Heart最新文献

{"title":"Prevalence and predictors of extra-aortic aneurysms in Marfan syndrome.","authors":"Hussein Abdul Nabi, Luke Arnulfo Dreher, Hunter Vandolah, Hend Bcharah, George Bcharah, Christopher Kanaan, Ramzi Ibrahim, Mahmoud Abdelnabi, Linnea M Baudhuin, Yuxiang Wang, Hicham Z El Masry, Chadi Ayoub, Fadi E Shamoun","doi":"10.1136/heartjnl-2025-327408","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327408","url":null,"abstract":"<p><strong>Background: </strong>The prevalence and clinical correlates of extra-aortic vascular disease in Marfan syndrome remain incompletely defined, and current surveillance strategies primarily target the thoracic aorta.</p><p><strong>Methods: </strong>We conducted a multicentre retrospective cohort study of 783 patients with Marfan syndrome across three tertiary centres, with systematic chart and imaging adjudication to define aneurysm and dissection distribution.</p><p><strong>Results: </strong>Extra-aortic aneurysms were identified in 32% of patients, most commonly involving the iliac, carotid and subclavian arteries. Extra-aortic dissections occurred in 5.2%. Extra-aortic aneurysms clustered strongly with markers of advanced aortic disease, including abdominal aortic aneurysm (adjusted OR 3.48), prior aortic dissection (OR 3.39) and extra-aortic dissection (OR 4.44), as well as age >40 years and male sex. Genetic confirmation status was not associated with extra-aortic aneurysm presence.</p><p><strong>Conclusions: </strong>Extra-aortic vascular involvement is common in Marfan syndrome and closely linked to advanced aortic pathology. These findings support risk-stratified vascular imaging beyond the thoracic aorta in higher-risk patients.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856190","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}

{"title":"Methodological lessons of implementation trials in heart failure.","authors":"Rafael Gonzalez-Manzanares, Xavier Rossello","doi":"10.1136/heartjnl-2026-328160","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328160","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856187","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}

{"title":"Practical applicability of life expectancy and age in the decision to perform transcatheter or surgical aortic valve replacement.","authors":"Mateo Marin-Cuartas, Michael A Borger, Samuel Heuts","doi":"10.1136/heartjnl-2026-328214","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-328214","url":null,"abstract":"","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856196","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}

{"title":"Catheter ablation and risk of major adverse cardiovascular events in high-risk patients with newly diagnosed atrial fibrillation: a target trial emulation.","authors":"Chi-Che Ho, Kuan-Hung Lin, Chih-Cheng Lai, Wen-Wen Tsai, Kuan-Hsien Lu","doi":"10.1136/heartjnl-2025-327113","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327113","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is a common cardiac arrhythmia associated with an increased risk of stroke, heart failure and mortality. While catheter ablation is increasingly used for early rhythm control, evidence on its cardiovascular outcomes in high-risk individuals with newly diagnosed AF remains limited. This study aimed to evaluate the association between catheter ablation and the risk of major adverse cardiovascular events (MACE) in high-risk patients with newly diagnosed AF using a target trial emulation design.</p><p><strong>Methods: </strong>We used the TriNetX database to identify adults with newly diagnosed AF between 1 January 2015 and 30 April 2022. Patients with prior stroke, prior cardiovascular events or valvular heart disease were excluded. Patients were assigned to ablation or non-ablation cohorts. Propensity score matching (1:1) and a landmark design with 1-year follow-up starting on Day 366 were employed. The primary outcome was MACEs. Subgroup and 2-year sensitivity analyses were performed.</p><p><strong>Results: </strong>Among 263 329 eligible patients, 2018 (0.8%) underwent catheter ablation. After matching, each group included 2018 patients. Catheter ablation was associated with a lower risk of MACE (2.1% vs 5.0%; HR 0.420, 95% CI 0.294 to 0.600) and heart failure (HR 0.627, 95% CI 0.494 to 0.797). Findings were consistent in the sensitivity analysis and subgroup analyses.</p><p><strong>Conclusion: </strong>In this study, catheter ablation was associated with a lower risk of MACE and heart failure in high-risk patients with newly diagnosed AF. These findings should be interpreted in the context of the selected study population.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856150","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}

{"title":"Stent thrombosis: an updated clinical overview from epidemiology to classification and management.","authors":"Lucio Giuseppe Granata, Marcello Marchetta, Giulia Alagna, Simona Giubilato, Olimpia Trio, Giuseppe Ando'","doi":"10.1136/heartjnl-2026-327899","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-327899","url":null,"abstract":"<p><p>Coronary stent implantation has revolutionised percutaneous coronary intervention (PCI), preventing vessel closure and reducing restenosis. Nonetheless, the permanent presence of an intracoronary endoprosthesis introduces two intrinsic major limitations: restenosis and stent thrombosis (ST). Although ST incidence has declined with last-generation drug-eluting stents, improved implantation technique and antiplatelet regimens, it remains a catastrophic event, typically presenting as ST-elevation myocardial infarction or sudden cardiac death, with persistently high early and late mortality. Standardised definitions classify ST by diagnostic certainty and timing from implantation, reflecting distinct underlying mechanisms across intraprocedural, early, late and very late phases. Early ST is most often driven by correctable procedural and pharmacological determinants, including underexpansion and malapposition, high thrombotic burden in acute coronary syndromes and premature discontinuation or inadequate effect, of dual antiplatelet therapy (DAPT). Late and very late ST are frequently related to delayed healing with uncovered struts, late-acquired malapposition and intrastent neoatherosclerosis or may involve hypersensitivity to stent components or allergy to external factors (Kounis syndrome type III). Intravascular imaging, particularly optical coherence tomography, complemented by intravascular ultrasound, is pivotal to identify the dominant mechanism and guide targeted therapy. Acute management relies on rapid reperfusion with PCI, mechanical optimisation and potent antithrombotic strategies; drug-coated balloon angioplasty is emerging as a mechanistically attractive option in selected late presentations to avoid additional metal. Prevention relies on imaging-guided implantation, individualised DAPT and strict risk-factor control. This narrative review summarises current definitions, epidemiology, mechanisms, diagnostic pathways and contemporary therapeutic and preventive strategies, integrating recent consensus recommendations.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856193","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}

{"title":"Efficacy of computerised cognitive training in patients with coronary heart disease and mild cognitive impairment: a randomised controlled trial.","authors":"Qing Chen, Yi Ye, Xiaoping Liu, Yaodong Ding, Yueling Sun, Fangjiang Li, Hongsen Tian, Le Wang, Wei Zhao, Xinhui Ning, Shiyi Li, Xiaoyi Wang, Yong Zeng","doi":"10.1136/heartjnl-2025-327472","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327472","url":null,"abstract":"<p><strong>Background: </strong>Adaptive digital therapy enhances cognitive training efficacy compared with traditional methods but evidence in patients with coronary heart disease (CHD) and mild cognitive impairment (MCI) is lacking.</p><p><strong>Methods: </strong>This randomised active-control trial compared multidomain adaptive (intervention) versus traditional non-adaptive (positive control) computerised cognitive training (CCT) in patients with CHD and MCI. Training lasted 30 min/session, five sessions/week, for 12 weeks (both groups) or 24 weeks (intervention only). The primary outcome was the proportion with improved overall cognitive function (Basic Cognitive Ability Test (BCAT)) at 12 weeks. Secondary outcomes included changes in overall/individual cognitive domains at 12/24 weeks improvements in patients' various quality of life scales. Exploratory outcomes included training compliance and brain structural changes. An intention-to-treat analysis was performed on all randomised participants. Missing data were managed using multiple imputation.</p><p><strong>Results: </strong>224 patients from eight Chinese medical centres were randomised into a 1:1 ratio to adaptive CCT (n=112) or traditional CCT (n=112). There was no significant difference in the proportion of BCAT improvement between the two groups (p=0.947, OR=1.02, 95% CI 0.51 to 2.05). Both groups showed improved cognitive abilities at 12 weeks versus baseline (p=0.015 and p=0.016). Adaptive CCT also improved health-related quality of life (EuroQol-5 Dimensions Questionnaire-3-Level) at 12 weeks compared with traditional CCT, and both interventions showed positive trends in improving anxiety and depression symptoms. The adaptive group had better compliance (p=0.009) and significantly increased grey-matter volume in the left supplementary motor area, right precuneus and right superior parietal lobule (P family-wise error=0.004).</p><p><strong>Conclusions: </strong>The efficacy of multidomain adaptive CCT in this population is not superior to that of traditional CCT. Although adaptive CCT has a higher compliance rate and can bring more significant changes in brain structure.</p><p><strong>Trial registration number: </strong>NCT05735041.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837016","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}

{"title":"Defibrillation of persistent shockable rhythms and survival after in-hospital cardiac arrest.","authors":"David Brooke Sidebottom, Martin Jonsson, Emma Blick Nordkvist, Linn Harrysson, Carl Magnusson, Anna Thorén, Andreas Claesson, Giulia Ferrannini, Akil Awad, Gabriel Riva","doi":"10.1136/heartjnl-2025-327697","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327697","url":null,"abstract":"<p><strong>Background: </strong>Persistent shockable rhythms (refractory to or recurring after three or more defibrillation attempts) are associated with poorer survival following out-of-hospital cardiac arrest, but little is known about this relationship following in-hospital cardiac arrest (IHCA). This study therefore explored the association between the number of defibrillation attempts and 30-day survival following IHCA.</p><p><strong>Method: </strong>This was a national retrospective cohort study using prospectively collected data from the Swedish Registry for Cardiopulmonary Resuscitation. All cases of adult IHCA between 1 January 2010 and 31 December 2020 presenting with a shockable rhythm who received at least one defibrillation attempt were included. Comorbidity data originated from the Swedish National Patient Register. The exposure was the total number of defibrillation attempts and the primary outcome was 30-day survival. A descriptive analysis was performed, followed by multivariable logistic regression with adjustment for patient and cardiac arrest factors. Missing data were imputed.</p><p><strong>Results: </strong>In total, 5325 IHCA cases were included. Persistent shockable rhythms occurred in 907 (17%) cases. 30-day survival decreased rapidly from 73% in patients receiving one defibrillation attempt to 41% in patients requiring four defibrillation attempts but subsequently plateaued with a minimum value (24%) at nine defibrillation attempts. An unwitnessed arrest (adjusted OR (aOR) 0.50, 95% CI 0.39 to 0.64), the absence of continuous cardiac monitoring (aOR 0.63, 95% CI 0.54 to 0.74) and a longer time to the first defibrillation attempt (aOR 0.89, 95% CI 0.86 to 0.91 per min) were potentially modifiable in-hospital factors associated with decreased survival.</p><p><strong>Conclusions: </strong>A persistent shockable rhythm occurred in around one sixth of IHCAs with an initial shockable rhythm. Successive defibrillation attempts were associated with a rapid fall in survival followed by a plateau phase. These findings warrant further investigation, as patients with IHCA may also benefit from novel strategies to more rapidly terminate shockable rhythms.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837047","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}

{"title":"Global variability in bicuspid aortic valve morphology and aortopathy among patients with severe aortic stenosis referred for transcatheter valve implantation.","authors":"Alfonso Ielasi, Elisabetta Moscarella, Monica Barki, Rodolfo Caminiti, Sanjeev Bhatt, Giulio Guagliumi, Paolo Calabrò, Maurizzio Tespili","doi":"10.1136/heartjnl-2025-327445","DOIUrl":"https://doi.org/10.1136/heartjnl-2025-327445","url":null,"abstract":"<p><strong>Background: </strong>While some studies have investigated the characteristics of patients from Asian versus European regions with bicuspid aortic valve (BAV) disease undergoing transcatheter aortic valve implantation (TAVI), geographic differences in a worldwide population remain poorly understood. The aim of our study was to evaluate the geographic differences of aortic valve morphology, annular size and associated aortopathy in a large, diverse population of India, West Europe, East Europe, Latin America, Middle East, Russia Commonwealth of Independent States, Asia Pacific and Africa patients with severe aortic stenosis (AS) referred for TAVI.</p><p><strong>Methods: </strong>Data from cardiovascular multislice CT of severe AS patients referred for TAVI were analysed in a centralised core laboratory. Differences in valvular phenotype, annular size and aortic morphology were analysed with a focus on BAV patients.</p><p><strong>Results: </strong>Among 12 712 patients evaluated, 3203 (25%) had BAV. These patients were more frequently male, younger and had larger annular area, aortic root diameters and higher prevalence of horizontal aorta (23% vs 10%, p<0.01) and severe calcifications (52% vs 32%, p<0.01). The highest prevalence of BAV was observed in patients from India (43%), with this group also being the youngest while the lowest was in patients from African regions (7%). Type 1 BAV was the most common (71%), followed by type 0 (26%) and type 2 (3%) subsets. Aortopathy was common across all geographic regions, but smaller aortic valve complex dimensions and lower coronary ostia height were seen in patients from India and the Asia-Pacific region. Eccentricity index and horizontal aorta were similar across different geographic regions.</p><p><strong>Conclusions: </strong>BAV morphology and annular size showed significant heterogeneity based on the geographical origin. These differences may be relevant for procedural planning and anatomical assessment in BAV patients undergoing TAVI worldwide.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837004","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}

{"title":"Age and sex-specific reference ranges of left ventricular strain rates and cardiovascular outcomes: the Copenhagen City Heart Study.","authors":"Jacob Christensen, Kristoffer Grundtvig Skaarup, Mats Christian Højbjerg Lassen, Niklas Dyrby Johansen, Magnus Thorsten Jensen, Gorm Boje Jensen, Peter Schnohr, Rasmus Møgelvang, Tor Biering-Sørensen","doi":"10.1136/heartjnl-2026-327980","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-327980","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular (LV) strain rates assessed by two-dimensional speckle-tracking echocardiography have exhibited clinical and prognostic significance but remain sparsely used.</p><p><strong>Objectives: </strong>We sought to establish age and sex-based normative values of LV strain rates and to assess the prognostic yield of lower limits of normality (LLN).</p><p><strong>Methods: </strong>LV strain rate parameters included global systolic strain rate (GSRs), global early diastolic strain rate (GSRe) and global late diastolic strain rate (GSRa). The primary population consisted of healthy participants free of risk factors from the Copenhagen City Heart Study. The prognostic yield of LLN was assessed against a composite endpoint of cardiovascular death, incident heart failure and acute myocardial infarction using Cox regression in a secondary validation population, regardless of health status.</p><p><strong>Results: </strong>The healthy population consisted of 1930 subjects with a median age of 46 years (IQR 33, 58), of whom 1193 (61.8%) were female. Median values were -0.97 s^-1 (IQR -1.07, -0.90) for GSRs, 1.43 s^-1 (1.17, 1.70) for GSRe and 0.77 s^-1 (0.60, 0.93) for GSRa. Normative values were determined according to sex and four age intervals. All three parameters differed across sexes, while GSRs was negatively correlated with heart rate; GSRe and GSRa were negatively and positively correlated with age, respectively. GSRa below the sex- and age-appropriate LLN was independently associated with a higher risk of the composite outcome.</p><p><strong>Conclusion: </strong>This is the largest study to report sex- and age-specific normal values for LV strain rates. The LLNs identified, namely for GSRa, provided independent prognostic information regarding adverse cardiovascular events.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837030","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}

{"title":"Derivation and validation of a prediction model for long-term mortality in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: the PREDICT-ST-Elevation Myocardial Infarction score.","authors":"Luis Ortega-Paz, Claudio Laudani, Salvatore Brugaletta, Pablo Vidal-Calés, Albert Ariza-Solé, Irene Buera, Mérida Cárdenas Manilla, Xavier Carrillo, Marcelo Jimenez, Jordi Guarinos, Juan Francisco Muñoz Camacho, Oriol De Diego, Helena Tizón-Marcos, Carlos Tomás-Querol, Josep Gomez-Lara, Victor Jimenez-Diaz, Pilar Jiménez-Quevedo, Roberto Diletti, Pascual Bordes, Gianluca Campo, Joan Antoni Gomez-Hospital, Antonio Greco, Marco Spagnolo, Davide Capodanno, Dominick Angiolillo, Manel Sabate","doi":"10.1136/heartjnl-2026-327811","DOIUrl":"https://doi.org/10.1136/heartjnl-2026-327811","url":null,"abstract":"<p><strong>Background: </strong>There are limited prediction models of long-term mortality for patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Against this background, we aimed to derive and validate a predictive model for long-term mortality in patients with STEMI undergoing PCI.</p><p><strong>Methods: </strong>A total of 23 086 patients from a STEMI network were included in the derivation cohort. Using time-to-event regression analysis, predictors of long-term mortality were identified and used to develop a score ranging from 0 to 206 points, with a score directly proportional to the probability of mortality. The predictive performance of this score was then validated in patients from the EXAMINATION-EXTEND study (n=1498) and Coronary Artery diSease Tracking registry (n=1112). An outcome-based cut-point optimisation analysis was performed to determine the best cut-off value in the derivation and validation cohorts.</p><p><strong>Results: </strong>The prediction model for long-term mortality in STEMI (PREDICT-STEMI) score comprised seven variables: age, diabetes mellitus, previous myocardial infarction, previous ischaemic stroke/transient ischaemic attack, haemodynamic status, three-vessel disease and mechanical circulatory support. The score showed a Concordance index for long-term mortality of 0.81 (95% CI 0.80 to 0.81) in the derivation and 0.81 (95% CI 0.78 to 0.84) and 0.84 (95% CI 0.81 to 0.87) in the validation cohorts, respectively. The optimal prediction model cut-off was 60 points; compared with those with a low score, patients with a high score had a sixfold increased risk of long-term mortality in both the derivation and validation cohorts.</p><p><strong>Conclusions: </strong>The PREDICT-STEMI score is a simple tool for predicting long-term mortality and facilitating early risk stratification and inform clinical decision-making.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769858","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}