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3.
PLoS One ; 15(3): e0230134, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160262

RESUMO

BACKGROUND: Recent studies concerning left ventricular noncompaction (LVNC) suggest that the extent of left ventricular (LV) hypertrabeculation has no impact on prognosis. The variety of methods of LV noncompacted myocardial mass (NCM) assessment may influence the results. Hence, we compared two methods of NCM estimation: largely observer-independent Hautvast's(H) computed algorithm-based approach and commonly used Jacquier's(J) method, and their associations with LV end-diastolic volume (EDV) and ejection fraction (EF). METHODS: Cardiac magnetic resonance images of 77 persons (45±17yo) - 42 LVNC, 15 non-ischemic dilative cardiomyopathy, 20 control group were analyzed. LVNC patients were divided into the subgroup with normal (LVNCN) and high EDV (LVNCDCM). NCM and total left ventricular mass (LVM) were estimated by Hautvast's [excluding intertrabecular blood (ITB) and including papillary muscles (PMs) into NCM] and Jacquier's approach (including ITB and PMs, if unclearly distinguished, into NCM). RESULTS: The cut-off value of NCM for LVNC diagnosis was 22% (AUC 0.933) for NCMH/LVMH and 26% (AUC 0.883) for NCMJ/LVMJ. Inter- and intra-observer variability (estimated by coefficient of variation [CoV] and intraclass correlation coefficient [ICC]) of NCMH/LVMH appeared better than of NCMJ/LVMJ (CoV 4.3%, ICC 0.981 and CoV 4.9%, ICC 0.978; respectively for NCMH/LVMH, while for NCMJ/LVMJ: CoV 19.7%, ICC 0.15 and CoV 12.9%, ICC 0.504). In LVNCN subgroup, the correlation between EDV and NCMH was stronger than NCMJ (r = 0.677, p<0.001 vs. r = 0.480, p = 0.038; respectively). In LVNC the EDV correlated with NCMH/LVMH (r = 0.391, p<0.01), but not with NCMJ/LVMJ. In the overall group a relationship was present between EF and NCMH/LVMH (r = -0.449, p<0.001), but not NCMJ/LVMJ. Only NCMH/LVMH explained the variability of EDV (b 0.434, p<0.001). CONCLUSIONS: Choosing a method of NCM assessment that is less observer-dependent might increase the reliability of results. The impact of method selection on the LV parameters and cut-off values for hypertrabeculation should be further investigated.

4.
Cardiol J ; 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31909474

RESUMO

BACKGROUND: Training on a professional level can lead to cardiac structural adaptations called the "athlete's heart". As marathon participation requires intense physical preparation, the question arises whether the features of "athlete's heart" can also develop in recreational runners. METHODS: The study included 34 males (mean age 40 ± 8 years) who underwent physical examination, a cardiopulmonary exercise test and echocardiographic examination (ECHO) before a marathon. ECHO results were compared with the sedentary control group, reference values for an adult male population and those for highly-trained athletes. Runners with abnormalities revealed by ECHO were referred for cardiac magnetic resonance imaging (CMR). RESULTS: The mean training distance was 56.5 ± 19.7 km/week, peak oxygen uptake was 53.7 ± 6.9 mL/kg/min and the marathon finishing time was 3.7 ± 0.4 h. Compared to sedentary controls, amateur athletes presented larger atria, increased left ventricular (LV) wall thickness, larger LV mass and basal right ventricular (RV) inflow diameter (p < 0.05). When compared with ranges for the general adult population, 56% of participants showed increased left atrial volume, indexed to body surface area (LAVI), 56% right atrial area and interventricular septum thickness, while 47% had enlarged RV proximal outflow tract diameter. In 50% of cases, LAVI exceeded values reported for highly-trained athletes. Due to ECHO abnormalities, CMR was performed in 6 participants, which revealed hypertrophic cardiomyopathy in 1 runner. CONCLUSIONS: "Athlete's heart" features occur in amateur marathon runners. In this group, ECHO reference values for highly-trained elite athletes should be considered, rather than those for the general population and even then LAVI can exceed the upper normal value.

5.
PLoS One ; 14(12): e0225829, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31790492

RESUMO

BACKGROUND: Despite advancements in pharmacological and device-based treatment, heart failure (HF) continues to impose an enormous burden for health care system worldwide. Decompensation of HF is one of the main causes of hospitalization, therefore the identification of patients with the highest risk of such complication is still of great clinical importance. The prognostic significance and utility of global longitudinal strain (GLS) has been previously studied in patients with the broad spectrum of cardiovascular diseases in various endpoints, however its role in assessing the risk of hospitalization due to HF exacerbation of optimally treated outpatients has not been fully explored. Therefore, the aim of the study was to verify whether the GLS of the left ventricle (LV) derived by 2D speckle tracking echocardiography has, independently of other well-known clinical parameters, an additional impact on the risk of HF decompensation in stable patients with LV systolic dysfunction of ischemic origin. METHODS: In 193 clinically stable HF outpatients with LV ejection fraction (LVEF) ≤ 50%, GLS, additionally to other clinical parameters, was analyzed. During 34 (14-71) months of follow-up, 58 patients were hospitalized due to HF decompensation (EVENT). RESULTS: EVENT was significantly associated with age, QRS width, NYHA functional class, left atrium diameter, LV systolic and diastolic volume, LVEF, hemoglobin, brain natriuretic peptide, diuretic treatment, absence of beta-blockers, impaired renal function and history of diabetes in univariate Cox analyzes. GLS with pre-specified cut-off value of -9.4% was also significantly associated with the EVENT (HR 15.16; 95% CI 1.81-126.91). After adjusting for above-mentioned parameters GLS was still a significant predictor of hospitalization due to HF decompensation. CONCLUSIONS: GLS measurement can provide incremental information on the risk of HF decompensation in stable outpatients with LV systolic dysfunction of ischemic origin.

6.
Ir J Med Sci ; 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31820318

RESUMO

The above article was published online with inverted given and family names of the corresponding author. Given name should be Ludmila and Danilowicz-Szymanowicz is the Family name. The correct presentation has been corrected above.

7.
Adv Clin Exp Med ; 28(12): 1667-1673, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31851792

RESUMO

BACKGROUND: Anticancer therapies can be accompanied by cardiovascular complications, including acute coronary syndrome (ACS). In turn, the presence of cancer can influence therapeutic decisions if ACS occurs. OBJECTIVES: The aim of the study was to analyze ACS treatment in patients with cancer. MATERIAL AND METHODS: The study consisted of a retrospective analysis based on the medical records of patients who were admitted due to ACS, with cancer diagnoses. Patients currently undergoing cancer treatment or having treatment which ended up to 6 months before the ACS were included. They were compared to a control group consisting of consecutive patients admitted for ACS during the same period, but who did not have a diagnosis of cancer; they were matched with the experimental group in terms of age, gender and clinical type of ACS. RESULTS: Thirty-two consecutive cancer patients (70 ±9 years; 53% men) met the inclusion criteria. In 22 of them (69%), ACS occurred during their cancer treatment, and in 10 (31%), it presented within 6 months of completing cancer treatment. Upon hospital admission, 19 (59%) cancer patients complained of dyspnea and 7 of typical angina, while in the control group 28, (87%) and 4 (13%) reported such symptoms, respectively.The clinical manifestation of ACS was NSTEMI in 16 patients (50%), UA in 10 (31%) and STEMI in 5 (15.6%). Coronary angiography was done in 25 (78%) of the cancer patients and in all members of the control group. Percutaneous coronary angioplasty (PCA) was performed in 17 (53%) and 23 (72%) of the patients from the respective groups. The median time to percutaneous coronary intervention (PCI) was 10 h (30 min-10 days) among the cancer patients and 7.5 h among the control group (30 min-6 days). There were no PCI-related complications or severe bleeding in both groups. In-hospital mortality was 6.25% in the cancer group and there were no reported hospital deaths in the control group. CONCLUSIONS: Dyspnea is the most common symptom of ACS in cancer patients who are treated invasively too rarely: the presence of cancer and active anticancer treatment should not limit the management of ACS in accordance with current guidelines.


Assuntos
Síndrome Coronariana Aguda , Angioplastia Coronária com Balão , Infarto do Miocárdio , Neoplasias/epidemiologia , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/cirurgia , Idoso , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
9.
Cardiol J ; 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31257569

RESUMO

BACKGROUND: Autonomic imbalance is associated with poor prognosis of patients with systolic dysfunction. Most of the previous data were written several years ago and constituted to cardiovascular or arrhythmic mortality. Current treatment of these patients has improved substantially over the last decades, and thus, the population at risk of death may have altered as well. Consequently, data on high-risk patients with systolic dysfunction in the modern era are sparse and those from previous trials may no longer be applicable. The aim herein, was to verify whether well-known autonomic indices - baroreflex sensitivity (BRS) and heart rate variability (HRV) - remain accurate predictors of mortality in patients with systolic dysfunction. METHODS: Non-invasively obtained BRS and HRV were analyzed in 205 clinically stable patients with left ventricular ejection fraction (LVEF) ≤ 40%. 28 patients died within 28 ± 9 month follow-up. RESULTS: Baroreflex sensitivity, low-frequency (LF) in normalized units, LF to high-frequency ratio and standard deviation of average R-R intervals were significantly associated with mortality; cut-off values of the highest discriminatory power for abovementioned parameters were ≤ 3.0 ms/mmHg, ≤ 41, ≤ 0.7 and ≤ 25 ms, respectively. In bivariate Cox analyses (adjusted for LVEF, New York Heart Association [NYHA] or absence of implantable cardioverter-defibrillator [ICD]) autonomic indices remain significant predictors of death. CONCLUSIONS: Baroreflex sensitivity and HRV - may still be helpful in identifying patients with left ventricular systolic dysfunction at the highest risk of all-cause mortality, independently of LVEF, NYHA class and ICD implantation.

12.
Artigo em Inglês | MEDLINE | ID: mdl-30835340

RESUMO

BACKGROUND: The left ventricular (LV) hypertrophy increases the risk of heart failure. Hypertension and infiltrative cardiomyopathies are the well-known reasons of LV hypertrophy. The growing interest of scientists in this issue affects hereditary hemochromatoris (HH), which characterizes by the excess deposition of iron mostly due to HFE gene mutation. The aim of our study was to investigate the possible influence of HH on LV parameters in patients with early-diagnosed (early HH) and long-lasting and long-treated (old HH) disease. MATERIALS AND METHODS: Thirty nine early HH and 19 old HH patients were prospectively enrolled in the study; age- and sex-matched healthy volunteers constituted the appropriate control groups. All participants had echocardiography performed (including three-dimension volume and mass analysis); the iron turnover parameters were measured at the time of enrolment in every HH patients. RESULTS: Echocardiographic parameters regarding to left atrium (LA), LV thickness, mass and long axis length were significantly higher, whereas LV ejection fraction was lower in early HH in comparison to healthy persons. In old HH patients the differences were similar to those mentioned before, except LV ejection fraction. The presence of hypertension in both HH groups did not influence echo parameters, as well as diabetes in old HH. The strongest correlation in all HH group was found between the time from HH diagnosis and LA, LV thickness and volumes parameters, but the correlations between iron turnover and echo parameters were non-existent. CONCLUSIONS: Hereditary haemochromatosis, not only long-lasting, but also early-diagnosed, could lead to exacerbation of left ventricular wall thickness and cardiac hypertrophy. This effect is not simply connected with hypertension and diabetes that are frequent additional diseases in these patients, but with the time from HH diagnosis.

13.
Pacing Clin Electrophysiol ; 42(5): 537-541, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30828826

RESUMO

BACKGROUND: Implantation of transvenous pacemaker systems is a standard method used to treat patients with bradycardia. There are some clinical settings in which that method cannot be used despite existing indications (such as developmental defects of the cardiovascular system and limited venous access or infections). In such cases, an epicardial pacing system may be implanted with cardiac surgery techniques, at a cost of certain surgical risks. The least invasive approach is subxyphoid, but it traditionally allows to place only a ventricular lead and achieve a single-chamber VVI pacing system. AIM: The aim of our study was to determine the feasibility of subxyphoid implantation of dual-chamber pacing systems using thoracoscopic tools, as well as to and examine the short- and mid-term outcomes of such procedures. METHODS: Patients were qualified for an epicardial pacemaker system in case of absolute indications for permanent pacing therapy and coexisting contraindications for a transvenous system. DDD systems were implanted in 10 consecutive patients, in general anesthesia, in a cardiac surgery operating room, using subxyphoid access to pericardial space and a standard set of minimally invasive thoracoscopic tools. RESULTS: Implantation of a dual-chamber pacing system using the above approach was successful in all attempts. No serious complications were observed. Pacing and sensing parameters were appropriate at implantation and remained such during the follow-up of 2-27 months. CONCLUSION: Implantation of a dual-chamber pacing system using a minimally invasive subxyphoid approach is feasible. Appropriate pacing and sensing values may be obtained and they remain stable during follow-up.


Assuntos
Bradicardia/terapia , Estimulação Cardíaca Artificial/métodos , Procedimentos Cirúrgicos Cardíacos , Eletrodos Implantados , Procedimentos Cirúrgicos Minimamente Invasivos , Marca-Passo Artificial , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
J Forensic Sci ; 64(5): 1551-1554, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30791122

RESUMO

The case of a 69-year-old man, equipped with an ICD and suffering from several chronic cardiac diseases, who died in a car accident, was presented. We analyzed electrogram records from the ICD explanted from the body during the autopsy, which showed that the driver had suffered from malignant ventricular arrhythmia-ventricular fibrillation (VF). A thorough analysis of the details of the accident, as well as the timing of VF and the rhythm observed after the discharge of the ICD showed that the direct cause of the accident was the episode of arrhythmia resulting in a loss of consciousness. Therefore, the presented case illustrates the usefulness of postmortem analysis of electrogram records from ICDs in the reconstruction of road traffic accidents. In such cases, if the victims are implanted with ICDs, it should be a routine procedure performed by forensic pathologists.


Assuntos
Acidentes de Trânsito , Desfibriladores Implantáveis , Inconsciência/etiologia , Fibrilação Ventricular/diagnóstico , Idoso , Humanos , Masculino
15.
Cardiol J ; 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30701515

RESUMO

BACKGROUND: Radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) can be curative. There are conflicting data on whether AF associated atrial and ventricular structural remodeling reverses after ablation. The aim of this study was to evaluate the hemodynamic effect of AF ablation in patients with preserved left ventricular ejection fraction (LVEF). METHODS: 43 AF patients were studied (aged 56 ± 11 years; 29 male, 23% persistent AF, LVEF ≥ 50%) in whom RFCA was performed. Echocardiographic evaluation of atrial and ventricular diameters, volumes and strain imaging by two-dimensional speckle tracking were performed before and at least 6 months after RFCA. Nine patients had AF during baseline examination. RESULTS: A significant decrease in the left (LA) and right (RA) atrial volume and an increase in the LA strain were observed 15 ± 7 months after RFCA. In the subgroup with baseline sinus rhythm, the increment in LA strain was only borderline significant. An increase in RA, right ventricular (RV) and Biatrial strain was noticed (p < 0.05). LVEF and global longitudinal strain of the left ventricle (LV), however, did not improve substantially. CONCLUSIONS: Radiofrequency catheter ablation of AF in patients with preserved LV systolic function results in significant improvement in RA and RV function with a substantial reduction in LA and RA size. No deleterious impact of AF ablation on LA function was revealed.

16.
Ann Noninvasive Electrocardiol ; 24(2): e12610, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30383318

RESUMO

AIMS: Microvolt T-wave alternans (MTWA) testing is a beat-to-beat fluctuation in the amplitude of T wave. We investigated whether: (a) MTWA can be new non-invasive tool for detection of reversible ischemia in patients with suspected CAD without structural heart disease, (b) MTWA can detect ischemia earlier and with greater test accuracy compared with exercise ECG ST-segment testing, and (c) threshold value of MTWA and heart rate at which the alternans is estimated can be different compared to standard values. METHODS: A total of 101 patients with suspected stable coronary disease, but without structural heart disease, were included. Echocardiography, exercise ECG test, MTWA with classical and modified threshold alternans values, and coronary angiography were performed. RESULTS: About 33.3% patients had a false-positive result on exercise ECG test. The sensitivity of exercise ECG ST-segment test in the detection of coronary artery disease was 97.8%, and the specificity was 42.5% (DOR 33.89). In a group of angiographically positive patients, standard MTWA accurately identified 60% of patients, while 40% had a false-negative result. About 91.8% patients with negative angiography result were accurately identified with 8.2% false positives. The sensitivity of MTWA was 59.61% and specificity 91.83%. Best ratio of sensitivity and specificity (86.53% and 95.91%, DOR 151.06) had modified criteria for positive MTWA (MTWA >1.5 µV at heart rate 115-125/min). CONCLUSIONS: This study showed that MTWA can be the new non-invasive tool for the detection of reversible ischemia in patients with suspected CAD without structural heart disease. Also, MTWA can detect ischemia earlier and with greater accuracy compared with exercise ECG testing.

17.
Adv Clin Exp Med ; 28(2): 263-270, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30048058

RESUMO

The increasing number of implantation procedures of implantable cardiac electronic devices (ICEDs) leads to a substantial growth of a cohort of patients in whom complications of such a therapy occur. Infective complications are among the most severe ones, as they are often associated with poor prognosis. Depending on the criteria applied, the incidence of cardiac device infection (CDI) is estimated at 0.5-2.2%. Many risk factors of CDIs have been identified, among which the most important are numerous previous cardiac electrotherapy procedures and their complexity, and the lack of perioperative antibiotic prophylaxis. Appropriate diagnosis of a suspected CDI is of utmost importance, as well as the correct classification of the infection, which leads to adequate treatment. Management of a CDI should include complete removal of the implanted device. Additionally, empirical and then targeted antibiotic therapy should be instituted. The prognosis of CDI may, nonetheless, be unfavorable. Despite appropriate treatment, the total mortality rate of such complication is estimated to be as high as 35%.


Assuntos
Antibioticoprofilaxia/métodos , Infecções Bacterianas/epidemiologia , Desfibriladores Implantáveis/efeitos adversos , Marca-Passo Artificial , Infecções Relacionadas à Prótese/microbiologia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Infecções Bacterianas/etiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Remoção de Dispositivo , Humanos , Prognóstico , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Fatores de Risco
18.
Cardiol J ; 26(6): 669-679, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30234904

RESUMO

BACKGROUND: Severe familial hypercholesterolemia (FH) individuals, refractory to conventional lipidlowering medications are at exceptionally high risk of cardiovascular events. The established therapeutic option of last choice is lipoprotein apheresis (LA). Herein, it was sought to investigate the clinical usefulness of LA in a highly selected group of severe heterozygous FH (HeFH), as recently described by the International Atherosclerosis Society (IAS), for their efficacy in lipid reduction and safety. METHODS: Efficacy and safety of LA were investigated in 318 sessions of 7 severe HeFH females with cardiovascular disease, over a mean period of 26.9 ± 6.5 months. Relative reduction of low density lipoprotein cholesterol (LDL-C) ≥ 60%, clinical complications and vascular access problems were evaluated and compared between the direct adsorption of lipoproteins (DALI) and lipoprotein filtration (Membrane Filtration Optimized Novel Extracorporeal Treatment [MONET]). Additionally, lipoprotein (a) [Lp(a)], total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglycerides (TG) and fibrinogen concentrations were investigated. RESULTS: The relative reduction of LDL-C, TC, TG and Lp(a) were 69.4 ± 12.9%, 59.7 ± 9.1, 51.5 ± ± 14.2% and 71.3 ± 14.4%, respectively. A similar efficacy was found in both systems in LDL-C removal. DALI system led to larger depletions of Lp(a) (80.0 [76-83]% vs. 73.0 [64.7-78.8]%; p < 0.001). The frequency of clinical side effects and vascular access problems were low (8.5%). CONCLUSIONS: Long-term LA in severe HeFH individuals is safe and efficiently reduces LDL-C and Lp(a). Higher efficacy of the DALI system than MONET in Lp(a) removal may indicate the need for individualized application of the LA system in severe HeFH individuals.

19.
Cardiol J ; 2018 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-30338841

RESUMO

Over the past decades, effective cancer therapies have resulted in a significant improvement in the survival rates for a number of cancers and an increase in the number of cancer survivors. Radiation therapy is widely used in the treatment of cancer, and it can induce various cardiotoxicities that differ considerably from chemotherapy-induced cardiotoxicity. They occur primarily as late radiation-induced complications, several years from the end of anticancer treatment and present as coronary artery disease, heart failure, pericardial disease, valvular heart disease and arrhythmias. Patients who recovered from cancer disease suffer from cardiac complications of anticancer treatment, it affects the quality of their lives and life expectancy, especially if the diagnosis is delayed. These patients may present distinct symptoms of cardiac injury, resulting from radiation-induced neurotoxicity and altered pain perception, which makes diagnosis difficult. This review highlights the need for a screening programme for patients who have undergone radiation therapy and which will subsequently have a potentially profound impact on morbidity and mortality.

20.
Echocardiography ; 35(11): 1772-1781, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30255609

RESUMO

BACKGROUND: Hereditary haemochromatosis (HH) is a common inherited disease. Abnormally increased intestinal iron absorption and accelerated recycling of iron by macrophages lead to progressive body iron accumulation and the generation of oxidative stress. In the late stages, iron overload can lead to dysfunction of the left ventricle (LV). It is believed that two-dimensional speckle tracking echocardiography (2D STE) can evaluate LV dysfunction more accurately than conventional echocardiography. This accurate evaluation seems to be clinically important in the early stages of HH before substantial damage of the LV. Evaluation of this assessment was the purpose of this paper. METHODS: We prospectively enrolled 24 patients with early diagnosed HH and without any history of cardiovascular diseases; 23 healthy age- and sex-matched volunteers constituted the control group. Standard echocardiographic parameters and LV rotation and strain parameters were assessed and compared between the groups. RESULTS: All echocardiographic parameters were within normal ranges, and there were no differences between the groups. 2D STE revealed significantly worse basal and apical rotation, twist and torsion values in HH patients. The peak systolic longitudinal strain was decreased in HH patients, even though the LV ejection fraction (LVEF) was normal. There were weak correlations between the iron turnover and 2D STE parameters. CONCLUSIONS: 2D STE seems to be more sensitive than traditional echocardiography for detecting LV abnormalities in HH patients who are diagnosed early. The results of this study may be clinically useful, but their relevance and therapeutic implications remain to be confirmed by further studies.


Assuntos
Ecocardiografia/métodos , Hemocromatose/complicações , Hemocromatose/fisiopatologia , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Adulto , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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