Cardiac Failure Review最新文献

{"title":"Positive Airway Pressure Therapies for Heart Failure: What Do the Trials Tell Us?","authors":"Jan Pec, Michael Arzt","doi":"10.15420/cfr.2025.23","DOIUrl":"10.15420/cfr.2025.23","url":null,"abstract":"<p><p>Sleep-disordered breathing (SDB) represents a modifiable treatment target in patients with heart failure (HF). Despite the evolution of positive airway pressure (PAP) therapy over the past several decades, randomised controlled trials have not demonstrated a consistent benefit in reducing mortality or hospital admissions related to HF. As a result, the use of PAP therapy has been primarily limited to symptom control of SDB. However, recent trials suggest that PAP therapy is safer than previously perceived and underscore an urgent need for a phenotype-based, individualised treatment approach. Stratifying patients according to sleep apnoea phenotypes or characteristic clinical clusters may enhance the identification of individuals most likely to respond favourably to PAP therapy in terms of clinical outcomes. This narrative review provides an outline of the current evidence regarding the use of PAP therapy in patients with SDB across the spectrum of HF phenotypes.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e30"},"PeriodicalIF":5.7,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12723816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Hypopnoea Classifications on the Assessment of Sleep Disordered Breathing in Heart Failure.","authors":"Sébastien Baillieul, Renaud Tamisier, Jean-Louis Pépin","doi":"10.15420/cfr.2025.37","DOIUrl":"10.15420/cfr.2025.37","url":null,"abstract":"<p><p>Sleep-related breathing disorders (SRBD), particularly central sleep apnoea and obstructive sleep apnoea, are highly prevalent among individuals with heart failure (HF). Accurate classification of SRBD is critical for accurate diagnosis and to improve management by limiting treatment failures. Hypopnoeas, defined as partial reductions in airflow, represent a significant proportion of respiratory events; however, inconsistencies in their scoring across various guidelines have affected disease classification and may lead to inappropriate treatment indications. This review examines the substantial impact that variations in hypopnoea definitions and the differentiation between central and obstructive hypopnoeas have on SRBD diagnosis in HF patients. The authors underscore the clinical and epidemiological importance of standardising hypopnoea scoring and advocate for the development of refined, HF-specific methodologies in SRBD assessment.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e31"},"PeriodicalIF":5.7,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12723812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Home Sleep Apnoea Testing: Advances, Challenges and Considerations in Heart Failure.","authors":"Rebecca Steinberg, Andrew R Spector, Todd McVeigh, Marat Fudim","doi":"10.15420/cfr.2025.29","DOIUrl":"10.15420/cfr.2025.29","url":null,"abstract":"<p><p>Sleep-disordered breathing (SDB), including obstructive and central sleep apnoea, is highly prevalent in heart failure (HF) and contributes to adverse outcomes. In-lab polysomnography is the diagnostic gold standard, but is limited by cost and accessibility. Home sleep apnoea testing (HSAT) offers an accessible alternative, but its accuracy in HF populations remains under evaluation. This review explores HSAT technologies, including peripheral arterial tonometry and respiratory inductance plethysmography, and their ability to detect SDB subtypes. Differentiating obstructive sleep apnoea from central sleep apnoea in HF is complicated by overlapping physiology, comorbidities, and fluid status. With further refinement, HSAT may improve access to timely diagnosis and management of SDB in HF, potentially enhancing outcomes in this high-risk population.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e29"},"PeriodicalIF":5.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging Pharmacological and Invasive Therapies for Hypertrophic Cardiomyopathy with Obstructive Physiology.","authors":"Emily Li-Wen Chu, Daniel Seung Kim, Ahmad Masri","doi":"10.15420/cfr.2025.08","DOIUrl":"10.15420/cfr.2025.08","url":null,"abstract":"<p><p>Hypertrophic cardiomyopathy is a prevalent condition characterised by ventricular hypertrophy, which results in left ventricular outflow obstruction in two-thirds of patients. Traditional pharmacological therapies, including β-blockers, calcium channel blockers and disopyramide, have been the cornerstone of symptom management but lack disease-modifying effects. The introduction of cardiac myosin inhibitors as the first therapy to directly target sarcomeric hypercontractility has dramatically changed clinical practice. However, several logistical factors presently limit the widespread adoption of cardiac myosin inhibitors, and their long-term side-effects and outcomes require ongoing investigation. Emerging pharmacological approaches, including EDG-7500 and gene therapies, aim to refine treatment strategies. For patients with refractory symptoms, invasive septal reduction therapies, including surgical myectomy and alcohol septal ablation, remain critical. Innovations such as radiofrequency ablation and septal scoring along the midline endocardium (SESAME) offer promising, minimally invasive alternatives. As treatment options expand, optimising patient selection, monitoring protocols and long-term outcomes remain essential to advancing care for patients with obstructive hypertrophic cardiomyopathy.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e27"},"PeriodicalIF":5.7,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12606454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon-like Peptide-1 Receptor Agonists in Heart Failure: Mechanisms, Evidence and Identifying Optimal Candidates.","authors":"Magdy Abdelhamid, Mostafa M Abdrabou, Emanuel Faris, Sameh El Kafas, Mohamed Hosny, Ahmed Hassan","doi":"10.15420/cfr.2025.17","DOIUrl":"10.15420/cfr.2025.17","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1RAs), established treatments for type 2 diabetes and obesity, exhibit cardiovascular benefits extending to heart failure (HF) with preserved ejection fraction (HFpEF). Mechanisms contributing to HF improvement include significant weight loss, blood pressure reduction, enhanced glycaemic control, anti-inflammatory effects and potential direct cardioprotective and vascular actions. Although cardiovascular outcome trials provided initial positive signals, dedicated HFpEF trials confirmed the efficacy of GLP-1RAs in HFpEF patients with obesity and/or diabetes. In some trials, GLP-1RAs significantly improved weight, symptoms of HF and HF events. Current evidence strongly supports GLP-1RAs in patients with HFpEF and obesity, with or without type 2 diabetes. The data do not support their use solely for HF with reduced ejection fraction.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e28"},"PeriodicalIF":5.7,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12606456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Prognostic Significance of Malnutrition Assessed by Two Scoring Systems in Hospitalised Elderly Patients with Chronic Heart Failure.","authors":"Mohammed El-Sheikh, Nora Olsen El Caidi, Aginsha Kandiah, Sandra Henriette Tonning, Ida Arentz Taraldsen, Frederik Dencker Wisborg, Ove Andersen, Jens Dahlgaard Hove, Johannes Grand","doi":"10.15420/cfr.2025.31","DOIUrl":"10.15420/cfr.2025.31","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition is common yet underrecognised in elderly patients (≥65 years) with chronic heart failure (CHF) and may accelerate disease progression through cytokine activation, autonomic dysfunction and cachexia. Early identification may improve risk stratification, but standardised diagnostic criteria are lacking. Inflammatory markers such as high-sensitivity C-reactive protein (hsCRP) and soluble urokinase plasminogen activator receptor (suPAR) may influence both the presence and prognostic implications of malnutrition, but their interaction with nutritional indices remains poorly understood. This study examined the prevalence and prognostic significance of malnutrition using Prognostic Nutritional Index (PNI) and Geriatric Nutritional Risk Index (GNRI).</p><p><strong>Methods: </strong>From 10,027 consecutive admissions, 597 elderly patients with CHF were included. Nutritional status was assessed using PNI and GNRI. Patients meeting either the PNI or GNRI criteria for moderate or severe malnutrition were classified as malnourished; others were considered well-nourished. One-year all-cause mortality was evaluated using Cox regression models. Predictive performance was assessed using receiver operating characteristic analysis and DeLong's test.</p><p><strong>Results: </strong>Moderate or severe malnutrition was identified in 42.2% using the PNI and in 31.2% using the GNRI. Severe malnutrition was independently associated with higher 1-year mortality (PNI: HR 1.43, p=0.038; GNRI: HR 1.78, p=0.043). GNRI showed better post-discharge discrimination (AUC 0.666 versus 0.586, p=0.002). Prognostic value of both indices varied by BMI and inflammation. GNRI-defined malnutrition showed significant interaction with hsCRP and suPAR.</p><p><strong>Conclusion: </strong>In elderly CHF patients, malnutrition was common and independently associated with mortality. Prognostic value varied by BMI and inflammation, with GNRI showing enhanced discriminatory ability. In acute care settings, PNI and GNRI may aid nutritional risk stratification.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e26"},"PeriodicalIF":5.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12590399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-implant Right Ventricular dP/dt Can Predict Severe Right Ventricular Failure After Left Ventricular Assist Device Implantation.","authors":"Parth Visrodia, Aniket S Rali, Gabriel Hernandez, Jenna Skowronski, Evan L Brittain, Sandip K Zalawadiya, Lisa A Mendes, JoAnn Lindenfeld, Antonio Hernandez, Aaron M Williams, Vineet Agrawal","doi":"10.15420/cfr.2025.21","DOIUrl":"10.15420/cfr.2025.21","url":null,"abstract":"<p><strong>Background: </strong>Right ventricular (RV) failure remains a major cause of morbidity and mortality after continuous flow left ventricular assist device (CF-LVAD) implantation. Previous risk assessment tools using pre-operative data to predict RV failure have performed only modestly well. We retrospectively evaluated the potential of a non-invasive measure of right ventricular contractility - RV dP/dt, derived from the echocardiographic Doppler signal of tricuspid regurgitation (TR) both without and with inotropes - to predict RV failure post-CF-LVAD.</p><p><strong>Methods: </strong>We studied 65 consecutive CF-LVAD recipients at Vanderbilt University Medical Center from 2013-2019 who had a baseline off inotrope echocardiogram with an evaluable TR signal within 3 months prior to LVAD implantation. Of the 65 patients, 40 were started on inotropes before LVAD implantation, 32 of whom had an evaluable TR signal on a repeat echocardiogram prior to LVAD. RV dP/dt was evaluated using spectral Doppler recordings from the TR and calculated by obtaining the time required from the TR velocity to increase from 0.5 m/s to 2 m/s. Off inotrope RV dP/dt of the 65 patients and on inotrope RV dP/dt of the 32 patients were collected. Post-CF-LVAD RV failure was defined by Interagency Registry for Mechanically Assisted Circulatory Support criteria. Overall survival was estimated by Kaplan-Meier curves and compared by log-rank test among different subgroups. Receiver operative characteristic curves were constructed to determine the optimal thresholds for prediction of severe RV failure post-LVAD.</p><p><strong>Results: </strong>Of the 65 patients, 30 had no/mild RV failure; RV failure was moderate in 17 and severe in 18 patients after LVAD. Subjects with severe RV failure had worse survival than patients with no/mild and moderate RV failure. Either a baseline off inotrope, or on inotrope RV dP/dt of greater than or equal to 300 mmHg/s predicted a low risk of severe RV failure with high sensitivity (89% and 80%, respectively) and negative predictive value (91% and 88% respectively). Persistently low RV dP/dt <300 mmHg/s despite being on inotrope was associated with a high likelihood of post-LVAD RV failure (OR 10.5; 95% CI [1.8-59.4]) compared with the rest of the cohort on inotropic therapy.</p><p><strong>Conclusion: </strong>Echocardiographic RV dP/dt may be a valuable adjunct tool for predicting post-operative RV failure in patients undergoing evaluation for CF-LVAD implantation.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e25"},"PeriodicalIF":5.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12590390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Benefits of Spironolactone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: Insights from a Win Ratio Analysis of the TOPCAT Trial.","authors":"Dung Viet Nguyen, Hoai Thi Thu Nguyen","doi":"10.15420/cfr.2025.28","DOIUrl":"10.15420/cfr.2025.28","url":null,"abstract":"<p><strong>Background: </strong>In recent heart failure (HF) trials, the win ratio statistical approach, developed to address the limitations of conventional methods, has been increasingly applied to better capture clinical benefits. The TOPCAT study was a randomised controlled trial designed to evaluate the efficacy of spironolactone in patients with HF and a left ventricular ejection fraction (LVEF) ≥45%. This study evaluated the cardiovascular benefits of spironolactone according to their clinical importance using the win ratio method.</p><p><strong>Methods: </strong>A post hoc analysis was conducted using data from the TOPCAT Americas cohort. The primary outcome was a hierarchical composite comprising the time to cardiovascular death, time to first aborted cardiac arrest, time to first hospitalisation for HF, time to first hospitalisation for arrhythmia and change in the Kansas City Cardiomyopathy Questionnaire Overall summary score at 36 months. Outcomes were analysed using the win ratio statistical model.</p><p><strong>Results: </strong>In all, 1,767 patients were included; 886 were assigned to receive spironolactone and 881 to receive placebo. Hierarchical analysis of the primary composite outcome revealed a significant higher probability of win (28.3%) compared to loss (23.1%) in the spironolactone group, yielding a win ratio of 1.22 (95% CI [1.05-1.42]; p=0.008) and a net clinical benefit (win difference) of 5.2% (95% CI [1.36-9.04]). Detailed assessment of the win differences revealed a concordant positive benefit (win difference >0) across all components of the outcome hierarchy. Subgroup analyses indicated no significant effect of age (<75 years versus ≥75 years), sex (male versus female) or LVEF (<50% versus ≥50%) on the efficacy of spironolactone (p for interaction>0.05).</p><p><strong>Conclusion: </strong>This post hoc analysis, using a novel statistical approach, demonstrates the consistent benefits of spironolactone across adverse cardiovascular events, patient symptoms, functional status and quality of life in individuals with HF and mildly reduced or preserved LVEF.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e24"},"PeriodicalIF":5.7,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12590389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Troponin I in Patients Following Off-pump Coronary Artery Bypass Grafting.","authors":"Hao Cui, Jinwei Zhang, Jianbo Yu, Meng He, Peng Sun, Shengwei Wang, Jie Du, Yongqiang Lai, Changwei Ren","doi":"10.15420/cfr.2025.18","DOIUrl":"10.15420/cfr.2025.18","url":null,"abstract":"<p><strong>Background: </strong>Blood troponin I (TnI) concentrations, the reasons for increases in TnI after coronary artery bypass grafting (CABG) and the effects of TnI on short- and long-term outcomes are not well understood.</p><p><strong>Methods: </strong>Patients undergoing off-pump CABG at Anzhen Hospital between 2011 and 2022 were reviewed. Data on peak postoperative TnI and high-sensitivity (hs) TnI were collected, and patients were divided into a high TnI group (TnI ≥10 ≥g/l or hsTnI ≥10,000 pg/ml) and low TnI group. Baseline characteristics, graft flow, perioperative outcomes and long-term mortality were compared between the two groups.</p><p><strong>Results: </strong>In all, 19,196 patients were included in the study (median age 63 years; interquartile range [IQR] 57-68 years; 14,423 (75.1%) male). Compared with the low TnI group, patients in the high TnI group were more likely to have an intra-aortic balloon pump inserted (17.8% vs. 2.9%; p<0.001), receive extracorporeal membrane oxygenation support (3.6% vs. 0.1%; p<0.001), and undergo early revascularisation (2.81% vs. 0.12%; p<0.001); the high TnI group also had more in-hospital deaths (2.7% vs. 0.2%; p<0.001). After propensity score matching, patients in the high TnI group had fewer grafts to the left circumflex artery (LCX; 0.71 ± 0.58 versus 0.81 ± 0.57; p<0.001) and right coronary artery (RCA; 0.89±0.53 versus 0.95±0.53; p=0.011), as well as less graft flow to the LCX (median 33 [IQR 21-55] versus 41 [IQR 25-67] ml/min; p<0.001) and RCA (30 [IQR 18-50] versus 35 [IQR 22-55] ml/min; p<0.001) than patients in the low TnI group. Patients with high postoperative TnI also had reduced long-term survival (HR 2.59; 95% CI [1.76-3.82]; p<0.001).</p><p><strong>Conclusion: </strong>Elevated TnI following off-pump CABG may be associated with incomplete revascularisation in the LCX and RCA. It is also associated with increased early and late mortality.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e23"},"PeriodicalIF":5.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting Transvenous Phrenic Nerve Stimulation in Central Sleep Apnoea and Heart Failure: Emerging Innovations in Clinical Trials Analysis.","authors":"Tarek Bekfani, Joseph D Abraham, William T Abraham","doi":"10.15420/cfr.2025.07","DOIUrl":"10.15420/cfr.2025.07","url":null,"abstract":"<p><p>Central sleep apnoea (CSA) is a common comorbidity in patients with heart failure. Due to its insidious and chronic nature, CSA often remains unrecognised. Patients with CSA typically present with symptoms, such as daytime fatigue, recurrent heart failure decompensations and cardiac arrhythmias. Although the pathophysiology of CSA is not yet fully understood, the most widely accepted theory suggests that fluctuations in PaCO₂ levels, particularly crossing the apnoeic threshold, play a central role in its development. CSA is associated with various changes, including activation of the sympathetic nervous system, neurohormonal disturbances and haemodynamic perturbations, all of which contribute to increased morbidity and mortality. Transvenous phrenic nerve stimulation (TPNS) has been demonstrated to be a safe and effective therapy for reducing the apnoea-hypopnoea index and improving both left ventricular ejection fraction and quality of life in patients with CSA. These benefits have been validated in randomised clinical trials (RCTs). New methods of analysing RCTs were recently introduced. Applying the win ratio method in a post hoc analysis of the primary RCTs evaluating TPNS suggested that TPNS may also contribute to reduced mortality and fewer heart failure hospitalisations. In this article we explore the pathophysiology of CSA and evaluate the existing evidence on therapeutic options, with a particular focus on TPNS.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e22"},"PeriodicalIF":5.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}