Circulation: Cardiovascular Imaging最新文献

{"title":"Utility of ¹⁸F-Flurpiridaz PET Relative Flow Reserve in Differentiating Obstructive From Nonobstructive Coronary Artery Disease.","authors":"Diana M Lopez, Dan Huck, Sanjay Divakaran, Jenifer M Brown, Brittany Weber, Mark Lemley, Valerie Builoff, Aakash Shanbhag, Zhou Lan, Christopher Buckley, Mouaz H Al-Mallah, Sharmila Dorbala, Ron Blankstein, Piotr Slomka, Marcelo F Di Carli","doi":"10.1161/CIRCIMAGING.125.018323","DOIUrl":"10.1161/CIRCIMAGING.125.018323","url":null,"abstract":"<p><strong>Background: </strong>Absolute quantification of myocardial blood flow (MBF) on positron emission tomography perfusion imaging improves the identification of coronary artery disease (CAD). However, distinguishing MBF impairment due to obstructive CAD from nonobstructive CAD remains challenging. We aimed to evaluate the incremental diagnostic value of positron emission tomography derived relative flow reserve (RFR) in the diagnosis of obstructive CAD.</p><p><strong>Methods: </strong>This is a post hoc analysis of the multicenter phase III trial of ¹⁸F-flurpiridaz positron emission tomography. Patients with available MBF quantification were included. Reduced stress MBF (sMBF) was defined as sMBF below the median (2.2 mL/min per gram). Obstructive CAD on quantitative invasive coronary angiography was defined as ≥70% stenosis. RFR was calculated as a ratio of the minimal segment sMBF over the highest reference vascular territory sMBF. RFR performance for predicting obstructive CAD was evaluated through receiver operating characteristic analysis and the net reclassification index of multivariable regression models.</p><p><strong>Results: </strong>The study included 231 patients (71% male; 56% with established CAD) drawn from the original cohort of 755 trial participants. No patients had 3-vessel CAD. In a per-vessel-based analysis, 82% of vessels with reduced sMBF had no obstructive CAD on invasive coronary angiography. RFR was significantly lower for vessels with obstructive CAD (0.55 versus 0.80; <i>P</i><0.0001). In vessels with reduced sMBF, RFR was independently associated with obstructive CAD even after accounting for stress total perfusion deficit and MFR (odds ratio, 3.08 [95% CI, 1.49-6.38]; <i>P</i>=0.002). Although the addition of RFR did not significantly improve discrimination (area under the curve, 0.806 versus 0.822; <i>P</i>=0.11), it significantly improved reclassification of vessels with and without obstructive CAD (net reclassification index, 0.93; obstructive CAD net reclassification index, 0.44; nonobstructive CAD net reclassification index, 0.49; <i>P</i><0.0001).</p><p><strong>Conclusions: </strong>RFR provides complementary diagnostic information beyond existing positron emission tomography parameters and may help refine the diagnosis of obstructive CAD in patients with reduced flows.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01347710.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018323"},"PeriodicalIF":7.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in the Relationship Between Psychosocial Stress and Myocardial Tissue Characteristics: A CMR Imaging Study.","authors":"Mayssa Moukarzel, Kian Soroush, Yixing Zhang, Jean-Philippe Gouin, Matthias G Friedrich, Judy M Luu","doi":"10.1161/CIRCIMAGING.124.017667","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.124.017667","url":null,"abstract":"<p><strong>Background: </strong>Psychosocial stress is linked to the development of cardiovascular disease, with a more pronounced impact in female participants. This study investigates sex differences in the association between perceived stress and myocardial tissue characteristics, as assessed by cardiovascular magnetic resonance imaging, and evaluates the contribution of psychosocial burden, including caregiving and perceived social standing.</p><p><strong>Methods: </strong>This study included 219 participants (53.9% females; mean age, 54.4±11.0 years) without overt cardiovascular disease, drawn from a prospective repository. Participants completed the perceived stress scale and cardiovascular magnetic resonance with native T1 and T2 mappings. Psychosocial variables included family caregiving responsibilities and perceived emotional support. The study investigated associations between perceived stress scale scores, and native T1 and T2 mapping sequences and assessed sex differences and psychosocial burden.</p><p><strong>Results: </strong>High-stress female participants had significantly longer T1 times than low-stress female participants in both healthy and at-risk groups and longer T2 times in the at-risk group. No significant differences were observed in male participants. Perceived stress scale scores significantly predicted T1 values in female participants (95% CI, 0.088-3.517; <i>P</i>=0.040) but not in male participants (94% CI, -0.687 to 2.139; <i>P</i>=0.310). In multivariable analysis, caregiving burden and perceived emotional support were independent predictors of T1 in female participants (<i>P</i>=0.009 and <i>P</i>=0.035, respectively) but not in male participants.</p><p><strong>Conclusions: </strong>Psychosocial stress was associated with early subclinical myocardial changes in female participants but not in male participants, suggesting sex-specific pathways linking stress to early myocardial remodeling. These findings support the integration of psychosocial factors into cardiovascular risk assessment for female individuals.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e017667"},"PeriodicalIF":7.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Ventricular Hinge Point LGE Is Highly Prevalent And Sex-Dependent In ELITE Athletes.","authors":"Sjoerd M Verwijs, Juliette C Van Hattum, Joëlle Jn Daems, S Matthijs Boekholdt, R Nils Planken, Maarten Groenink, Adrienne van Randen, Raschel D van Luijk, Jules L Nelissen, Maarten H Moen, Birgitta K Velthuis, Yigal M Pinto, Arthur Am Wilde, Niek Hj Prakken, Harald T Jørstad","doi":"10.1161/CIRCIMAGING.124.017765","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.124.017765","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reverse Remodeling Following Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy: As Transformed as Otto's Heart?","authors":"Lan Shen, Timothy C Wong","doi":"10.1161/CIRCIMAGING.125.018959","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.125.018959","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018959"},"PeriodicalIF":7.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Extracellular Volume Fraction on Coronary CTA in Patients With Coronary Microvascular Dysfunction.","authors":"Kodai Sayama, Yoshihisa Kanaji, Eisuke Usui, Masahiro Hada, Tatsuhiro Nagamine, Hiroki Ueno, Kai Nogami, Mirei Setoguchi, Tomohiro Tahara, Hikaru Shimosato, Takahiro Watanabe, Tatsuya Sakamoto, Rika Sai, Takashi Mineo, Nobutaka Wakasa, Masahiro Hoshino, Tomoyo Sugiyama, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta","doi":"10.1161/CIRCIMAGING.125.018368","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.125.018368","url":null,"abstract":"<p><strong>Background: </strong>Coronary computed tomography angiography (CCTA) could evaluate myocardial fibrosis as well by estimating extracellular volume fraction (ECV). While coronary microvascular dysfunction (CMD) has been increasingly recognized as an important pathophysiological mechanism underlying chest pain, the association between CMD in angina with nonobstructive coronary artery disease (ANOCA) and CCTA-derived ECV remains to be elucidated. We sought to evaluate the association between CCTA-derived ECV and CMD in patients with ANOCA.</p><p><strong>Methods: </strong>We retrospectively analyzed 57 patients with ANOCA from a single center who underwent CCTA on ECV protocol with subtraction method (including precontrast and 7-minute delayed postcontrast) and invasive functional testing using pressure-temperature sensor-tipped wire. Patients with significant epicardial stenosis (fractional flow reserve ≤0.80 or stenosis on computed tomography ≥50%), prior history of revascularization, known myocardial infarction, or heart failure were excluded. CMD was defined as a coronary flow reserve of <2.5 in any of the vessels evaluated. Standard transthoracic echocardiography assessed diastolic dysfunction (DD).</p><p><strong>Results: </strong>Among the 57 patients included, 26 (45.6%) were diagnosed with CMD. CMD was significantly associated with age, NT-proBNP (N-terminal pro-B-type natriuretic peptide) level, calcium score, DD, and higher ECV. In a multivariable logistic regression analysis, a CCTA-derived ECV >31.9% (the optimal cutoff value derived from receiver operating characteristic curve analysis) was independently associated with CMD (odds ratio, 10.50 [95% CI, 2.34-47.40]; <i>P</i>=0.002). DD also emerged as an independent predictor (odds ratio, 17.90 [95% CI, 2.53-127.00]; <i>P</i>=0.004). The addition of elevated ECV to a clinical model including DD significantly enhanced the discrimination efficacy for CMD (area under the receiver operating characteristic curve, 0.742 versus 0.854; <i>P</i>=0.019).</p><p><strong>Conclusions: </strong>In patients with ANOCA with CMD, ECV was significantly elevated, alongside a higher prevalence of DD. These findings suggest that ECV and DD may serve as pivotal markers for personalized management strategies in patients with CMD with ANOCA disease.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018368"},"PeriodicalIF":7.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fully Automated Artificial Intelligence-Based Global Longitudinal and Circumferential Strain for Prediction of Cardiovascular Events: Unleash the Power of Stress CMR.","authors":"Bo Xu, Mohammad Al Zein","doi":"10.1161/CIRCIMAGING.125.019010","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.125.019010","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e019010"},"PeriodicalIF":7.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attenuating Postinfarction Left Ventricular Remodeling: New Mechanisms, Old Challenges.","authors":"Louai Razzouk, Sunil V Rao","doi":"10.1161/CIRCIMAGING.125.018960","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.125.018960","url":null,"abstract":"","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018960"},"PeriodicalIF":7.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intramyocardial Hydrogel Delivery Decreases Left Ventricular Remodeling and Increases Angiogenesis Post Myocardial Infarction.","authors":"Inga H Melvinsdottir, Dan Midgett, Shin Rong Lee, Stephanie L Thorn, Selen Uman, Ricardo Avendano, Taras Lysyy, Fatema Tuj Zohora, Kevin Chen, Marina Mamarian, James S Duncan, Francis G Spinale, Jason A Burdick, Albert J Sinusas","doi":"10.1161/CIRCIMAGING.125.018357","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.125.018357","url":null,"abstract":"<p><strong>Background: </strong>Intramyocardial injection of hydrogel into myocardial infarction (MI) areas can reduce left ventricular remodeling and potentially increase angiogenesis post-MI. The radiotracer ^99mTc-Maraciclatide binds to activated αvβ3-integrin, a key factor in angiogenesis, and can be used to evaluate myocardial angiogenesis. This study used multimodality imaging to assess the effects of imageable intramyocardial hydrogel delivery on left ventricular remodeling and angiogenesis after MI.</p><p><strong>Methods: </strong>Fourteen pigs (N=14) underwent 90 minutes of balloon occlusion and reperfusion. Five days post-MI, they were randomized to receive either intramyocardial hydrogel (n=8) or control saline injections (n=6). Contrast cine-computed tomography was used to assess biomechanical changes before and after treatment (day 1, day 5, and day 12). ^99mTc-Maraciclatide uptake was measured with gamma well counting. Scar burden and angiogenesis were evaluated through histology.</p><p><strong>Results: </strong>Both groups initially showed a decrease in ejection fraction and an increase in end-diastolic volume post-MI. Hydrogel delivery on day 5 led to a reduction in end-diastolic volume and improvement in left ventricular ejection fraction by day 12. The hydrogel group also exhibited decreased compensatory radial strain in remote myocardial segments, but decreased strain in the hydrogel myocardial segments. There was increased uptake of ^99mTc-maraciclatide in the infarct segments after hydrogel delivery, associated with increased αvβ3-integrin and factor VIII expression in the hydrogel treatment group on histology. However, there was no difference in regional inflammation or scar size between the groups.</p><p><strong>Conclusions: </strong>Intramyocardial delivery of hydrogel early post-MI resulted in decreased left ventricular remodeling and increased αvβ3-integrin activation associated with an increase in angiogenesis.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018357"},"PeriodicalIF":7.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Led Whole Coronary Artery OCT Analysis; Validation and Identification of Drug Efficacy and Higher-Risk Plaques.","authors":"Benn Jessney, Xu Chen, Sophie Gu, Yuan Huang, Martin Goddard, Adam Brown, Daniel Obaid, Michael Mahmoudi, Hector M Garcia Garcia, Stephen P Hoole, Lorenz Räber, Francesco Prati, Carola-Bibiane Schönlieb, Michael Roberts, Martin Bennett","doi":"10.1161/CIRCIMAGING.125.018133","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.125.018133","url":null,"abstract":"<p><strong>Background: </strong>Intracoronary optical coherence tomography (OCT) can identify changes following drug/device treatment and high-risk plaques, but analysis requires expert clinician or core laboratory interpretation, while artifacts and limited sampling markedly impair reproducibility. Assistive technologies such as artificial intelligence-based analysis may therefore aid both detailed OCT interpretation and patient management. We determined if artificial intelligence-based OCT analysis (AutoOCT) can rapidly process, optimize and analyze OCT images, and identify plaque composition changes that predict drug success/failure and high-risk plaques.</p><p><strong>Methods: </strong>AutoOCT deep learning artificial intelligence modules were designed to correct segmentation errors from poor-quality or artifact-containing OCT images, identify tissue/plaque composition, classify plaque types, measure multiple parameters including lumen area, lipid and calcium arcs, and fibrous cap thickness, and output segmented images and clinically useful parameters. Model development used 36 212 frames (127 whole pullbacks, 106 patients). Internal validation of tissue and plaque classification and measurements used ex vivo OCT pullbacks from autopsy arteries, while external validation for plaque stabilization and identifying high-risk plaques used core laboratory analysis of IBIS-4 (Integrated Biomarkers and Imaging Study-4) high-intensity statin (83 patients) and CLIMA (Relationship Between Coronary Plaque Morphology of Left Anterior Descending Artery and Long-Term Clinical Outcome Study; 62 patients) studies, respectively.</p><p><strong>Results: </strong>AutoOCT recovered images containing common artifacts with measurements and tissue and plaque classification accuracy of 83% versus histology, equivalent to expert clinician readers. AutoOCT replicated core laboratory plaque composition changes after high-intensity statin, including reduced lesion lipid arc (13.3° versus 12.5°) and increased minimum fibrous cap thickness (18.9 µm versus 24.4 µm). AutoOCT also identified high-risk plaque features leading to patient events including minimal lumen area <3.5 mm², Lipid arc >180°, and fibrous cap thickness <75 µm, similar to the CLIMA core laboratory.</p><p><strong>Conclusions: </strong>AutoOCT-based analysis of whole coronary artery OCT identifies tissue and plaque types and measures features correlating with plaque stabilization and high-risk plaques. Artificial intelligence-based OCT analysis may augment clinician or core laboratory analysis of intracoronary OCT images for trials of drug/device efficacy and identifying high-risk lesions.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018133"},"PeriodicalIF":7.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial Entropy and Risk Predictors in Hypertrophic Cardiomyopathy: An Analysis From the NHLBI HCM Registry.","authors":"Panagiotis Antiochos, Yin Ge, Michael Jerosch-Herold, Louis-Philippe David, Bobak Heydari, Paul Kolm, Dong-Yun Kim, Rob J van der Geest, Hugh Watkins, Milind Y Desai, Carolyn Y Ho, Sarahfaye F Dolman, Patrice Desvigne-Nickens, Martin S Maron, Jeanette Schulz-Menger, Stefan K Piechnik, Evan Appelbaum, William S Weintraub, Stefan Neubauer, Christopher M Kramer, Raymond Y Kwong","doi":"10.1161/CIRCIMAGING.125.018031","DOIUrl":"https://doi.org/10.1161/CIRCIMAGING.125.018031","url":null,"abstract":"<p><strong>Background: </strong>Entropy, a novel measure of myocardial tissue heterogeneity by cardiovascular magnetic resonance imaging, may have clinical value in patients with hypertrophic cardiomyopathy (HCM). We aimed to investigate the associations of entropy with risk predictors in HCM, using the National Heart, Lung, and Blood Institute HCM Registry.</p><p><strong>Methods: </strong>Entropy values were calculated using the probability distribution of pixel signal intensities of the left ventricular (LV) myocardium on the late gadolinium enhancement (LGE) short-axis stack images. Entropy values were correlated with demographic, genetic, imaging, and serum biomarkers as well as ambulatory Holter recordings and the European Society of Cardiology risk score of sudden cardiac death at 5 years.</p><p><strong>Results: </strong>Among 1736 patients with HCM, LV entropy demonstrated significant associations with sarcomere mutations, history of ventricular tachycardia, atrial fibrillation, and elevation of cTnT (cardiac troponin T) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels (<i>P</i><0.001). Furthermore, LV entropy demonstrated an association with increased maximal LV wall thickness, LGE presence and extent, higher extracellular volume, left atrial area and function, myocardial strain (<i>P</i><0.001), and was positively correlated with higher values of the European Society of Cardiology risk score (<i>P</i><0.001). In the subgroup of patients without LGE (n=858), entropy values remained significantly associated with a history of ventricular tachycardia, increased maximal wall thickness, decreased myocardial strain, and the European Society of Cardiology risk score (<i>P</i><0.05 for all). In both the whole cohort and in patients without LGE, LV entropy was the strongest predictor of ventricular tachycardia on Holter.</p><p><strong>Conclusions: </strong>In patients with HCM, LV entropy demonstrated associations with clinical, imaging, and biological predictors of adverse outcomes independent of LGE presence and was the strongest predictor of ventricular tachycardia on Holter.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01915615.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018031"},"PeriodicalIF":7.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}