The Pathobiology of Pulmonary Arterial Hypertension
Pulmonary arterial hypertension is characterized by obliteration and obstruction of the pulmonary arterioles that in turn results in high right ventricular afterload and right heart failure. The pathobiology of pulmonary arterial hypertension is complex, with contributions from multiple pathophysiologic processes that are regulated by a variety of molecular mechanisms. This nature likely explains the limited efficacy of our current therapies, which only target a small portion of the pathobiological mechanisms that underlie advanced disease. Here we review the pathobiology of pulmonary arterial hypertension, focusing on the...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Sudarshan Rajagopal, Yen-Rei A. Yu Source Type: research
Update on Medical Management of Pulmonary Arterial Hypertension
Pulmonary arterial hypertension is a rare disease characterized by pulmonary microvasculature remodeling leading to right ventricular failure and death. Medical management of pulmonary hypertension has grown increasingly complex as more therapeutic agents have been developed. Evolving treatment strategies leveraging the endothelin, nitric oxide, and prostacyclin pathways lead to improved exercise capacity and outcomes in patients; however, significant opportunities for advancement remain. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Alexander E. Sherman, Rajan Saggar, Richard N. Channick Source Type: research
Pulmonary Hypertension Associated with Connective Tissue Disease
Pulmonary hypertension (PH), a syndrome characterized by elevated pulmonary pressures, commonly complicates connective tissue disease (CTD) and is associated with increased morbidity and mortality. The incidence of PH varies widely between CTDs; patients with systemic sclerosis are most likely to develop PH. Several different types of PH can present in CTD, including PH related to left heart disease and respiratory disease. Importantly, CTD patients are at risk for developing pulmonary arterial hypertension, a rare form of PH that is associated with high morbidity and mortality. Future therapies targeting pulmonary vascula...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Stephen C. Mathai Source Type: research
Pulmonary Arterial Hypertension in Patients Infected with the Human Immunodeficiency Virus
It is important to recognize and treat human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) because of the associated morbidity and mortality. With the introduction of antiretroviral therapies (ART), improved survival has changed the focus of treatment management from immunodeficiency-related opportunistic infections to chronic cardiovascular complications, including HIV-PAH. The 2018 6th World Symposium of Pulmonary Hypertension recommended a revised definition of PAH that might result in a greater number of patients with HIV-PAH; however, the implication of this change is not yet clear. Here,...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Stephanie M. Hon, Rodolfo M. Alpizar-Rivas, Harrison W. Farber Source Type: research
Lung Disease –Related Pulmonary Hypertension
Patients with advanced lung disease can develop pulmonary hypertension and succumb to right ventricular failure/cor pulmonale. Patients with pulmonary hypertension owing to chronic lung disease, or World Health Organization group 3 pulmonary hypertension, are more limited and carry a high risk of mortality. Adjunctive therapies remain the cornerstones of treatment. Recent evidence suggests that inhaled pulmonary vasodilator therapy can be helpful in patients with pulmonary hypertension owing to interstitial lung disease. Lung transplantation may be the only life-saving option in select patients, whereas palliative care and...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Kareem Ahmad, Vikramjit Khangoora, Steven D. Nathan Source Type: research
Pulmonary Hypertension in Adults with Congenital Heart Disease
Pulmonary arterial hypertension related to congenital heart disease (PAH-CHD) affects 5% to 10% of adults with CHD and is associated with significant morbidity and mortality. PAH-CHD develops as a consequence of intracardiac or extracardiac systemic-to-pulmonary shunts that lead to pulmonary vascular remodeling through a pathologic process that is similar to other causes of PAH. Eisenmenger syndrome is the most severe phenotype of PAH-CHD and is characterized by severe elevation in pulmonary vascular resistance, with shunt reversal causing hypoxemia and central cyanosis. The primary management strategy for most patients wi...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Sarah A. Goldstein, Richard A. Krasuski Source Type: research
Left Heart Disease-Related Pulmonary Hypertension
Pulmonary hypertension (PH) due to left heart disease (LHD; group 2 PH) is a common complication of heart failure with reduced ejection fraction and heart failure with preserved ejection fraction and is often related to disease severity and duration of these diseases. PH due to LHD is associated with negative impact on outcomes in addition to worse symptoms and exercise capacity. Risk factors for group 2 PH are older age, hypertension, atrial fibrillation, and features of metabolic syndrome. The main mechanisms for group 2 PH are believed to be vascular remodeling secondary to sustained elevated intravascular pressure. (So...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Ayedh K. Alamri, Christy L. Ma, John J. Ryan Source Type: research
Surgical Management of Chronic Thromboembolic Pulmonary Hypertension
Chronic thromboembolic pulmonary hypertension is a progressive disease, which may lead to severe right ventricular dysfunction and debilitating symptoms. Pulmonary thromboendarterectomy (PTE) provides the best opportunity for complete resolution of obstructing thromboembolic disease and functional improvement in appropriately selected patients. In this article, the authors review preoperative workup, patient selection, operative technique, postoperative care, and outcomes after PTE. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Andrew M. Vekstein, Joseph R. Nellis, Sharon L. McCartney, John C. Haney Source Type: research
Interventional Management of Chronic Thromboembolic Pulmonary Hypertension
Chronic thromboembolic pulmonary hypertension is a distinct form of pulmonary hypertension characterized by the nonresolution of thrombotic material in the pulmonary tree; whenever feasible and safe, first-line treatment should be pulmonary thromboendarterectomy. In patients who are not operative candidates, balloon pulmonary angioplasty (BPA) has emerged as an effective treatment modality that results in improvements in functional class, symptoms, hemodynamics, 6-minute walk distance, and right ventricular and pulmonary artery mechanics. Careful attention to procedural technique and rapid identification and treatment of c...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: J.D. Serfas, Richard A. Krasuski Source Type: research
Management of Pulmonary Hypertension in the Pediatric Patient
This article reviews the various forms of PH in childhood, with a focus on both established and investigational therapies that are available for children with PH. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Rebecca Epstein, Usha S. Krishnan Source Type: research
Advanced Circulatory Support and Lung Transplantation in Pulmonary Hypertension
Pulmonary arterial hypertension (PAH) is a progressive fatal disease. Although medical therapies have improved the outlook for these patients, there still exists a cohort of patients with PAH who are refractory to these therapies. Lung transplantation (LT), and in certain cases heart –lung transplantation (HLT), is a therapeutic option for patients with severe PAH who are receiving optimal therapy yet declining. ECMO may serve as a bridge to transplant or recovery in appropriate patients. Although, the mortality within the first 3 months after transplant is higher in PAH recip ients than the other indications for LT,...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Marie M. Budev, James J. Yun Source Type: research
I was a recently minted fellow at Duke University Medical Center in early 1998 when my mentor, Dr Bashore, asked me to come up with a research project utilizing a device he had just purchased for the catheterization laboratory. The INOvent Delivery System (Ohmeda Medical, Laurel, MD, USA) facilitated the controlled delivery of nitric oxide blended with oxygen through a ventilator circuit.1 I immediately began working on my institutional review board submission with a goal to study patients with what was then known as “primary pulmonary hypertension” and compare them with patients with “secondary pulmonary...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Richard A. Krasuski Tags: Preface Source Type: research
Medical Management of Peripheral Artery Disease
Peripheral artery disease is a highly morbid yet undertreated atherosclerotic disease. The cornerstones of peripheral artery disease therapy consist of smoking cessation, lipid-lowering therapy, and hypertension treatment. More recently, clinical trials have demonstrated that novel antiplatelet and antithrombotic therapies reduce the risk of both cardiovascular and limb events in this patient population. In this review, we highlight the components of optimal medical therapy of peripheral artery disease and the evidence base for these therapies. (Source: Cardiology Clinics)
Source: Cardiology Clinics - October 20, 2021 Category: Cardiology Authors: Tara A. Holder, J. Antonio Gutierrez, Aaron W. Aday Source Type: research
Acute Aortic Syndromes
Acute aortic syndromes, classified into aortic dissection, intramural hematoma, and penetrating aortic ulcer, are associated with high early mortality for which early diagnosis and management are crucial to optimize outcomes. Patients often present with nonspecific clinical symptoms and signs; therefore, it is important for providers to maintain a high index of suspicion for acute aortic syndromes. Electrocardiogram-gated computed tomographic angiography of the chest, abdomen, and pelvis is currently the most practical imaging modality for diagnosis and identification of complications. Evolution in surgical techniques and ...
Source: Cardiology Clinics - October 20, 2021 Category: Cardiology Authors: R. Kevin Rogers, T. Brett Reece, Marc P. Bonaca, Connie N. Hess Source Type: research
Thoracic Aortic Aneurysm
Thoracic aortic aneurysms are common. Most thoracic aortic aneurysms are degenerative. However, some are associated with connective tissue disorders, bicuspid aortic valves, or familial/genetic predisposition. Most are asymptomatic, discovered incidentally on imaging. Aortic diameter is the best predictor of the natural history and risk of complications. Treating hypertension and smoking cessation can slow their growth. Surveillance imaging and referral for prophylactic aortic repair based on absolute aneurysm diameter is the primary means to decrease mortality from thoracic aortic aneurysm. We provide a practical evidence...
Source: Cardiology Clinics - October 20, 2021 Category: Cardiology Authors: Ethan M. Senser, Shantum Misra, Stanislav Henkin Source Type: research
Abdominal Aortic and Visceral Artery Aneurysms
Abdominal aortic aneurysms account for nearly 9000 deaths annually, with ruptured abdominal aortic aneurysms being the thirteenth leading cause of death in the United States. Abdominal aortic aneurysms can be detected by screening, but a majority are detected incidentally. Visceral artery aneurysms are often discovered incidentally, and treatment is guided by symptoms, etiology, and size. A timely diagnosis and referral to a vascular specialist are essential for timely open or endovascular repair and to ensure successful patient outcomes. (Source: Cardiology Clinics)
Source: Cardiology Clinics - October 20, 2021 Category: Cardiology Authors: Indrani Sen, Camila Franco-Mesa, Young Erben, Randall R. DeMartino Source Type: research
Renovascular Disease and Mesenteric Vascular Disease
This article reviews the epidemiology, pathophysiology, diagnosis, and management of these two conditions. (Source: Cardiology Clinics)
Source: Cardiology Clinics - October 20, 2021 Category: Cardiology Authors: Swapna Sharma, Stanislav Henkin, Michael N. Young Source Type: research
Revascularization Strategies for Acute and Chronic Limb Ischemia
Chronic limb-threatening ischemia requires aggressive risk factor management and a thoughtful approach to the complex decision of best strategy for revascularization. Patients often have multilevel disease amenable to endovascular, open surgical, or hybrid approaches. Limited high-quality evidence is available to support a specific strategy; randomized trials are ongoing. Acute limb ischemia is associated with a high risk of limb loss and mortality. Catheter-directed thrombolysis is mainstay of therapy in patients with marginally threatened limbs, whereas those immediately threatened with motor deficits require more rapid ...
Source: Cardiology Clinics - October 20, 2021 Category: Cardiology Authors: Jocelyn M. Beach Source Type: research
Risk Stratification and Management of Extracranial Carotid Artery Disease
Stroke is the fifth leading cause of death in the United States and is a leading cause of disability. Extracranial internal carotid artery stenosis is a major cause of ischemic stroke, as it is estimated to cause 8% to 15% of ischemic strokes. It is critical to improve our strategies for stroke prevention and treatment in order to reduce the burden of this disease. Herein, we review approaches for the diagnosis and risk stratification of carotid artery disease as well as interventional strategies for the prevention and treatment of strokes caused by carotid artery disease. (Source: Cardiology Clinics)
Source: Cardiology Clinics - October 20, 2021 Category: Cardiology Authors: Anna K. Krawisz, Brett J. Carroll, Eric A. Secemsky Source Type: research
Venous Thromboembolism for the Practicing Cardiologist
Venous thromboembolism (VTE), encompassing pulmonary embolism (PE) and deep vein thrombosis (DVT), is encountered commonly. Acute PE may present as a high-risk cardiovascular emergency, and acute DVT can cause acute and chronic vascular complications. The goal of this review is to ensure that cardiologists are comfortable managing VTE —including risk stratification, anticoagulation therapy, and familiarity with primary reperfusion therapy. Clinical assessment and determination of degree of right ventricular dysfunction are critical in initial risk stratification of PE and determination of parenteral versus oral antic...
Source: Cardiology Clinics - October 20, 2021 Category: Cardiology Authors: Abby M. Pribish, Eric A. Secemsky, Alec A. Schmaier Source Type: research
Varicose Veins and Chronic Venous Disease
Chronic venous disease is a worldwide problem associated with significant morbidity and is expected to increase in prevalence as the current population ages. This is a comprehensive review of the anatomy, pathophysiology, genomics, clinical classification, and treatment modalities of chronic venous disease. (Source: Cardiology Clinics)
Source: Cardiology Clinics - October 20, 2021 Category: Cardiology Authors: Tom Alsaigh, Eri Fukaya Source Type: research
Raynaud Phenomenon and Other Vasospastic Disorders
Vasospastic disorders are prevalent in the general population and can affect individuals of any age. Primary (or idiopathic) vasospastic disorders often have a benign course; treatment focuses on the control of symptoms. Secondary vasospastic disorders occur owing to an underlying condition and have an increased risk of complications, including tissue loss and digital ulcerations; treatment should focus on the underlying condition. In this review, we discuss the pathophysiology, clinical presentation, diagnosis, and management of vasospastic disorders, including Raynaud syndrome, acrocyanosis, livedo reticularis, and perni...
Source: Cardiology Clinics - October 20, 2021 Category: Cardiology Authors: Ana I. Casanegra, Roger F. Shepherd Source Type: research
Management of Vascular Disorders in Cardiovascular Practice
Although cardiovascular disease includes common and possibly life-threatening disorders, such as peripheral artery disease (PAD), venous thromboembolism (VTE), aortic aneurysm, cerebrovascular disease, and others, peripheral vascular diseases are often underdiagnosed and undertreated. Individuals with polyvascular disease (ie, atherosclerosis in multiple arterial beds) are at higher risk of major adverse events and mortality than patients with coronary artery disease or peripheral vascular disease alone. (Source: Cardiology Clinics)
Source: Cardiology Clinics - October 20, 2021 Category: Cardiology Authors: Stanislav Henkin, Mark A. Creager Tags: Preface Source Type: research
Introduction to Nephrocardiology
The interaction between nephrology and cardiovascular medicine is much broader than the cardiorenal syndrome. Many different aspects of cardiovascular medicine are interconnected with and substantially influenced by the conditions that fall into the realm of nephrology, and vice versa. Those aspects include pathophysiology, risk factors, epidemiology, prognosis, prevention, diagnosis, monitoring, and therapy. Discovery of the interconnected areas and development of appropriate knowledge and skill to optimally approach those circumstances can improve the quality of care and outcome of a large population of patients. Therefo...
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Parta Hatamizadeh Source Type: research
Uremic Toxins and Cardiovascular System
This article reviews the main cardiotoxic mechanisms related to uremic toxin retention (endothelial dysfunction, vascular smooth muscle cell alterations, inflammation, mineral bone disorder, insulin resistance, and thrombogenicity) and the main responsible retention compounds. Therapeutic options are reviewed, such as influencing solute generation by intestinal microbiota. (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Sophie Valkenburg, Griet Glorieux, Raymond Vanholder Source Type: research
Anemia: A Connection Between Heart Failure and Kidney Failure
Erythropoiesis-stimulating agents (ESAs) have improved the quality of life and reduced the need for transfusions in patients with chronic kidney disease. However, randomized trials showed no benefit but possible safety issues following high doses of ESAs given to reach normal hemoglobin levels. Iron therapy is used together with ESA; when given proactively, it may reduce the risk of mortality and cardiovascular events in hemodialysis patients. Recent trials also showed benefits of intravenous iron therapy in patients with heart failure. New drugs for correcting anemia may retain the present efficacy of ESAs as antianemic d...
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Francesco Locatelli, Lucia Del Vecchio, Roberto Minutolo, Luca De Nicola Source Type: research
Pulmonary Hypertension in Chronic Kidney Disease
There is a high prevalence of pulmonary hypertension in chronic kidney disease (CKD), with rates increasing as glomerular filtration rate declines. Pulmonary hypertension is associated with a higher risk of cardiovascular events and mortality in non –dialysis-dependent CKD stages 3 to 5, dialysis-dependent CKD, as well as kidney transplant recipients. The pathophysiology of pulmonary hypertension in CKD is multifactorial and includes higher pulmonary capillary wedge pressure caused by ischemic heart disease and cardiomyopathy, higher cardiac output caused by anemia and arteriovenous access used for hemodialysis, as w...
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Alison Travers, Harrison W. Farber, Mark J. Sarnak Source Type: research
Atrial Fibrillation in Patients with Chronic Kidney Disease
This article discusses an integrated care approach toward the management of patients with AF, including those with CKD. There is an increasing risk of both ischemic stroke and bleeding with progressive deterioration of renal function, complicating the decision of optimal stroke prevention strategies among patients with AF and CKD. The optimal stroke prevention strategy in patients with AF and severe CKD remains uncertain. An individualized approach incorporating stroke and bleeding risk stratification is needed, especially in those with end-stage renal disease. (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Agnieszka Kotalczyk, Wern Yew Ding, Christopher F. Wong, Anirudh Rao, Dhiraj Gupta, Gregory Y.H. Lip Source Type: research
Approach to Resistant Hypertension from Cardiology and Nephrology Standpoints
This article details an approach to the diagnosis and treatment of resistant hypertension with special consideration for patients with preexisting renal and/or cardiovascular disease. (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Luke J. Laffin, George L. Bakris Source Type: research
New Antidiabetes Medications and Their Cardiovascular and Renal Benefits
This article reviews the major CVOTs that support the use of these agents, describes the mechanisms of action that lead to their broad cardiorenal benefits, explains current guidelines, and offers prac tical clinical advice to initiate and monitor treatment with these agents. (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Enrico G. Ferro, Mohamed B. Elshazly, Deepak L. Bhatt Source Type: research
Dyslipidemia in Patients with Kidney Disease
This article focuses on epidemiology of CKD, how dyslipidemias confer a higher risk for CVD, the approach to management and treatment of dyslipidemias, and recent guidelines. (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Aneesha Thobani, Terry A. Jacobson Source Type: research
The Impact of Uric Acid and Hyperuricemia on Cardiovascular and Renal Systems
The description of gout dates back almost 5000 years, and scientific interest in uric acid increased when it was found to be involved in the pathogenesis of gout. Since then, many basic and clinical studies have assessed the implications of uric acid for the oxidative system, inflammation, and cardiovascular and renal outcomes. Uric acid–low ering therapy failed to improve clinical hard outcomes in asymptomatic hyperuricemia, and it is retained in symptomatic hyperuricemia. Dietary and lifestyle modifications are critical to manage hyperuricemia. More studies are warranted to investigate the role of uric acid&n...
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Davide Agnoletti, Arrigo F.G. Cicero, Claudio Borghi Source Type: research
Advances in Diagnosis and Treatment of Cardiac and Renal Amyloidosis
Diagnoses of amyloidosis are increasing annually, and advances in bone scintigraphy and cardiac MRI accompanied by development of nonbiopsy diagnostic criteria have specifically led to a huge increase in transthyretin amyloidosis cardiomyopathy (ATTR-CM) diagnoses worldwide. Tafamidis use is increasing, and there are several ongoing phase III clinical trials of novel agents that promise to transform the treatment landscape for patients with ATTR-CM. In systemic light chain (AL) amyloidosis, more effective chemotherapeutic agents continue to improve patient outcomes. Accelerating the removal of amyloid deposits to accompany...
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Steven Law, Marianna Fontana, Julian D. Gillmore Source Type: research
Atherosclerotic Vascular Disease Associated with Chronic Kidney Disease
Cardiovascular risk increases as glomerular filtration rate (GFR) declines in progressive renal disease and is maximal in patients with end-stage renal disease requiring maintenance dialysis. Atherosclerotic vascular disease, for which hyperlipidemia is the main risk factor and lipid-lowering therapy is the key intervention, is common. However, the pattern of dyslipidemia changes with low GFR and the association with vascular events becomes less clear. While the pathophysiology and management of patients with early chronic kidney disease (CKD) is similar to the general population, advanced and end-stage CKD is characterize...
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Matthew J. Tunbridge, Alan G. Jardine Source Type: research
Nonatherosclerotic Vascular Abnormalities Associated with Chronic Kidney Disease
Nonatherosclerotic vascular diseases are manifested by endothelial dysfunction, hypertension, vascular calcification, coronary microvascular dysfunction, and calciphylaxis. Unfortunately, there are no definitive treatments for many of these disorders other than hypertension. In addition, although hypertension is more difficult to treat in the chronic kidney disease population, it is necessary to try and target a blood pressure of less than 130/80 mm Hg through the use of aggressive angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, diuretics, and other antihypertensive medications. New therapies ...
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Rajesh Mohandas, Gajapathiraju Chamarthi, Mark S. Segal Source Type: research
A Comparison of Hemodialysis and Peritoneal Dialysis in Patients with Cardiovascular Disease
This article reviews and compares hemodialysis and peritoneal dialysis in association with different cardiovascular diseases affecting dialysis patients, including hypertension, coronary artery disease, myocardial stunning, cardiac arrhythmias, heart failure, and the cardiorenal syndrome. (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Rehab B. Albakr, Joanne M. Bargman Source Type: research
Coexisting dysfunction of heart and kidney, the cardiorenal syndrome, is a common condition and is associated with worsening of outcomes and complexities of diagnostic, preventive, and therapeutic approaches. The knowledge of the physiology of heart and kidney and their interaction with each other and with other organ systems has progressed significantly in recent years, resulting in a better understanding of the pathogenesis of cardiorenal syndrome. A robust knowledge of the pathophysiology and of the latest practical advancements about cardiorenal syndrome is necessary for cardiologists, nephrologists, and other practiti...
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Parta Hatamizadeh Source Type: research
Time to Recognize Nephrocardiology as a Discipline
There is a large intersection between nephrology and cardiovascular medicine, which has grown over time with the advancement of the two subspecialties. Although cardiorenal syndrome is probably the most recognized entity in nephrocardiology, the field includes a much broader spectrum of topics, many of which have been studied by investigators in nephrology, cardiology, and other specialties, even though they might have not been portrayed as a nephrocardiology-related condition. (Source: Cardiology Clinics)
Source: Cardiology Clinics - July 9, 2021 Category: Cardiology Authors: Parta Hatamizadeh Tags: Preface Source Type: research