Pub Date : 2025-02-01DOI: 10.1016/j.rec.2024.05.006
Fabian Tran , Francisco Javier Ruperti-Repilado , Philip Haaf , Pedro Lopez-Ayala , Matthias Greutmann , Markus Schwerzmann , Judith Bouchardy , Harald Gabriel , Dominik Stambach , Juerg Schwitter , Kerstin Wustmann , Michael Freese , Christian Mueller , Daniel Tobler
Introduction and objectives
The role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the risk prediction of patients with systemic right ventricles (sRV) is not well defined. The aim of this study was to analyze the prognostic value of NT-proBNP in patients with an sRV.
Methods
The prognostic value of NT-proBNP was assessed in 98 patients from the SERVE trial. We used an adjusted Cox proportional hazards model, survival analysis, and c-statistics. The composite primary outcome was the occurrence of clinically relevant arrhythmia, heart failure, or death. Correlations between baseline NT-proBNP values and biventricular volumes and function were assessed by adjusted linear regression models.
Results
The median age [interquartile range] at baseline was 39 [32-48] years and 32% were women. The median NT-proBNP was 238 [137-429] ng/L. Baseline NT-proBNP concentrations were significantly higher among the 20 (20%) patients developing the combined primary outcome compared with those who did not (816 [194-1094] vs 205 [122-357]; P = .003). In patients with NT-proBNP concentrations > 75th percentile (> 429 ng/L), we found an exponential increase in the sex- and age-adjusted hazard ratio for the primary outcome. The prognostic value of NT-proBNP was comparable to right ventricular ejection fraction and peak oxygen uptake on exercise testing (c-statistic: 0.71, 0.72, and 0.71, respectively).
Conclusions
In patients with sRVs, NT-proBNP concentrations correlate with sRV volumes and function and may serve as a simple tool for predicting adverse outcomes.
{"title":"NT-proBNP in systemic right ventricles: a new cutoff level for risk stratification?","authors":"Fabian Tran , Francisco Javier Ruperti-Repilado , Philip Haaf , Pedro Lopez-Ayala , Matthias Greutmann , Markus Schwerzmann , Judith Bouchardy , Harald Gabriel , Dominik Stambach , Juerg Schwitter , Kerstin Wustmann , Michael Freese , Christian Mueller , Daniel Tobler","doi":"10.1016/j.rec.2024.05.006","DOIUrl":"10.1016/j.rec.2024.05.006","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the risk prediction of patients with systemic right ventricles (sRV) is not well defined. The aim of this study was to analyze the prognostic value of NT-proBNP in patients with an sRV.</div></div><div><h3>Methods</h3><div>The prognostic value of NT-proBNP was assessed in 98 patients from the SERVE trial. We used an adjusted Cox proportional hazards model, survival analysis, and c-statistics. The composite primary outcome was the occurrence of clinically relevant arrhythmia, heart failure, or death. Correlations between baseline NT-proBNP values and biventricular volumes and function were assessed by adjusted linear regression models.</div></div><div><h3>Results</h3><div>The median age [interquartile range] at baseline was 39 [32-48] years and 32% were women. The median NT-proBNP was 238 [137-429] ng/L. Baseline NT-proBNP concentrations were significantly higher among the 20 (20%) patients developing the combined primary outcome compared with those who did not (816 [194-1094] vs 205 [122-357]; <em>P</em> <!-->=<!--> <!-->.003). In patients with NT-proBNP concentrations<!--> <!-->> 75th percentile (> 429 ng/L), we found an exponential increase in the sex- and age-adjusted hazard ratio for the primary outcome. The prognostic value of NT-proBNP was comparable to right ventricular ejection fraction and peak oxygen uptake on exercise testing (c-statistic: 0.71, 0.72, and 0.71, respectively).</div></div><div><h3>Conclusions</h3><div>In patients with sRVs, NT-proBNP concentrations correlate with sRV volumes and function and may serve as a simple tool for predicting adverse outcomes.</div></div>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"78 2","pages":"Pages 107-116"},"PeriodicalIF":7.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.rec.2024.08.005
Laura Sanchis , Pedro Cepas-Guillén , Eduardo Flores , Ander Regueiro , Marta Sitges , Xavier Freixa
{"title":"A minimalist approach for left atrial appendage occlusion with the use of a mini-transesophageal 4D probe","authors":"Laura Sanchis , Pedro Cepas-Guillén , Eduardo Flores , Ander Regueiro , Marta Sitges , Xavier Freixa","doi":"10.1016/j.rec.2024.08.005","DOIUrl":"10.1016/j.rec.2024.08.005","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"78 2","pages":"Pages 156-158"},"PeriodicalIF":7.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.rec.2024.06.002
Felix Voll , Constantin Kuna , Maria Scalamogna , Thorsten Kessler , Sebastian Kufner , Tobias Rheude , Hendrik B. Sager , Erion Xhepa , Jens Wiebe , Michael Joner , Robert A. Byrne , Heribert Schunkert , Gjin Ndrepepa , Barbara E. Stähli , Adnan Kastrati , Salvatore Cassese
Introduction and objectives
Multivessel percutaneous coronary intervention (MV-PCI) is recommended in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) without cardiogenic shock. The present network meta-analysis investigated the optimal timing of MV-PCI in this context.
Methods
We pooled the aggregated data from randomized trials investigating stable STEMI patients with multivessel CAD treated with a strategy of either MV-PCI or culprit vessel-only PCI. The primary outcome was all-cause death. The main secondary outcomes were cardiovascular death, myocardial infarction, and unplanned ischemia-driven revascularization.
Results
Among 11 trials, a total of 10 507 patients were randomly assigned to MV-PCI (same sitting, n = 1683; staged during the index hospitalization, n = 3460; staged during a subsequent hospitalization within 45 days, n = 3275) or to culprit vessel-only PCI (n = 2089). The median follow-up was 18.6 months. In comparison with culprit vessel-only PCI, MV-PCI staged during the index hospitalization significantly reduced all-cause death (risk ratio, 0.73; 95%CI, 0.56-0.92; P = .008) and ranked as possibly the best treatment option for this outcome compared with all other strategies. In comparison with culprit vessel-only PCI, a MV-PCI reduced cardiovascular mortality without differences dependent on the timing of revascularization. MV-PCI within the index hospitalization, either in a single procedure or staged, significantly reduced myocardial infarction and unplanned ischemia-driven revascularization, with no significant difference between each other.
Conclusions
In patients with STEMI and multivessel CAD without cardiogenic shock, multivessel PCI within the index hospitalization, either in a single procedure or staged, represents the safest and most efficacious approach. The different timings of multivessel PCI did not result in any significant differences in all-cause death.
This study is registered at PROSPERO (CRD42023457794).
{"title":"Timing of multivessel revascularization in stable patients with STEMI: a systematic review and network meta-analysis","authors":"Felix Voll , Constantin Kuna , Maria Scalamogna , Thorsten Kessler , Sebastian Kufner , Tobias Rheude , Hendrik B. Sager , Erion Xhepa , Jens Wiebe , Michael Joner , Robert A. Byrne , Heribert Schunkert , Gjin Ndrepepa , Barbara E. Stähli , Adnan Kastrati , Salvatore Cassese","doi":"10.1016/j.rec.2024.06.002","DOIUrl":"10.1016/j.rec.2024.06.002","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Multivessel percutaneous coronary intervention (MV-PCI) is recommended in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) without cardiogenic shock. The present network meta-analysis investigated the optimal timing of MV-PCI in this context.</div></div><div><h3>Methods</h3><div>We pooled the aggregated data from randomized trials investigating stable STEMI patients with multivessel CAD treated with a strategy of either MV-PCI or culprit vessel-only PCI. The primary outcome was all-cause death. The main secondary outcomes were cardiovascular death, myocardial infarction, and unplanned ischemia-driven revascularization.</div></div><div><h3>Results</h3><div>Among 11 trials, a total of 10 507 patients were randomly assigned to MV-PCI (same sitting, n<!--> <!-->=<!--> <!-->1683; staged during the index hospitalization, n<!--> <!-->=<!--> <!-->3460; staged during a subsequent hospitalization within 45 days, n<!--> <!-->=<!--> <!-->3275) or to culprit vessel-only PCI (n<!--> <!-->=<!--> <!-->2089). The median follow-up was 18.6 months. In comparison with culprit vessel-only PCI, MV-PCI staged during the index hospitalization significantly reduced all-cause death (risk ratio, 0.73; 95%CI, 0.56-0.92; <em>P</em> <!-->=<!--> <!-->.008) and ranked as possibly the best treatment option for this outcome compared with all other strategies. In comparison with culprit vessel-only PCI, a MV-PCI reduced cardiovascular mortality without differences dependent on the timing of revascularization. MV-PCI within the index hospitalization, either in a single procedure or staged, significantly reduced myocardial infarction and unplanned ischemia-driven revascularization, with no significant difference between each other.</div></div><div><h3>Conclusions</h3><div>In patients with STEMI and multivessel CAD without cardiogenic shock, multivessel PCI within the index hospitalization, either in a single procedure or staged, represents the safest and most efficacious approach. The different timings of multivessel PCI did not result in any significant differences in all-cause death.</div><div>This study is registered at PROSPERO (CRD42023457794).</div></div>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"78 2","pages":"Pages 127-137"},"PeriodicalIF":7.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.rec.2024.08.008
Manel Sabaté
{"title":"Percutaneous coronary intervention and TAVR: the simpler the better","authors":"Manel Sabaté","doi":"10.1016/j.rec.2024.08.008","DOIUrl":"10.1016/j.rec.2024.08.008","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"78 2","pages":"Pages 94-96"},"PeriodicalIF":7.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.rec.2024.05.002
Marisa Avvedimento , Francisco Campelo-Parada , Luis Nombela-Franco , Quentin Fischer , Pierre Donaint , Vicenç Serra , Gabriela Veiga , Enrique Gutiérrez , Anna Franzone , Victoria Vilalta , Alberto Alperi , Ander Regueiro , Lluis Asmarats , Henrique B. Ribeiro , Anthony Matta , Antonio Muñoz-García , Gabriela Tirado , Marina Urena , Damien Metz , Eduard Rodenas-Alesina , Josep Rodés-Cabau
Introduction and objectives
In patients undergoing percutaneous coronary intervention (PCI) in the workup pre-transcatheter aortic valve replacement (TAVR), the clinical impact of coronary revascularization complexity remains unknown. This study sought to examine the impact of PCI complexity on clinical outcomes after TAVR in patients undergoing PCI in the preprocedural workup.
Methods
This was a multicenter study including consecutive patients scheduled for TAVR with concomitant significant coronary artery disease. Complex PCI was defined as having at least 1 of the following features: 3 vessels treated, ≥ 3 stents implanted, ≥ 3 lesions treated, bifurcation with 2 stents implanted, total stent length > 60 mm, or chronic total occlusion. The rates of major adverse cardiac events (MACE), including cardiovascular mortality, myocardial infarction, and coronary revascularization were evaluated.
Results
A total of 1550 patients were included, of which 454 (29.3%) underwent complex PCI in the pre-TAVR workup. After a median follow-up period of 2 [1-3] years after TAVR, the incidence of MACE was 9.6 events per 100 patients-years. Complex PCI significantly increased the risk of cardiac death (HR, 1.44; 95%CI, 1.01-2.07), nonperiprocedural myocardial infarction (HR, 1.52; 95%CI, 1.04-2.21), and coronary revascularization (HR, 2.46; 95%CI, 1.44-4.20). In addition, PCI complexity was identified as an independent predictor of MACE after TAVR (HR, 1.31; 95%CI, 1.01-1.71; P = .042).
Conclusions
In TAVR candidates with significant coronary artery disease requiring percutaneous treatment, complex revascularization was associated with a higher risk of MACE. The degree of procedural complexity should be considered a strong determinant of prognosis in the PCI-TAVR population.
{"title":"Clinical impact of complex percutaneous coronary intervention in the pre-TAVR workup","authors":"Marisa Avvedimento , Francisco Campelo-Parada , Luis Nombela-Franco , Quentin Fischer , Pierre Donaint , Vicenç Serra , Gabriela Veiga , Enrique Gutiérrez , Anna Franzone , Victoria Vilalta , Alberto Alperi , Ander Regueiro , Lluis Asmarats , Henrique B. Ribeiro , Anthony Matta , Antonio Muñoz-García , Gabriela Tirado , Marina Urena , Damien Metz , Eduard Rodenas-Alesina , Josep Rodés-Cabau","doi":"10.1016/j.rec.2024.05.002","DOIUrl":"10.1016/j.rec.2024.05.002","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>In patients undergoing percutaneous coronary intervention (PCI) in the workup pre-transcatheter aortic valve replacement (TAVR), the clinical impact of coronary revascularization complexity remains unknown. This study sought to examine the impact of PCI complexity on clinical outcomes after TAVR in patients undergoing PCI in the preprocedural workup.</div></div><div><h3>Methods</h3><div>This was a multicenter study including consecutive patients scheduled for TAVR with concomitant significant coronary artery disease. Complex PCI was defined as having at least 1 of the following features: 3 vessels treated, ≥ 3 stents implanted, ≥ 3 lesions treated, bifurcation with 2 stents implanted, total stent length ><!--> <!-->60<!--> <!-->mm, or chronic total occlusion. The rates of major adverse cardiac events (MACE), including cardiovascular mortality, myocardial infarction, and coronary revascularization were evaluated.</div></div><div><h3>Results</h3><div><span>A total of 1550 patients were included, of which 454 (29.3%) underwent complex PCI in the pre-TAVR workup. After a median follow-up period of 2 [1-3] years after TAVR, the incidence of MACE<span> was 9.6 events per 100 patients-years. Complex PCI significantly increased the risk of cardiac death (HR, 1.44; 95%CI, 1.01-2.07), nonperiprocedural myocardial infarction (HR, 1.52; 95%CI, 1.04-2.21), and coronary revascularization (HR, 2.46; 95%CI, 1.44-4.20). In addition, PCI complexity was identified as an independent predictor of MACE after TAVR (HR, 1.31; 95%CI, 1.01-1.71; </span></span><em>P</em> <!-->=<!--> <!-->.042).</div></div><div><h3>Conclusions</h3><div>In TAVR candidates with significant coronary artery disease requiring percutaneous treatment, complex revascularization was associated with a higher risk of MACE. The degree of procedural complexity should be considered a strong determinant of prognosis in the PCI-TAVR population.</div></div>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"78 2","pages":"Pages 82-93"},"PeriodicalIF":7.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141041469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This real-world study—the first of its kind in a Spanish population—aimed to explore severe risk for cardiovascular events and all-cause death following exacerbations in a large cohort of patients with chronic obstructive pulmonary disease (COPD).
Methods
We included individuals with a COPD diagnosis code between 2014 and 2018 from the BIG-PAC health care claims database. The primary outcome was a composite of a first severe cardiovascular event (acute coronary syndrome, heart failure decompensation, cerebral ischemia, arrhythmia) or all-cause death following inclusion in the cohort. Time-dependent Cox proportional hazards models estimated HRs for associations between exposed time periods (1-7, 8-14, 15-30, 31-180, 181-365, and > 365 days) following an exacerbation of any severity, and following moderate or severe exacerbations separately (vs unexposed time before a first exacerbation following cohort inclusion).
Results
During a median follow-up of 3.03 years, 18 901 of 24 393 patients (77.5%) experienced ≥ 1 moderate/severe exacerbation, and 8741 (35.8%) experienced the primary outcome. The risk of a severe cardiovascular event increased following moderate/severe COPD exacerbation onset vs the unexposed period, with rates being most increased during the first 1 to 7 days following exacerbation onset (HR, 10.10; 95%CI, 9.29-10.97) and remaining increased > 365 days after exacerbation onset (HR, 1.65; 95%CI, 1.49-1.82).
Conclusions
The risk of severe cardiovascular events or death increased following moderate/severe exacerbation onset, illustrating the need for proactive multidisciplinary care of patients with COPD to prevent exacerbations and address other cardiovascular risk factors.
{"title":"Risk of severe cardiovascular events following COPD exacerbations: results from the EXACOS-CV study in Spain","authors":"Salud Santos , Nicolás Manito , Joaquín Sánchez-Covisa , Ignacio Hernández , Carmen Corregidor , Luciano Escudero , Kirsty Rhodes , Clementine Nordon","doi":"10.1016/j.rec.2024.06.003","DOIUrl":"10.1016/j.rec.2024.06.003","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>This real-world study—the first of its kind in a Spanish population—aimed to explore severe risk for cardiovascular events and all-cause death following exacerbations in a large cohort of patients with chronic obstructive pulmonary disease (COPD).</div></div><div><h3>Methods</h3><div>We included individuals with a COPD diagnosis code between 2014 and 2018 from the BIG-PAC health care claims database. The primary outcome was a composite of a first severe cardiovascular event (acute coronary syndrome, heart failure decompensation, cerebral ischemia, arrhythmia) or all-cause death following inclusion in the cohort. Time-dependent Cox proportional hazards models estimated HRs for associations between exposed time periods (1-7, 8-14, 15-30, 31-180, 181-365, and ><!--> <!-->365 days) following an exacerbation of any severity, and following moderate or severe exacerbations separately (vs unexposed time before a first exacerbation following cohort inclusion).</div></div><div><h3>Results</h3><div>During a median follow-up of 3.03 years, 18 901 of 24 393 patients (77.5%) experienced ≥ 1 moderate/severe exacerbation, and 8741 (35.8%) experienced the primary outcome. The risk of a severe cardiovascular event increased following moderate/severe COPD exacerbation onset vs the unexposed period, with rates being most increased during the first 1 to 7 days following exacerbation onset (HR, 10.10; 95%CI, 9.29-10.97) and remaining increased ><!--> <!-->365 days after exacerbation onset (HR, 1.65; 95%CI, 1.49-1.82).</div></div><div><h3>Conclusions</h3><div>The risk of severe cardiovascular events or death increased following moderate/severe exacerbation onset, illustrating the need for proactive multidisciplinary care of patients with COPD to prevent exacerbations and address other cardiovascular risk factors.</div></div>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"78 2","pages":"Pages 138-150"},"PeriodicalIF":7.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.rec.2024.08.013
Fernando Alfonso , Jorge Salamanca , Iván Núñez-Gil , Náyade Del Prado , Nicolás Rosillo , Javier Elola
{"title":"Trends in hospital admissions and mortality for tako-tsubo syndrome in Spain","authors":"Fernando Alfonso , Jorge Salamanca , Iván Núñez-Gil , Náyade Del Prado , Nicolás Rosillo , Javier Elola","doi":"10.1016/j.rec.2024.08.013","DOIUrl":"10.1016/j.rec.2024.08.013","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"78 2","pages":"Pages 158-160"},"PeriodicalIF":7.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.rec.2024.10.004
James F. Howick V , Bernard J. Gersh
{"title":"Revascularization in ischemic cardiomyopathy. Is viability testing still viable?","authors":"James F. Howick V , Bernard J. Gersh","doi":"10.1016/j.rec.2024.10.004","DOIUrl":"10.1016/j.rec.2024.10.004","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"78 2","pages":"Pages 78-81"},"PeriodicalIF":7.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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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