients with SAS (indexed aortic valve area < 0.6 cm<sup>2</sup>/m<sup>2</sup>). Among them, we enrolled patients with high-gradient (HG) SAS [mean pressure gradient (mPG) ≥40 mmHg] and LFLG AS (stroke volume index ≤35 ml/m<sup>2</sup>, mPG <40 mmHg). The two groups were further categorized into four subgroups following the presence or absence of AF as HG SAS with AF (n = 27), HG SAS without AF (n = 68), LFLG AS with AF (n = 30), and LFLG AS without AF (n = 67). The primary endpoint was worsening HF that required unplanned hospitalization or HF drug therapy.</p><p><strong>Results: </strong>We observed worsening HF in 65 patients. The Kaplan-Meier curve revealed a higher rate of worsening HF in LFLG AS with AF than that in HG SAS without AF (log-rank p < 0.001) without any significant difference compared to HG SAS with AF. The Cox hazard analysis among LFLG AS patients identified the presence of AF as an independent predictor for worsening HF [hazard ratio (HR): 2.79; 95 % confidence interval (CI): 1.17-6.96; p = 0.021]. In addition, the Kaplan-Meier analysis curve revealed a higher risk of worsening HF in patients with LFLG AS and paroxysmal AF (PAF) or chronic AF (CAF) than in those without AF (PAF: HR: 4.71, 95 % CI: 1.79-11.9, p = 0.0024; CAF: HR: 3.22, 95 % CI: 1.29-7.83, p = 0.013, respectively).</p><p><strong>Conclusions: </strong>Patients with LFLG AS and concomitant AF exhibited an unfavorable prognosis for HF, with no significantly different rate of worsening HF compared with patients with HG SAS and conc.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although diastolic dysfunction is the main pathophysiological feature of hypertrophic cardiomyopathy (HCM), it remains to be clarified whether parameters of diastolic function can reliably determine HCM prognosis. In patients with reduced left ventricular (LV) distensibility, chronic elevation of LV diastolic pressure is seen with a smaller than expected LV size. Accordingly, patients with HCM with severe LV diastolic dysfunction typically demonstrate left atrial (LA) dilation and a disproportionately smaller left ventricle. Therefore, we investigated the relationship between LA/LV diameter ratio, as a potential indicator of disease progression, and outcomes in patients with HCM.
Methods
We included 468 patients in whom LA and LV end-diastolic diameter were successfully evaluated by echocardiography at the initial assessment. We divided the patients into two groups: those with an LA/LV diameter ratio > 1 and those with an LA/LV diameter ratio ≤ 1. We compared the HCM-related death rates between the two groups.
Results
Of the 468 patients, 96 patients (20.5 %) with HCM showed an LA/LV diameter ratio > 1. In the univariate analysis, patients with an LA/LV diameter ratio > 1 had a significantly greater likelihood of HCM-related death than patients with an LA/LV diameter ratio ≤ 1 (log-rank p = 0.002). In the multivariate Cox proportional hazards analysis, when including LA/LV diameter ratio > 1 and imbalanced baseline variables, an LA/LV diameter ratio > 1 was an independent determinant of HCM-related death (adjusted hazard ratio: 1.87, 95 % confidence interval: 1.08–3.24; p = 0.024).
Conclusion
LA/LV diameter ratio can be easily evaluated and may be useful for risk stratification of HCM-related death in patients with HCM.
{"title":"Relationship between left atrial/left ventricular diameter ratio and outcomes in patients with hypertrophic cardiomyopathy","authors":"Keigo Kanbayashi MD, Yuichiro Minami MD, PhD, FJCC, Shintaro Haruki MD, PhD, Chihiro Saito MD, PhD, Junichi Yamaguchi MD, PhD, FJCC","doi":"10.1016/j.jjcc.2024.09.003","DOIUrl":"10.1016/j.jjcc.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Although diastolic dysfunction is the main pathophysiological feature of hypertrophic cardiomyopathy (HCM), it remains to be clarified whether parameters of diastolic function can reliably determine HCM prognosis. In patients with reduced left ventricular (LV) distensibility, chronic elevation of LV diastolic pressure is seen with a smaller than expected LV size. Accordingly, patients with HCM with severe LV diastolic dysfunction typically demonstrate left atrial (LA) dilation and a disproportionately smaller left ventricle. Therefore, we investigated the relationship between LA/LV diameter ratio, as a potential indicator of disease progression, and outcomes in patients with HCM.</div></div><div><h3>Methods</h3><div>We included 468 patients in whom LA and LV end-diastolic diameter were successfully evaluated by echocardiography at the initial assessment. We divided the patients into two groups: those with an LA/LV diameter ratio > 1 and those with an LA/LV diameter ratio ≤ 1. We compared the HCM-related death rates between the two groups.</div></div><div><h3>Results</h3><div>Of the 468 patients, 96 patients (20.5 %) with HCM showed an LA/LV diameter ratio > 1. In the univariate analysis, patients with an LA/LV diameter ratio > 1 had a significantly greater likelihood of HCM-related death than patients with an LA/LV diameter ratio ≤ 1 (log-rank <em>p</em> = 0.002). In the multivariate Cox proportional hazards analysis, when including LA/LV diameter ratio > 1 and imbalanced baseline variables, an LA/LV diameter ratio > 1 was an independent determinant of HCM-related death (adjusted hazard ratio: 1.87, 95 % confidence interval: 1.08–3.24; <em>p</em> = 0.024).</div></div><div><h3>Conclusion</h3><div>LA/LV diameter ratio can be easily evaluated and may be useful for risk stratification of HCM-related death in patients with HCM.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 309-314"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142265371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dialysis patients undergoing transcatheter aortic valve replacement (TAVR) generally have poor prognosis compared with non-dialysis patients. Furthermore, there are few reliable risk models in this clinical setting. Therefore, we aimed to establish a risk model in dialysis patients undergoing TAVR that would be informative for their prognosis and the decision-making process of TAVR.
Methods
A total 118 dialysis patients (full cohort) with severe aortic stenosis underwent TAVR in our institute between 2012 and 2022. The patients of the full cohort were randomly assigned to two groups in a 2:1 ratio to form derivation and validation cohorts. Risk factors contributing to deaths were analyzed from the preoperative variables and a risk model was established from Cox proportional hazard model.
Results
There were 69 deaths following TAVR derived from infectious disease (43.5 %), cardiovascular-related disease (11.6 %), cerebral stroke or hemorrhage (2.9 %), cancer (1.4 %), unknown origin (18.8 %), and others (21.7 %) during the observational period (811 ± 719 days). The cumulative overall survival rates using the Kaplan-Meier method at 1 year, 3 years, and 5 years in the full cohort were 82.8 %, 41.9 %, and 24.2 %, respectively. An optimal risk model composed of five contributors: peripheral vascular disease, serum albumin, left ventricular ejection fraction < 40 %, operative age, and hemoglobin level, was established. The estimated C index for the developed models were 0.748 (95 % CI: 0.672–0.824) in derivation cohort and 0.705 (95 % CI: 0.578–0.832) in validation cohort. The prediction model showed good calibration [intraclass correlation coefficient = 0.937 (95%CI: 0.806–0.981)] between actual and predicted survival.
Conclusions
The risk model was a good indicator to estimate the prognosis in dialysis patients undergoing TAVR.
{"title":"A risk model of mortality rate in dialysis patients following transcatheter aortic valve replacement","authors":"Kizuku Yamashita MD, PhD , Koichi Maeda MD, PhD , Kyongsun Pak PhD , Kazuo Shimamura MD, PhD , Ai Kawamura MD, PhD , Isamu Mizote MD, PhD , Masaki Taira MD , Daisuke Yoshioka MD, PhD , Shigeru Miyagawa MD, PhD","doi":"10.1016/j.jjcc.2024.07.009","DOIUrl":"10.1016/j.jjcc.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Dialysis patients undergoing transcatheter aortic valve replacement (TAVR) generally have poor prognosis compared with non-dialysis patients. Furthermore, there are few reliable risk models in this clinical setting. Therefore, we aimed to establish a risk model in dialysis patients undergoing TAVR that would be informative for their prognosis and the decision-making process of TAVR.</div></div><div><h3>Methods</h3><div>A total 118 dialysis patients (full cohort) with severe aortic stenosis underwent TAVR in our institute between 2012 and 2022. The patients of the full cohort were randomly assigned to two groups in a 2:1 ratio to form derivation and validation cohorts. Risk factors contributing to deaths were analyzed from the preoperative variables and a risk model was established from Cox proportional hazard model.</div></div><div><h3>Results</h3><div>There were 69 deaths following TAVR derived from infectious disease (43.5 %), cardiovascular-related disease (11.6 %), cerebral stroke or hemorrhage (2.9 %), cancer (1.4 %), unknown origin (18.8 %), and others (21.7 %) during the observational period (811 ± 719 days). The cumulative overall survival rates using the Kaplan-Meier method at 1 year, 3 years, and 5 years in the full cohort were 82.8 %, 41.9 %, and 24.2 %, respectively. An optimal risk model composed of five contributors: peripheral vascular disease, serum albumin, left ventricular ejection fraction < 40 %, operative age, and hemoglobin level, was established. The estimated C index for the developed models were 0.748 (95 % CI: 0.672–0.824) in derivation cohort and 0.705 (95 % CI: 0.578–0.832) in validation cohort. The prediction model showed good calibration [intraclass correlation coefficient = 0.937 (95%CI: 0.806–0.981)] between actual and predicted survival.</div></div><div><h3>Conclusions</h3><div>The risk model was a good indicator to estimate the prognosis in dialysis patients undergoing TAVR.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 329-333"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.jjcc.2024.09.012
Dan Yan PhD , Shifang Zhan MM , Chenyu Guo MM , Jiawen Han MM , Lin Zhan PhD , Qianyi Zhou PhD , Dan Bing , Xiaoyan Wang PhD
Purpose
This paper aims to review the research progress in repairing injury caused by acute myocardial infarction, focusing on myocardial regeneration, cardiomyocyte apoptosis, and fibrosis. The goal is to investigate the current research trends and challenges in the field of myocardial injury repair.
Methods
The review delves into the latest research on myocardial regeneration, cardiomyocyte apoptosis, and fibrosis following acute myocardial infarction. It highlights stem cell transplantation and gene therapy as key areas of current research focus, while emphasizing the significance of cardiomyocyte apoptosis and fibrosis in the myocardial injury repair process. Additionally, the review addresses the challenges and unresolved issues that require further investigation in the field of myocardial injury repair.
Summary
Acute myocardial infarction is a prevalent cardiovascular condition that results in myocardial damage necessitating repair. Myocardial regeneration plays a crucial role in repairing myocardial injury, with current research focusing on stem cell transplantation and gene therapy. Cardiomyocyte apoptosis and fibrosis are key factors in the repair process, significantly impacting the restoration of myocardial structure and function. Nonetheless, there remain numerous challenges and unresolved issues that warrant further investigation in the realm of myocardial injury repair.
{"title":"The role of myocardial regeneration, cardiomyocyte apoptosis in acute myocardial infarction: A review of current research trends and challenges","authors":"Dan Yan PhD , Shifang Zhan MM , Chenyu Guo MM , Jiawen Han MM , Lin Zhan PhD , Qianyi Zhou PhD , Dan Bing , Xiaoyan Wang PhD","doi":"10.1016/j.jjcc.2024.09.012","DOIUrl":"10.1016/j.jjcc.2024.09.012","url":null,"abstract":"<div><h3>Purpose</h3><div>This paper aims to review the research progress in repairing injury caused by acute myocardial infarction, focusing on myocardial regeneration, cardiomyocyte apoptosis, and fibrosis. The goal is to investigate the current research trends and challenges in the field of myocardial injury repair.</div></div><div><h3>Methods</h3><div>The review delves into the latest research on myocardial regeneration, cardiomyocyte apoptosis, and fibrosis following acute myocardial infarction. It highlights stem cell transplantation and gene therapy as key areas of current research focus, while emphasizing the significance of cardiomyocyte apoptosis and fibrosis in the myocardial injury repair process. Additionally, the review addresses the challenges and unresolved issues that require further investigation in the field of myocardial injury repair.</div></div><div><h3>Summary</h3><div>Acute myocardial infarction is a prevalent cardiovascular condition that results in myocardial damage necessitating repair. Myocardial regeneration plays a crucial role in repairing myocardial injury, with current research focusing on stem cell transplantation and gene therapy. Cardiomyocyte apoptosis and fibrosis are key factors in the repair process, significantly impacting the restoration of myocardial structure and function. Nonetheless, there remain numerous challenges and unresolved issues that warrant further investigation in the realm of myocardial injury repair.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 283-292"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In patients with persistent atrial fibrillation (AF), extensive ablation for substrate modification, such as linear ablation or complex fractionated atrial electrogram ablation in addition to pulmonary vein isolation (PVI) remains controversial. Previous studies investigating extensive ablation have demonstrated its varying efficacy, suggesting the possible heterogeneity of its efficacy. Aging is a major risk factor for AF and is associated with atrial remodeling. We aimed to compare the efficacy and safety of the extensive ablation strategy compared with PVI alone strategy between young and elderly patients.
Methods
This study is a post-hoc analysis of the multicenter, randomized controlled, noninferiority trial investigating the efficacy and safety of PVI-only (PVI-alone arm) compared with extensive ablation (PVI-plus arm) in patients with persistent AF (EARNEST-PVI trial). We divided the overall population into 2 groups based on age and assessed treatment effects.
Results
In the young group (age <65 years, N = 206), there was no significant difference in the recurrence rate between the PVI-alone group and PVI-plus group [hazard ratio (HR): 1.00, 95 % CI: 0.57–1.73, p = 0.987], whereas the recurrence rate was significantly lower in the PVI-plus group compared to the PVI-alone group in the elderly group (age ≥65 years, N = 291) (HR: 0.47, 95 % CI: 0.29–0.76, p = 0.0021) (p for interaction = 0.0446). There were no fatal procedural complications.
Conclusion
In patients with persistent AF, the extensive ablation strategy was more effective than the PVI-alone strategy in elderly patients, while the effectiveness of both approaches was comparable in young patients.
{"title":"Extensive ablation for elderly patients with persistent atrial fibrillation: insights from the EARNEST-PVI prospective randomized trial","authors":"Yuki Matsuoka MD , Yohei Sotomi MD, PhD , Shungo Hikoso MD, PhD , Akihiro Sunaga MD, PhD , Daisaku Nakatani MD, PhD , Katsuki Okada MD, PhD , Tomoharu Dohi MD, PhD , Taiki Sato MD, PhD , Hirota Kida MAS , Daisuke Sakamoto MD , Tetsuhisa Kitamura MD, MSc, DrPH , Nobuaki Tanaka MD , Masaharu Masuda MD, PhD , Tetsuya Watanabe MD, PhD , Hitoshi Minamiguchi MD , Yasuyuki Egami MD , Takafumi Oka MD, PhD , Miwa Miyoshi MD, PhD , Masato Okada MD , Yasuhiro Matsuda MD , Yasushi Sakata MD, PhD, FJCC","doi":"10.1016/j.jjcc.2024.09.001","DOIUrl":"10.1016/j.jjcc.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>In patients with persistent atrial fibrillation (AF), extensive ablation for substrate modification, such as linear ablation or complex fractionated atrial electrogram ablation in addition to pulmonary vein isolation (PVI) remains controversial. Previous studies investigating extensive ablation have demonstrated its varying efficacy, suggesting the possible heterogeneity of its efficacy. Aging is a major risk factor for AF and is associated with atrial remodeling. We aimed to compare the efficacy and safety of the extensive ablation strategy compared with PVI alone strategy between young and elderly patients.</div></div><div><h3>Methods</h3><div>This study is a post-hoc analysis of the multicenter, randomized controlled, noninferiority trial investigating the efficacy and safety of PVI-only (PVI-alone arm) compared with extensive ablation (PVI-plus arm) in patients with persistent AF (EARNEST-PVI trial). We divided the overall population into 2 groups based on age and assessed treatment effects.</div></div><div><h3>Results</h3><div>In the young group (age <65 years, <em>N</em> = 206), there was no significant difference in the recurrence rate between the PVI-alone group and PVI-plus group [hazard ratio (HR): 1.00, 95 % CI: 0.57–1.73, <em>p</em> = 0.987], whereas the recurrence rate was significantly lower in the PVI-plus group compared to the PVI-alone group in the elderly group (age ≥65 years, <em>N</em> = 291) (HR: 0.47, 95 % CI: 0.29–0.76, <em>p</em> = 0.0021) (<em>p</em> for interaction = 0.0446). There were no fatal procedural complications.</div></div><div><h3>Conclusion</h3><div>In patients with persistent AF, the extensive ablation strategy was more effective than the PVI-alone strategy in elderly patients, while the effectiveness of both approaches was comparable in young patients.</div></div><div><h3>Trial registration</h3><div>URL: <span><span>https://clinicaltrials.gov</span><svg><path></path></svg></span>; Unique identifier: <span><span>NCT03514693</span><svg><path></path></svg></span>.</div><div>URL: <span><span>https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000022454</span><svg><path></path></svg></span></div><div>Unique ID issued by UMIN: UMIN000019449.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 301-308"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142265370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In hypertrophic cardiomyopathy (HCM), the determinants of exercise tolerance and the usefulness of exercise stress echocardiography (ESE) for predicting hard endpoints have not been fully investigated. We aimed to assess the key parameters of ESE for exercise tolerance and the factors predictive of cardiovascular events and new-onset atrial fibrillation (AF) in patients with HCM.
Methods
Seventy-four consecutive patients with HCM who underwent ESE and with an ejection fraction ≥50 % were enrolled. The primary endpoint was a composite of cardiovascular death, heart failure hospitalization, ventricular fibrillation or tachycardia, and ventricular assist device implantation. The secondary endpoint was new-onset AF.
Results
The primary endpoint occurred in 13 patients. The left and right ventricular functions during exercise were responsible for decreased exercise tolerance. Peak exercise e′ and tricuspid annular plane systolic excursion (TAPSE) significantly predicted increased primary outcome risk (hazard ratio 1.35, 95 % confidence interval 1.10–1.76, p = 0.003; hazard ratio 1.19, 95 % confidence interval 1.07–1.32, p = 0.002, respectively), and the results were consistent even after adjustment by maximum workload. These ESE parameters improved the prognostic model containing estimated glomerular filtration rate (eGFR) and left atrial (LA) volume index. In AF-naive patients (n = 58), LA volume, peak exercise LA reservoir strain, and left ventricular outflow tract (LVOT) pressure gradient predicted new-onset AF.
Conclusions
In patients with HCM, ESE parameters related to left and right ventricular function were responsible for low exercise tolerance. Furthermore, e′ and TAPSE at peak workload could be useful for predicting cardiovascular events in addition to eGFR and LA volume index. LVOT pressure gradient and LA function during exercise predicted new-onset AF.
背景：在肥厚型心肌病（HCM）患者中，运动耐量的决定因素以及运动负荷超声心动图（ESE）在预测硬终点方面的作用尚未得到充分研究。我们的目的是评估 ESE 运动耐量的关键参数以及预测 HCM 患者心血管事件和新发房颤（AF）的因素：74例连续接受ESE治疗且射血分数大于50%的HCM患者被纳入研究。主要终点是心血管死亡、心衰住院、心室颤动或心动过速和心室辅助装置植入的复合终点。次要终点是新发房颤：13名患者达到了主要终点。运动时左心室和右心室功能导致运动耐量下降。运动峰值e'和三尖瓣环面收缩期偏移（TAPSE）可显著预测主要结局风险的增加（危险比分别为1.35，95%置信区间为1.10-1.76，p = 0.003；危险比分别为1.19，95%置信区间为1.07-1.32，p = 0.002），即使根据最大工作量进行调整后，结果也是一致的。这些 ESE 参数改善了包含估计肾小球滤过率（eGFR）和左心房（LA）容积指数的预后模型。在未发生房颤的患者（58 人）中，LA 容积、运动峰值 LA 储能应变和左心室流出道（LVOT）压力梯度可预测新发房颤：结论：在 HCM 患者中，与左心室和右心室功能相关的 ESE 参数是导致低运动耐量的原因。此外，除了基线时的 eGFR 和 LA 容积指数外，峰值负荷时的 e' 和 TAPSE 也可用于预测心血管事件。运动时左心室出口压力梯度和 LA 功能可预测新发房颤。
{"title":"Usefulness of exercise stress echocardiography for predicting cardiovascular events and atrial fibrillation in hypertrophic cardiomyopathy","authors":"Tomohiro Yoshii MD , Masashi Amano MD, PhD , Kenji Moriuchi MD, PhD , Shoko Nakagawa MD, PhD , Hitomi Nishimura MS , Yurie Tamai MS , Ayaka Mizumoto MS , Aiko Koda MS , Yutaka Demura MS , Yoshito Jo MS , Yuki Irie MD , Takahiro Sakamoto MD, PhD , Makoto Amaki MD, PhD , Hideaki Kanzaki MD, PhD, FJCC , Teruo Noguchi MD, PhD , Kunihiro Nishimura MD, PhD , Takeshi Kitai MD, PhD , Chisato Izumi MD, PhD, FJCC","doi":"10.1016/j.jjcc.2024.08.010","DOIUrl":"10.1016/j.jjcc.2024.08.010","url":null,"abstract":"<div><h3>Background</h3><div>In hypertrophic cardiomyopathy (HCM), the determinants of exercise tolerance and the usefulness of exercise stress echocardiography (ESE) for predicting hard endpoints have not been fully investigated. We aimed to assess the key parameters of ESE for exercise tolerance and the factors predictive of cardiovascular events and new-onset atrial fibrillation (AF) in patients with HCM.</div></div><div><h3>Methods</h3><div>Seventy-four consecutive patients with HCM who underwent ESE and with an ejection fraction ≥50 % were enrolled. The primary endpoint was a composite of cardiovascular death, heart failure hospitalization, ventricular fibrillation or tachycardia, and ventricular assist device implantation. The secondary endpoint was new-onset AF.</div></div><div><h3>Results</h3><div>The primary endpoint occurred in 13 patients. The left and right ventricular functions during exercise were responsible for decreased exercise tolerance. Peak exercise e′ and tricuspid annular plane systolic excursion (TAPSE) significantly predicted increased primary outcome risk (hazard ratio 1.35, 95 % confidence interval 1.10–1.76, p = 0.003; hazard ratio 1.19, 95 % confidence interval 1.07–1.32, p = 0.002, respectively), and the results were consistent even after adjustment by maximum workload. These ESE parameters improved the prognostic model containing estimated glomerular filtration rate (eGFR) and left atrial (LA) volume index. In AF-naive patients (n = 58), LA volume, peak exercise LA reservoir strain, and left ventricular outflow tract (LVOT) pressure gradient predicted new-onset AF.</div></div><div><h3>Conclusions</h3><div>In patients with HCM, ESE parameters related to left and right ventricular function were responsible for low exercise tolerance. Furthermore, e′ and TAPSE at peak workload could be useful for predicting cardiovascular events in addition to eGFR and LA volume index. LVOT pressure gradient and LA function during exercise predicted new-onset AF.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 321-328"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atrial fibrillation (AF) is the most common arrhythmia worldwide and its prevalence increases with age. The main and most severe complication of AF is ischemic stroke, yet an estimated 50 % of eligible patients cannot tolerate or are contraindicated to receive oral anticoagulation (OAC). In patients with AF, the left atrial appendage (LAA) is the main source of thrombus formation. Percutaneous LAA closure (LAAC) has emerged over the past two decades as a valuable alternative to OAC for reducing the risk of strokes and systemic embolisms in patients with AF who cannot tolerate long-term OAC. With newer generation devices such as the Watchman (Boston Scientific, Natick, MA, USA) and Amulet (Abbott, Abbott Park, IL, USA) gaining approval from the US Food and Drug Administration in recent years, the safety and efficacy of LAAC in specific populations intolerant to OAC have increased and more patients are being treated. This systematic review provides the indications for LAAC and the evidence for evaluating the use of the currently available device therapies. We also examine the current unsolved problems with patient selection and postprocedural antithrombotic regimens.
{"title":"Current evidence and indications for left atrial appendage closure","authors":"Masaya Shinohara MD, PhD , Mike Saji MD, PhD , Hideki Koike MD, PhD , Hiroshi Ohara MD, PhD , Yoshinari Enomoto MD, PhD , Rine Nakanishi MD, PhD , Tadashi Fujino MD, PhD , Takanori Ikeda MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.01.014","DOIUrl":"10.1016/j.jjcc.2025.01.014","url":null,"abstract":"<div><div>Atrial fibrillation (AF) is the most common arrhythmia worldwide and its prevalence increases with age. The main and most severe complication of AF is ischemic stroke, yet an estimated 50 % of eligible patients cannot tolerate or are contraindicated to receive oral anticoagulation (OAC). In patients with AF, the left atrial appendage (LAA) is the main source of thrombus formation. Percutaneous LAA closure (LAAC) has emerged over the past two decades as a valuable alternative to OAC for reducing the risk of strokes and systemic embolisms in patients with AF who cannot tolerate long-term OAC. With newer generation devices such as the Watchman (Boston Scientific, Natick, MA, USA) and Amulet (Abbott, Abbott Park, IL, USA) gaining approval from the US Food and Drug Administration in recent years, the safety and efficacy of LAAC in specific populations intolerant to OAC have increased and more patients are being treated. This systematic review provides the indications for LAAC and the evidence for evaluating the use of the currently available device therapies. We also examine the current unsolved problems with patient selection and postprocedural antithrombotic regimens.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 268-274"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.jjcc.2024.09.004
Bekure B. Siraw MD, MPH , Mohamed A. Ebrahim MD , Shahin Isha MD , Parth Patel MD , Abdulrahim Y. Mehadi MD , Eli A. Zaher MD , Yordanos T. Tafesse MD, MPH , Biruk Siraw MD, MS
Background
Cardiogenic shock poses a critical challenge characterized by diminished cardiac output and organ perfusion. Timely recognition and risk stratification are essential for effective intervention. Liver cirrhosis adds complexity due to its diverse systemic manifestations. The effect of liver cirrhosis on in-hospital outcomes in cardiogenic shock remains underexplored.
Methods
We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2020, matching cirrhotic patients with non-cirrhotic counterparts using propensity scores. The Cochran-Mantel-Haenszel method was used to assess the impact of cirrhosis on in-hospital mortality and complications. Simple linear regression models were used to assess differences in length of stay and cost of hospitalization.
Results
There were a total of 44,288 patients in the cohort, evenly distributed between the group with and without liver cirrhosis. Mean age of the cohort was 64 years (SD 12.5), 69.7 % were males, and 61.3 % were white. The overall in-hospital mortality rate in the cohort was 37.2 % with higher odds of in-hospital mortality in cirrhotic patients [OR = 1.3; 95 % CI (1.25, 1.35)]. Patients with cirrhosis exhibited increased risks of bowel ischemia, acute kidney injury, and sepsis compared to those without cirrhosis. Additionally, they had a heightened overall risk of major bleeding, particularly gastrointestinal bleeding, but a lower risk of intracranial hemorrhage and access site bleeding. Conversely, patients with cirrhosis had lower odds of deep vein thrombosis and pulmonary embolism, as well as arterial access site thrombosis and dissection, leading to reduced odds of peripheral angioplasty, thrombectomy, and amputation. Cirrhotic patients also had increased length of stay and cost of hospitalization.
Conclusion
Liver cirrhosis exacerbates outcomes in cardiogenic shock, necessitating tailored management strategies. Further research is warranted to optimize patient care and understand the underlying mechanisms.
{"title":"The impact of liver cirrhosis on in-hospital outcomes among patients hospitalized for cardiogenic shock: A propensity score matched retrospective cohort study","authors":"Bekure B. Siraw MD, MPH , Mohamed A. Ebrahim MD , Shahin Isha MD , Parth Patel MD , Abdulrahim Y. Mehadi MD , Eli A. Zaher MD , Yordanos T. Tafesse MD, MPH , Biruk Siraw MD, MS","doi":"10.1016/j.jjcc.2024.09.004","DOIUrl":"10.1016/j.jjcc.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Cardiogenic shock poses a critical challenge characterized by diminished cardiac output and organ perfusion. Timely recognition and risk stratification are essential for effective intervention. Liver cirrhosis adds complexity due to its diverse systemic manifestations. The effect of liver cirrhosis on in-hospital outcomes in cardiogenic shock remains underexplored.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2020, matching cirrhotic patients with non-cirrhotic counterparts using propensity scores. The Cochran-Mantel-Haenszel method was used to assess the impact of cirrhosis on in-hospital mortality and complications. Simple linear regression models were used to assess differences in length of stay and cost of hospitalization.</div></div><div><h3>Results</h3><div>There were a total of 44,288 patients in the cohort, evenly distributed between the group with and without liver cirrhosis. Mean age of the cohort was 64 years (SD 12.5), 69.7 % were males, and 61.3 % were white. The overall in-hospital mortality rate in the cohort was 37.2 % with higher odds of in-hospital mortality in cirrhotic patients [OR = 1.3; 95 % CI (1.25, 1.35)]. Patients with cirrhosis exhibited increased risks of bowel ischemia, acute kidney injury, and sepsis compared to those without cirrhosis. Additionally, they had a heightened overall risk of major bleeding, particularly gastrointestinal bleeding, but a lower risk of intracranial hemorrhage and access site bleeding. Conversely, patients with cirrhosis had lower odds of deep vein thrombosis and pulmonary embolism, as well as arterial access site thrombosis and dissection, leading to reduced odds of peripheral angioplasty, thrombectomy, and amputation. Cirrhotic patients also had increased length of stay and cost of hospitalization.</div></div><div><h3>Conclusion</h3><div>Liver cirrhosis exacerbates outcomes in cardiogenic shock, necessitating tailored management strategies. Further research is warranted to optimize patient care and understand the underlying mechanisms.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 293-300"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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