Fatima Amin, A. S. Shaikh, S. Bangash, A. Kamran, Nida Rafique, M. Rehman, Najma Patel
Objectives: The objective of this study was to determine the correlation between intraoperative direct (needle) and transesophageal echocardiographic (TEE) assessment of right ventricular outflow tract (RVOT) pressure gradient in patients undergoing Tetralogy of Fallot (TOF) repair. Methodology: A total of 100 patients underwent for TOF repair were included. After completion of surgery and successful weaning from cardiopulmonary bypass, the TEE derived RVOT gradients were obtained from, the midesophageal ascending aortic short axis (AA Sax) view, upper esophageal aortic arch short axis (Arch Sax) view and trans-gastric RV outflow (TG RV outflow) view. Direct (needle) derived pressures from right ventricular (RV) and pulmonary artery (PA) were obtained by surgeon using a saline filled pressure transducer system. Correlation coefficient was computed between intraoperative direct and TEE assessment of RVOT gradient was evaluated. Results: In the sample of 100 patients, 41% were females and median age was 8 [5-11] years. The TEE derived RVOT gradients obtained in AA Sax, Arch Sax and TG RV outflow view were 26.46±6.98, 26.60±6.55, and 22.64±6.21 mmHg, respectively. Intraoperative RVOT pressure gradient was 19.05±8.9 mmHg. The correlation between intraoperative direct (needle) and TEE assessment of RVOT pressure gradient obtained in AA Sax, Arch Sax, and TG RV outflow view were 0.588 (p<0.001), 0.283 (p<0.001), and 0.383 (p<0.001), respectively. Conclusion: Intraoperative TEE assessment of RVOT pressure gradient showed a moderate correlation with the direct (needle) assessment. The ascending aorta short axis view was found to be the superior esophageal view.
{"title":"Correlation between Intraoperative Direct and Transesophageal Echocardiographic Assessment of Right Ventricular Outflow Tract Pressure Gradient in Patients Undergoing Tetralogy of Fallot Repair","authors":"Fatima Amin, A. S. Shaikh, S. Bangash, A. Kamran, Nida Rafique, M. Rehman, Najma Patel","doi":"10.47144/phj.v56i1.2484","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2484","url":null,"abstract":"Objectives: The objective of this study was to determine the correlation between intraoperative direct (needle) and transesophageal echocardiographic (TEE) assessment of right ventricular outflow tract (RVOT) pressure gradient in patients undergoing Tetralogy of Fallot (TOF) repair.\u0000Methodology: A total of 100 patients underwent for TOF repair were included. After completion of surgery and successful weaning from cardiopulmonary bypass, the TEE derived RVOT gradients were obtained from, the midesophageal ascending aortic short axis (AA Sax) view, upper esophageal aortic arch short axis (Arch Sax) view and trans-gastric RV outflow (TG RV outflow) view. Direct (needle) derived pressures from right ventricular (RV) and pulmonary artery (PA) were obtained by surgeon using a saline filled pressure transducer system. Correlation coefficient was computed between intraoperative direct and TEE assessment of RVOT gradient was evaluated.\u0000Results: In the sample of 100 patients, 41% were females and median age was 8 [5-11] years. The TEE derived RVOT gradients obtained in AA Sax, Arch Sax and TG RV outflow view were 26.46±6.98, 26.60±6.55, and 22.64±6.21 mmHg, respectively. Intraoperative RVOT pressure gradient was 19.05±8.9 mmHg. The correlation between intraoperative direct (needle) and TEE assessment of RVOT pressure gradient obtained in AA Sax, Arch Sax, and TG RV outflow view were 0.588 (p<0.001), 0.283 (p<0.001), and 0.383 (p<0.001), respectively.\u0000Conclusion: Intraoperative TEE assessment of RVOT pressure gradient showed a moderate correlation with the direct (needle) assessment. The ascending aorta short axis view was found to be the superior esophageal view.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46512358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Inadvertent malposition of pacing leads is a recognized complication of temporary cardiac pacing procedure, which can be fatal particularly if lead placement is in the left ventricular (LV) cavity because of the risk of thromboembolic events.1 Malposition leads can be either due to unrecognized congenital heart defects including atrial or ventricular septal defects, patent foramen ovale or due to iatrogenic perforation of interventricular septum but sometimes it may be due to faulty insertion via trans-arterial instead of trans-venous access.2 References Gupta S, Annamalaisamy R, Coupe M. Misplacement of temporary pacing wire into the left ventricle via an anomalous vein. Hellenic J Cardiol. 2010;51(2):175-7. Garg N, Moorthy N. Inadvertent temporary pacemaker lead placement in aortic sinus. Heart views: the official journal of the Gulf Heart Association. 2013;14(4):182.
{"title":"12-Lead Electrocardiogram - A Valuable Tool in Temporary Cardiac Pacing Management","authors":"S. H. Naqvi","doi":"10.47144/phj.v56i1.2376","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2376","url":null,"abstract":"Inadvertent malposition of pacing leads is a recognized complication of temporary cardiac pacing procedure, which can be fatal particularly if lead placement is in the left ventricular (LV) cavity because of the risk of thromboembolic events.1 Malposition leads can be either due to unrecognized congenital heart defects including atrial or ventricular septal defects, patent foramen ovale or due to iatrogenic perforation of interventricular septum but sometimes it may be due to faulty insertion via trans-arterial instead of trans-venous access.2\u0000 \u0000References\u0000\u0000Gupta S, Annamalaisamy R, Coupe M. Misplacement of temporary pacing wire into the left ventricle via an anomalous vein. Hellenic J Cardiol. 2010;51(2):175-7.\u0000Garg N, Moorthy N. Inadvertent temporary pacemaker lead placement in aortic sinus. Heart views: the official journal of the Gulf Heart Association. 2013;14(4):182.\u0000","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42998600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
U. Butt, I. Saleem, Hafiz Abdul Mannan Shahid, Waqar Hassan, M. A. Dar, Z. Akram
Objectives: To evaluate the quantity and duration of junctional rhythm during radiofrequency ablation among atrioventricular nodal reentry tachycardia (AVRNT) patients. Methodology: A Cross sectional study was conducted at Punjab Institute of cardiology from May – July, 2022. Ablations of slow pathway were executed on 50 patients who fulfilled the inclusion criteria using ablation catheters of 4-mm tip. Power output was kept between 35- 40 Watt with a temperature control at 60 °C depending upon the occurrence of junctional rhythm. The target end points of radio frequency ablation (RFA) were inability to either induce or spontaneously demonstrate clinical tachycardia. Presence of more than one atrio-ventricular (AV) nodal echo beat was the criteria to continue further ablations as it was considered indicator residual slow pathway. Data was entered in SPSS software version 21.0 and were presented as mean ± SD were used. Results: The mean age of the patients was 36.50 ± 7.129 years. Ablation power was titrated between 35-40 watts (Mean 39.6 ± 1.37). The average amount of junctional beats in each patient was 57.34 ± 9.71 (73-38) with mean duration of junctional rhythm was 29.20 ± 3.47 sec. Successful ablation mean was 54.25 + 8.45 as compared to unsuccessful attempts of 44.32 ± 5.77 and was statistically significant (p<0.001). Conclusion: The study concluded that RFA had high success rate and a low recurrence rate with less complication. Junctional rhythm is a sensitive predictor of successful ablation and is a safe and effective way of permanent termination of AVNRT.
{"title":"Evaluation of the Quantity and Duration of Junctional Rhythm during Successful Radiofrequency Ablation among Patients with Atrioventricular Nodal Re-Entry Tachycardia","authors":"U. Butt, I. Saleem, Hafiz Abdul Mannan Shahid, Waqar Hassan, M. A. Dar, Z. Akram","doi":"10.47144/phj.v56i1.2368","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2368","url":null,"abstract":"Objectives: To evaluate the quantity and duration of junctional rhythm during radiofrequency ablation among atrioventricular nodal reentry tachycardia (AVRNT) patients.\u0000Methodology: A Cross sectional study was conducted at Punjab Institute of cardiology from May – July, 2022. Ablations of slow pathway were executed on 50 patients who fulfilled the inclusion criteria using ablation catheters of 4-mm tip. Power output was kept between 35- 40 Watt with a temperature control at 60 °C depending upon the occurrence of junctional rhythm. The target end points of radio frequency ablation (RFA) were inability to either induce or spontaneously demonstrate clinical tachycardia. Presence of more than one atrio-ventricular (AV) nodal echo beat was the criteria to continue further ablations as it was considered indicator residual slow pathway. Data was entered in SPSS software version 21.0 and were presented as mean ± SD were used.\u0000Results: The mean age of the patients was 36.50 ± 7.129 years. Ablation power was titrated between 35-40 watts (Mean 39.6 ± 1.37). The average amount of junctional beats in each patient was 57.34 ± 9.71 (73-38) with mean duration of junctional rhythm was 29.20 ± 3.47 sec. Successful ablation mean was 54.25 + 8.45 as compared to unsuccessful attempts of 44.32 ± 5.77 and was statistically significant (p<0.001).\u0000Conclusion: The study concluded that RFA had high success rate and a low recurrence rate with less complication. Junctional rhythm is a sensitive predictor of successful ablation and is a safe and effective way of permanent termination of AVNRT.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41863412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nindya Sari Diajeng Laras Ati, Agus Subagjo, Rizal Muhammad, M. Aditya
Septic embolism associated with infective endocarditis (IE) is the occlusion of a blood vessel caused by an infected thrombus traveling through the bloodstream resulting in ischemia and/or infarction. Septic embolism can result in ischemia and/or infarction due to vascular occlusion and infection, resulting in inflammation and possible abscess formation. Systemic embolization generally occurs in left-sided IE, causing stroke, blindness due to embolism or endophthalmitis, splenic or renal infarct, limb ischemia, or even acute myocardial infarction. Here, we report a case of acute on chronic limb-threatening ischemia due to septic embolism in patient with IE.
{"title":"Acute on Chronic Limb-Threatening Ischemia Associated with Septic Embolism in Patient with Infective Endocarditis","authors":"Nindya Sari Diajeng Laras Ati, Agus Subagjo, Rizal Muhammad, M. Aditya","doi":"10.47144/phj.v56i1.2408","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2408","url":null,"abstract":"Septic embolism associated with infective endocarditis (IE) is the occlusion of a blood vessel caused by an infected thrombus traveling through the bloodstream resulting in ischemia and/or infarction. Septic embolism can result in ischemia and/or infarction due to vascular occlusion and infection, resulting in inflammation and possible abscess formation. Systemic embolization generally occurs in left-sided IE, causing stroke, blindness due to embolism or endophthalmitis, splenic or renal infarct, limb ischemia, or even acute myocardial infarction. Here, we report a case of acute on chronic limb-threatening ischemia due to septic embolism in patient with IE.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46869200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: This is a real world prospective study to evaluate the effects of Neprlysin Inhibition (ARNI) using sacubitril/valsartan in patients with heart failure with reduced ejection fraction (HFrEF). Methodology: This was an outpatient study on patients of HFrEF (EF<40%) and stable blood pressure after obtaining informed consent. Consecutive patients were enrolled and followed at 6 and 12 weeks. Detailed clinical and echocardiographic examinations were performed on all visits. Biochemistry evaluating ProBNP, renal profile, HbA1C and electrolytes were performed in 24 patients at baseline and follow-up. Results: We enrolled 80 patients, but 63 patients could be followed. Mean age was 53.54±13.32 years and 55% were males. After 12 weeks treatment improvement in NYHA functional class was seen in 66% and improvement by more than one grade in 31% (p<0.01). Pro-BNP reduced from 3552.71±1804.74 at the baseline to 723±930 on the second FU visit (p<0.002). Structural improvement was seen in 33% of patients. Left ventricular (LV) end-diastolic diameter (EDD) reduced by 3.49 mm and LV end systolic diameter (ESD) by 3.97 mm (p<0.014). Fractional shortening (FS) increased by 2.07% and EF by 3.52 (p<0.01). Patients tolerated the drug well, but most could not tolerate the higher recommended dosage. Renal status, electrolytes, and HbA1C did not alter significantly. Conclusion: Treatment with sacubitril/valsartan in addition to the guideline directed medical therapy (GDMT) resulted in marked reduction in ProBNP, significant improvement in functional class and enhancement of cardiac pumping activity with reduction in LVEDD and LVESD and improvement in FS and EF.
目的:这是一项真实世界的前瞻性研究，旨在评估使用苏比里尔/缬沙坦进行Neprlysin Inhibition (ARNI)治疗心力衰竭伴射血分数降低(HFrEF)患者的效果。方法:这是一项门诊研究，研究对象为HFrEF (EF<40%)且血压稳定的患者，经知情同意后。连续入组患者，并在6周和12周进行随访。所有就诊均进行了详细的临床和超声心动图检查。在基线和随访时对24例患者进行了ProBNP、肾谱、HbA1C和电解质的生化评估。结果:入组患者80例，可随访63例。平均年龄53.54±13.32岁，男性占55%。治疗12周后，66%的NYHA功能评分改善，31%的NYHA功能评分改善1级以上(p<0.01)。Pro-BNP从基线时的3552.71±1804.74降至第二次FU时的723±930 (p<0.002)。33%的患者结构改善。左室舒张末期内径(EDD)减少3.49 mm，左室收缩末期内径(ESD)减少3.97 mm (p<0.014)。分数缩短(FS)增加2.07%，EF增加3.52 (p<0.01)。患者对该药耐受性良好，但大多数患者无法耐受更高的推荐剂量。肾脏状态、电解质和HbA1C没有明显改变。结论:在指导药物治疗(GDMT)的基础上加用苏比利/缬沙坦治疗可显著降低ProBNP，显著改善功能等级，增强心脏泵活动，降低LVEDD和LVESD，改善FS和EF。
{"title":"Evaluation of Angiotensin Receptor and Neprlysin Inhibition (ARNI) in Patients of Heart Failure with Reduced Ejection Fraction (HFrEF) - a real-world study","authors":"M. Hafizullah, W. Aman, Hisar Afridi","doi":"10.47144/phj.v56i1.2454","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2454","url":null,"abstract":"Objectives: This is a real world prospective study to evaluate the effects of Neprlysin Inhibition (ARNI) using sacubitril/valsartan in patients with heart failure with reduced ejection fraction (HFrEF).\u0000Methodology: This was an outpatient study on patients of HFrEF (EF<40%) and stable blood pressure after obtaining informed consent. Consecutive patients were enrolled and followed at 6 and 12 weeks. Detailed clinical and echocardiographic examinations were performed on all visits. Biochemistry evaluating ProBNP, renal profile, HbA1C and electrolytes were performed in 24 patients at baseline and follow-up.\u0000Results: We enrolled 80 patients, but 63 patients could be followed. Mean age was 53.54±13.32 years and 55% were males. After 12 weeks treatment improvement in NYHA functional class was seen in 66% and improvement by more than one grade in 31% (p<0.01). Pro-BNP reduced from 3552.71±1804.74 at the baseline to 723±930 on the second FU visit (p<0.002). Structural improvement was seen in 33% of patients. Left ventricular (LV) end-diastolic diameter (EDD) reduced by 3.49 mm and LV end systolic diameter (ESD) by 3.97 mm (p<0.014). Fractional shortening (FS) increased by 2.07% and EF by 3.52 (p<0.01). Patients tolerated the drug well, but most could not tolerate the higher recommended dosage. Renal status, electrolytes, and HbA1C did not alter significantly.\u0000Conclusion: Treatment with sacubitril/valsartan in addition to the guideline directed medical therapy (GDMT) resulted in marked reduction in ProBNP, significant improvement in functional class and enhancement of cardiac pumping activity with reduction in LVEDD and LVESD and improvement in FS and EF.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42797937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Sheikh, A. Farooq, Abeer Sarfaraz, S. Sarfaraz, S. Athar, Aemon Zehra
Objectives: To compare the levels of N Terminal- ProBrain natriuretic peptide (NT-proBNP) and Troponin I (Trop I) to predict left ventricular ejection fraction (LVEF) in patients presenting with first ST-elevation myocardial infarction (STEMI). Methodology: A cross-sectional study was carried out in Cardiology department of a tertiary care hospital from June to November 2021. A total of 150 patients who presented at emergency department with first STEMI and underwent primary percutaneous coronary intervention (PCI) were included. The patient’s second set of troponin I and NT-proBNP were collected during hospitalization. Echocardiography was done. Left ventricular function was assessed using modified Simpson’s method. For data analysis, SPSS 21 was used. Results: The mean age was 60.60±11.1 years. There were 76% males, 53% hypertensive, 44% diabetic, 14% smokers with the most prominent type of myocardial infarction being anterior wall myocardial infarction accounting for 76.7%. Mean Trop I was 12.2±6.81 ng/ml, 9.5±8.63 ng/ml and 3.0±5.41 ng/ml for LVEF≤40%, 41-49% and >50% respectively while NT-proBNP was 7136.4±7.97pmol/l, 2328.9±3498.6pmol/l and 441±283.6pmol/l for LVEF ≤40%, 41-49%, and >50% respectively. We found a significant mean difference for Trop I (p=0.000) and NT-proBNP (p=0.0001). There was an inverse significant relationship of left ventricular ejection fraction with Trop I (r=-0.290, p=0.000) and NT- proBNP (r=-0.388, p=0.000). Conclusion: In comparison to Troponin I, NT-proBNP serves as a better marker to predict LVEF in patients presenting with first STEMI.
{"title":"Comparison between the Levels of N Terminal Pro-Brain Natriuretic Peptide and Troponin I to Predict Left Ventricular Ejection Fraction in Patients Presenting with First ST-Elevation Myocardial Infarction","authors":"K. Sheikh, A. Farooq, Abeer Sarfaraz, S. Sarfaraz, S. Athar, Aemon Zehra","doi":"10.47144/phj.v56i1.2328","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2328","url":null,"abstract":"Objectives: To compare the levels of N Terminal- ProBrain natriuretic peptide (NT-proBNP) and Troponin I (Trop I) to predict left ventricular ejection fraction (LVEF) in patients presenting with first ST-elevation myocardial infarction (STEMI).\u0000Methodology: A cross-sectional study was carried out in Cardiology department of a tertiary care hospital from June to November 2021. A total of 150 patients who presented at emergency department with first STEMI and underwent primary percutaneous coronary intervention (PCI) were included. The patient’s second set of troponin I and NT-proBNP were collected during hospitalization. Echocardiography was done. Left ventricular function was assessed using modified Simpson’s method. For data analysis, SPSS 21 was used.\u0000Results: The mean age was 60.60±11.1 years. There were 76% males, 53% hypertensive, 44% diabetic, 14% smokers with the most prominent type of myocardial infarction being anterior wall myocardial infarction accounting for 76.7%. Mean Trop I was 12.2±6.81 ng/ml, 9.5±8.63 ng/ml and 3.0±5.41 ng/ml for LVEF≤40%, 41-49% and >50% respectively while NT-proBNP was 7136.4±7.97pmol/l, 2328.9±3498.6pmol/l and 441±283.6pmol/l for LVEF ≤40%, 41-49%, and >50% respectively. We found a significant mean difference for Trop I (p=0.000) and NT-proBNP (p=0.0001). There was an inverse significant relationship of left ventricular ejection fraction with Trop I (r=-0.290, p=0.000) and NT- proBNP (r=-0.388, p=0.000).\u0000Conclusion: In comparison to Troponin I, NT-proBNP serves as a better marker to predict LVEF in patients presenting with first STEMI.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43482678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Study conducted for Gouty arthritis at Pan Pakistan level in 2017 showed mean Uric Acid levels of 6.11±1.7mg/dl with frequency of hyperuricemia of 39% and having 27.9% male and 49.35 women respectively.1 This type of arthritis results from monosodium urate crystal deposition in and around the joints affecting big toe around the joints of hands and feet. Gout has been shown to increase with age and associated with diabetes & hypertension.2,3 It has also been shown that hyperuricemia may be tied to increased risk of cardiovascular disease mortality.4 Hyperuricemia has also shown to increase atherosclerosis by systemic inflammation and oxidative stress. It also causes endothelial dysfunction and oxidation of lipoproteins with formation of atherosclerotic plaques.5 Recent studies have shown hypertension, coronary artery disease, cardiovascular diseases, vascular dementia and preclampsia to be associated with high uric acid levels. The studies include Rotterdam (Serum Uric Acid Level and Myocardial infraction),2 PUMA study (Serum Uric Acid levels with cardiovascular events and deaths in hypertensive patients),6 PAMELA study (increased risk of cardiovascular deaths with increase of every 1mg /dl).4 Three important co-relation i.e. Hyperuricemia, atherosclerosis and heart failure need bit of understanding. In one study elevated uric acid levels (75.5mg/dl) in 90% of adolescents with essential hypertension7 and lower uric acid levels in teens with either white coat or secondary hypertension.7 Secondly association between increased uric acid levels and coronary artery calcification has shown an independent risk factor for subclinical atherosclerosis in young adults.8 Similar association was also seen in atherosclerotic vulnerable carotid plaque.9 Thirdly in cardiovascular health study incidence of heart failure was 21% with Chronic hyperuricemia and 18% without.10 For management of hyperuricemia (gout) multidisciplinary approach involving primary care physicians, rheumatologist and cardiologists might improve associated cardiovascular diseases other than primary pathology. Drugs like non-steroidal anti-inflammatory drug (NSAIDS), steroids & colchicine may improve Gout but improvement in cardiovascular comorbids are questionable.11,12 Though different epidemiological studies have shown hyperuricemia as an independent risk factor for cardiovascular diseases and hypertension. Further studies are needed that my elucidate association of increased uric acid level with cardiovascular diseases. Multidisciplinary approach, awareness and counselling patient will hopefully prevent onset of heart disease and improve survival outcomes for gouty patients. References Raja S, Kumar A, Aahooja RD, Thakuria U, Ochani S, Shaukat F. Frequency of Hyperuricemia and its Risk Factors in the Adult Population. Cureus. 2019;11(3):e4198. Grassi D, Ferri L, Desideri G, Di Giosia P, Cheli P, Del Pinto R, et al. Chronic hyperuricemia, uric acid deposit and cardiovascular risk. Curr
2017年在Pan巴基斯坦进行的痛风性关节炎研究显示，平均尿酸水平为6.11±1.7mg/dl，高尿酸血症发生率为39%，男性占27.9%，女性占49.35%。这种类型的关节炎是由关节内和周围的尿酸钠晶体沉积引起的，影响手和脚关节周围的大脚趾。痛风已被证明随着年龄的增长而增加，并与糖尿病和高血压有关。2,3也有研究表明，高尿酸血症可能与心血管疾病死亡风险增加有关。高尿酸血症也通过全身炎症和氧化应激增加动脉粥样硬化。它还引起内皮功能障碍和脂蛋白氧化，形成动脉粥样硬化斑块。最近的研究表明，高血压、冠状动脉疾病、心血管疾病、血管性痴呆和先兆子痫与高尿酸水平有关。这些研究包括鹿特丹研究(血清尿酸水平和心肌梗死)，2项PUMA研究(血清尿酸水平与高血压患者心血管事件和死亡的关系)，6项PAMELA研究(每增加1mg /dl心血管死亡风险增加)。高尿酸血症、动脉粥样硬化和心力衰竭三个重要的相互关系需要了解。在一项研究中，90%患有原发性高血压的青少年尿酸水平升高(75.5mg/dl)，而患有白大褂或继发性高血压的青少年尿酸水平较低其次，尿酸水平升高与冠状动脉钙化之间的关联已显示为年轻人亚临床动脉粥样硬化的独立危险因素类似的关联也见于动脉粥样硬化性颈动脉易损斑块第三，在心血管健康研究中，慢性高尿酸血症患者的心力衰竭发生率为21%，非慢性高尿酸血症患者为18%。对于高尿酸血症(痛风)的治疗，包括初级保健医生、风湿病学家和心脏病学家在内的多学科方法可能改善相关的心血管疾病，而不是原发性病理。非甾体抗炎药(NSAIDS)、类固醇和秋水仙碱等药物可能改善痛风，但对心血管合并症的改善尚存疑问。11,12尽管不同的流行病学研究表明高尿酸血症是心血管疾病和高血压的独立危险因素。尿酸水平升高与心血管疾病的关系有待进一步研究。多学科的方法，意识和咨询患者有望预防心脏病的发作和改善生存结果痛风患者。参考文献raja S, Kumar A, Aahooja RD, Thakuria U, Ochani S, Shaukat F.成人高尿酸血症发生率及其危险因素。Cureus。2019;11 (3):e4198。格拉西D, Ferri L, Desideri G, Di Giosia P, Cheli P, Del Pinto R，等。慢性高尿酸血症、尿酸沉积与心血管风险。中国医药杂志，2013;19(13):2432-8。痛风患者高尿酸血症的治疗:当前的治疗选择，最新发展和临床意义。中华肌肉骨骼杂志，2016;8(4):145-59。刘建军，刘建军，刘建军，等。尿酸与心血管疾病的关系研究进展。中华心血管病杂志，2016;11(1):54-9。Hayden MR, Tyagi SC.尿酸:对心血管疾病、代谢综合征和2型糖尿病的旧危险标志物的新认识:尿酸氧化还原穿梭。中华医学杂志，2004;1(1):1-5。王晓明，王晓明，王晓明。高尿酸血症与心血管疾病的关系。Cureus。2021;13 (5):e14855。李飞，姜德华，李荣杰。尿酸和心血管风险中华医学杂志，2008;32(3):391 - 391。Krishnan E, Pandya BJ, Chung L, Dabbous O.高尿酸血症与亚临床冠状动脉粥样硬化的风险——来自前瞻性观察队列研究的数据。中华关节炎杂志，2011;13(2):1-8。李强，周勇，董凯，王安，杨霞，张超，等。血清尿酸水平与易损动脉粥样硬化性颈动脉斑块患病率之间的关系:一项横断面研究。科学通报，2015;5(1):10003。Kuwabara M, Niwa K, Nishi Y, Mizuno A, Asano T, Masuda K，等。未接受高尿酸血症和高血压治疗的日本人血清尿酸水平与高血压的关系医学进展，2014;37(8):785-9。刘建军，刘建军，刘建军，等。风湿性关节炎与痛风的相关性研究。中华风湿病杂志，2013;3(1):558 -70。Kajikawa M, Higashi Y, Tomiyama H, Maruhashi T, Kurisu S, Kihara Y, Mutoh A, Ueda SI。秋水仙碱短期治疗对冠心病患者内皮功能的影响。中华心血管病杂志，2019;28(1):39 - 39。
{"title":"Can We Take Hyperuricemia as a Cardiovascular Risk?","authors":"T. Ashraf, Raffat Sultana","doi":"10.47144/phj.v56i1.2537","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2537","url":null,"abstract":"Study conducted for Gouty arthritis at Pan Pakistan level in 2017 showed mean Uric Acid levels of 6.11±1.7mg/dl with frequency of hyperuricemia of 39% and having 27.9% male and 49.35 women respectively.1\u0000This type of arthritis results from monosodium urate crystal deposition in and around the joints affecting big toe around the joints of hands and feet. Gout has been shown to increase with age and associated with diabetes & hypertension.2,3 It has also been shown that hyperuricemia may be tied to increased risk of cardiovascular disease mortality.4\u0000Hyperuricemia has also shown to increase atherosclerosis by systemic inflammation and oxidative stress. It also causes endothelial dysfunction and oxidation of lipoproteins with formation of atherosclerotic plaques.5\u0000Recent studies have shown hypertension, coronary artery disease, cardiovascular diseases, vascular dementia and preclampsia to be associated with high uric acid levels. The studies include Rotterdam (Serum Uric Acid Level and Myocardial infraction),2 PUMA study (Serum Uric Acid levels with cardiovascular events and deaths in hypertensive patients),6 PAMELA study (increased risk of cardiovascular deaths with increase of every 1mg /dl).4\u0000Three important co-relation i.e. Hyperuricemia, atherosclerosis and heart failure need bit of understanding. In one study elevated uric acid levels (75.5mg/dl) in 90% of adolescents with essential hypertension7 and lower uric acid levels in teens with either white coat or secondary hypertension.7 Secondly association between increased uric acid levels and coronary artery calcification has shown an independent risk factor for subclinical atherosclerosis in young adults.8 Similar association was also seen in atherosclerotic vulnerable carotid plaque.9 Thirdly in cardiovascular health study incidence of heart failure was 21% with Chronic hyperuricemia and 18% without.10\u0000For management of hyperuricemia (gout) multidisciplinary approach involving primary care physicians, rheumatologist and cardiologists might improve associated cardiovascular diseases other than primary pathology.\u0000Drugs like non-steroidal anti-inflammatory drug (NSAIDS), steroids & colchicine may improve Gout but improvement in cardiovascular comorbids are questionable.11,12\u0000Though different epidemiological studies have shown hyperuricemia as an independent risk factor for cardiovascular diseases and hypertension. Further studies are needed that my elucidate association of increased uric acid level with cardiovascular diseases. Multidisciplinary approach, awareness and counselling patient will hopefully prevent onset of heart disease and improve survival outcomes for gouty patients.\u0000References\u0000\u0000Raja S, Kumar A, Aahooja RD, Thakuria U, Ochani S, Shaukat F. Frequency of Hyperuricemia and its Risk Factors in the Adult Population. Cureus. 2019;11(3):e4198.\u0000Grassi D, Ferri L, Desideri G, Di Giosia P, Cheli P, Del Pinto R, et al. Chronic hyperuricemia, uric acid deposit and cardiovascular risk. Curr ","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48610387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Rai, Rajesh Kumar, S. Raza, M. Batra, Zafar Iqbal Mandokhail, Haroon Ishaque, Muhammad Ishtiaq Ali, Abdul Basit, M. Siddiqui, Kubbra Rahooja, Maryam Samad, Fawad Farooq, Z. Rehman, T. Saghir, J. Sial
Objectives: Objective of this study was to assess the difference in terms of presentation and in-hospital course between patients with right vs. left dominant arterial circulation undergoing “primary percutaneous coronary intervention (PCI)” for culprit proximal left anterior descending artery (LAD). Methodology: We included consecutive adult (≥18 years) patients diagnosed with STE-ACS undergoing primary PCI for culprit proximal LAD. Patients were categorized into right vs. left dominant circulation on left heart catheterization. Demographic, clinical characteristics, presentation, and hospital course were compared between the matched (propensity matched) and unmatched cohort of patients with right vs. left dominance. Results: We included 775 patients, out of which 81.3% (630) were males and mean age was 54.59 ± 11.3 years. On coronary angiogram left dominance was observed in 14.3% (111). Single vessel disease was higher with left compared to right dominant system, 53.2% vs. 43.5%, respectively. The rate of slow flow/no-reflow (15.4% vs. 7.2%; p=0.0.230), heart failure (9.3% vs. 6.3%; p=0.299), and in-hospital mortality (5.1% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively. In the matched cohorts, the frequency of slow flow/no-reflow (15.3% vs. 7.2%; p=0.056), heart failure (6.3% vs. 6.3%; p>0.999), and mortality (5.4% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively. Conclusion: No significant increase in complications and outcomes is witnessed among patients with left dominant arterial circulation undergoing primary PCI for culprit proximal LAD. However, careful handling of left main during intervention is warranted due lack of support from right system.
目的:本研究的目的是评估右主动脉循环与左主动脉循环患者在主因左前降支(LAD)近端行“经皮冠状动脉介入治疗(PCI)”时的表现和住院过程的差异。方法:我们纳入了连续诊断为STE-ACS的成人(≥18岁)患者，他们接受了原发性PCI治疗罪魁祸首近端LAD。患者在左心导管时被分为右主导循环和左主导循环。在匹配(倾向匹配)和不匹配的左、右优势患者队列之间比较人口统计学、临床特征、表现和住院过程。结果:纳入775例患者，其中男性630例(81.3%)，平均年龄54.59±11.3岁。冠状动脉造影显示左侧优势占14.3%(111)。左侧单支血管病变高于右侧优势系统，分别为53.2%和43.5%。慢流/无回流率(15.4% vs. 7.2%;P =0.0.230)，心力衰竭(9.3% vs. 6.3%;P =0.299)，住院死亡率(5.1% vs. 3.6%， P =0.493)在左、右两种方式下均无差异。在匹配的队列中，慢流/无回流的频率(15.3% vs. 7.2%;P =0.056)，心力衰竭(6.3% vs. 6.3%;P >0.999)，死亡率(5.4% vs. 3.6%， P =0.493)右、左优势组无差异。结论:左主动脉循环患者行原发性PCI治疗罪魁祸首近端LAD的并发症和预后无明显增加。然而，由于缺乏右侧系统的支持，在干预期间小心处理左主干是有必要的。
{"title":"Effect of Coronary Artery Dominance In-terms of Presentation and In-hospital Outcomes of patients undergoing Primary PCI for Culprit Proximal Left Anterior Descending Artery","authors":"L. Rai, Rajesh Kumar, S. Raza, M. Batra, Zafar Iqbal Mandokhail, Haroon Ishaque, Muhammad Ishtiaq Ali, Abdul Basit, M. Siddiqui, Kubbra Rahooja, Maryam Samad, Fawad Farooq, Z. Rehman, T. Saghir, J. Sial","doi":"10.47144/phj.v56i1.2460","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2460","url":null,"abstract":"Objectives: Objective of this study was to assess the difference in terms of presentation and in-hospital course between patients with right vs. left dominant arterial circulation undergoing “primary percutaneous coronary intervention (PCI)” for culprit proximal left anterior descending artery (LAD).\u0000Methodology: We included consecutive adult (≥18 years) patients diagnosed with STE-ACS undergoing primary PCI for culprit proximal LAD. Patients were categorized into right vs. left dominant circulation on left heart catheterization. Demographic, clinical characteristics, presentation, and hospital course were compared between the matched (propensity matched) and unmatched cohort of patients with right vs. left dominance.\u0000Results: We included 775 patients, out of which 81.3% (630) were males and mean age was 54.59 ± 11.3 years. On coronary angiogram left dominance was observed in 14.3% (111). Single vessel disease was higher with left compared to right dominant system, 53.2% vs. 43.5%, respectively. The rate of slow flow/no-reflow (15.4% vs. 7.2%; p=0.0.230), heart failure (9.3% vs. 6.3%; p=0.299), and in-hospital mortality (5.1% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively. In the matched cohorts, the frequency of slow flow/no-reflow (15.3% vs. 7.2%; p=0.056), heart failure (6.3% vs. 6.3%; p>0.999), and mortality (5.4% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively.\u0000Conclusion: No significant increase in complications and outcomes is witnessed among patients with left dominant arterial circulation undergoing primary PCI for culprit proximal LAD. However, careful handling of left main during intervention is warranted due lack of support from right system.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48943743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vashu Mal, Rameez Ahmed, A. Asad, M. Batra, A. Ammar, Rajesh Kumar, Abdul Hakeem, N. Khan, J. Sial, T. Saghir
Objectives: To determine the frequency of pre-hospital aspirin use in patients presenting with ST- segment elevation myocardial infarction and to assess the demographic and clinical characteristics of the patients taken pre-hospital aspirin. Methodology: It was a prospective study conducted at tertiary care hospital for the duration of six months. About 657 patients aged between 18-80 years, of either gender and diagnosed with ST-elevation myocardial infraction were included in the study. Use of pre-hospital aspirin after symptoms was assessed in all patients, then followed and outcomes such as discharge status and length of hospital in days were evaluated. Results: Overall mean age was 54.60±12.06 years and most of them were males (79.1%). About 254 patients (38.7%) received aspirin before transfer to hospital and 403 patients (61.3%) received aspirin after arrival in hospital. Frequency of pre-hospital use of aspirin was significantly associated with gender (p=0.001), educational status (p=0.006), and monthly income (p=0.003). The mean rank of length of hospital stay was similar significantly lower in STEMI patients who received pre-hospital aspirin as compared to those who did not receive pre-hospital aspirin (p=0.001). Moreover, the death rate was lower in patients with pre-hospital aspirin administration as compared to those who did not receive pre-hospital aspirin (1.2%vs2%). However, the difference between pre-hospital aspirin use and discharge status was not statistically significant (p=0.434). Conclusion: Frequency of pre-hospital aspirin use was lower in patients with STEMI. Gender, educational status, and socio-economic status were the significant factors for pre-hospital aspirin use.
{"title":"Early Use of Aspirin after Symptoms in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention","authors":"Vashu Mal, Rameez Ahmed, A. Asad, M. Batra, A. Ammar, Rajesh Kumar, Abdul Hakeem, N. Khan, J. Sial, T. Saghir","doi":"10.47144/phj.v56i1.2393","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2393","url":null,"abstract":"Objectives: To determine the frequency of pre-hospital aspirin use in patients presenting with ST- segment elevation myocardial infarction and to assess the demographic and clinical characteristics of the patients taken pre-hospital aspirin.\u0000Methodology: It was a prospective study conducted at tertiary care hospital for the duration of six months. About 657 patients aged between 18-80 years, of either gender and diagnosed with ST-elevation myocardial infraction were included in the study. Use of pre-hospital aspirin after symptoms was assessed in all patients, then followed and outcomes such as discharge status and length of hospital in days were evaluated.\u0000Results: Overall mean age was 54.60±12.06 years and most of them were males (79.1%). About 254 patients (38.7%) received aspirin before transfer to hospital and 403 patients (61.3%) received aspirin after arrival in hospital. Frequency of pre-hospital use of aspirin was significantly associated with gender (p=0.001), educational status (p=0.006), and monthly income (p=0.003). The mean rank of length of hospital stay was similar significantly lower in STEMI patients who received pre-hospital aspirin as compared to those who did not receive pre-hospital aspirin (p=0.001). Moreover, the death rate was lower in patients with pre-hospital aspirin administration as compared to those who did not receive pre-hospital aspirin (1.2%vs2%). However, the difference between pre-hospital aspirin use and discharge status was not statistically significant (p=0.434).\u0000Conclusion: Frequency of pre-hospital aspirin use was lower in patients with STEMI. Gender, educational status, and socio-economic status were the significant factors for pre-hospital aspirin use.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47553150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Kiani, Waheed Ashraf, M. Khan, A. Chaudhry, N. Azad, Waheed Ul Rehman, A. Zafar
Objectives: We investigated the correlation between baseline C-reactive protein (Hs-CRP) levels and severity of coronary artery disease (CAD), measured in terms of Syntax Score (SScore), among patients presenting with acute coronary syndromes (ACS). Methodology: This cross-sectional study was conducted at the Armed Forces Institute of Cardiology (AFIC), Rawalpindi, from April 2022 to October 2022. Baseline Hs-CRP levels were obtained for all the patients. Patients were divided into three groups as per the SScore as low (≤ 22), intermediate (≥ 23), and high (≥ 33) burden of CAD. Results: Out of the 200 patients studied, 82.5% (165) were males, and mean age was 60.16±10.66 years. Diabetics were 50% (100) of the sample, 48.5% (97) were hypertensive, and smokers were 17.5% (35). Median Hs-CRP was 4.0 mg/L [2.0-12.5 mg/L], and median left ventricular ejection fraction (LVEF) was 45% [40-55%]. Median SScore was 23.5 [14.5-30.0], with 44.5% (89) categorized as low, 36.5% (73) as intermediate, and 19% (38) as high burden of CAD. The correlation between Hs-CRP and SScore was 0.236 (p=0.001) and -0.229 (p=0.001) with LVEF. A significant increase in Hs-CRP was observed in relation to the burden of CAD (p<0.001) with median of 2.0 mg/L [1.0-4.2 mg/L], 6.0 mg/L [3.1-15.7 mg/L], and 12.5 mg/L [5.8-20.7 mg/L] for low, intermediate, high burden of CAD, respectively. Conclusion: Admission Hs-CRP was found to be positively correlated with the burden of CAD and negatively correlated with LVEF in patients with ACS.
{"title":"The Role of High-sensitive C-Reactive Protein in predicting Severity of Coronary Artery Disease in Patients with Acute Coronary Syndromes","authors":"S. Kiani, Waheed Ashraf, M. Khan, A. Chaudhry, N. Azad, Waheed Ul Rehman, A. Zafar","doi":"10.47144/phj.v56i1.2468","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2468","url":null,"abstract":"Objectives: We investigated the correlation between baseline C-reactive protein (Hs-CRP) levels and severity of coronary artery disease (CAD), measured in terms of Syntax Score (SScore), among patients presenting with acute coronary syndromes (ACS).\u0000Methodology: This cross-sectional study was conducted at the Armed Forces Institute of Cardiology (AFIC), Rawalpindi, from April 2022 to October 2022. Baseline Hs-CRP levels were obtained for all the patients. Patients were divided into three groups as per the SScore as low (≤ 22), intermediate (≥ 23), and high (≥ 33) burden of CAD.\u0000Results: Out of the 200 patients studied, 82.5% (165) were males, and mean age was 60.16±10.66 years. Diabetics were 50% (100) of the sample, 48.5% (97) were hypertensive, and smokers were 17.5% (35). Median Hs-CRP was 4.0 mg/L [2.0-12.5 mg/L], and median left ventricular ejection fraction (LVEF) was 45% [40-55%]. Median SScore was 23.5 [14.5-30.0], with 44.5% (89) categorized as low, 36.5% (73) as intermediate, and 19% (38) as high burden of CAD. The correlation between Hs-CRP and SScore was 0.236 (p=0.001) and -0.229 (p=0.001) with LVEF. A significant increase in Hs-CRP was observed in relation to the burden of CAD (p<0.001) with median of 2.0 mg/L [1.0-4.2 mg/L], 6.0 mg/L [3.1-15.7 mg/L], and 12.5 mg/L [5.8-20.7 mg/L] for low, intermediate, high burden of CAD, respectively.\u0000Conclusion: Admission Hs-CRP was found to be positively correlated with the burden of CAD and negatively correlated with LVEF in patients with ACS.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46631108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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