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1.
Zhen Ci Yan Jiu ; 46(10): 880-4, 2021 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-34698464

RESUMO

OBJECTIVE: To observe the effect of auriculotherapy with miniature bian needle on anxious emotion, the condition of angina pectoris attack and sleep quality in the patients with anxiety after percutaneous coronary intervention (post-PCI). METHODS: A total of 74 eligible patients of post-PCI combined with anxious depression were randomized into an auriculotherapy group (37 cases, 2 cases dropped out) and a control group (37 cases, 3 cases dropped out). In the auriculotherapy group, on the base of the conventional secondary prevention medication for coronary heart disease (CHD), auriculotherapy with miniature bian needle was supplemented. In the control group, a proper physical exercise was combined on the base of the secondary prevention medication for CHD. The duration of treatment was 4 weeks in two groups. Separately, the score of Hamilton anxiety scale (HAMA), the score Seattle angina questionnaire (SAQ) and the score of Pittsburgh sleep quality index (PSQI) were assessed in the patients of the two groups before and after treatment. RESULTS: After treatment, the score of HAMA, the score of each item of SAQ and PSQI score were all improved significantly as compared with those before treatment respectively in both the auriculotherapy group and the control group (P<0.001, P<0.05). After treatment, HAMA score, PSQI score and the scores of physical limitation (PL), anginal stability (AS), anginal frequency (AF) and treatment satisfaction (TS) in SAQ in the auriculotherapy group were all better than those in the control group (P<0.001, P<0.05). The total effective rate was 91.43% (32/35) in the auriculotherapy group, obviously higher than 58.82% (20/34) in the control group (P<0.001). CONCLUSION: Auriculotherapy with miniature bian needle effectively relieves anxious emotions and the condition of angina pectrois attack and improves sleep quality in the post-PCI patients with anxiety.


Assuntos
Auriculoterapia , Intervenção Coronária Percutânea , Angina Pectoris/terapia , Ansiedade/terapia , Humanos , Qualidade de Vida , Resultado do Tratamento
2.
J Assoc Physicians India ; 69(8): 11-12, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34472819

RESUMO

Worldwide, coronary heart disease (CHD), have assumed epidemic proportions. Increasing use of interventional therapy and a higher adherence to medical therapy have led to a 33% reduction in cardiac deaths at 5 years after hospital discharge. Angina pectoris is a common symptom of ischemic heart disease. The goals of anti-ischemia therapy in patients with stable coronary artery disease (CAD) include relieving angina symptoms, improving duration of exercise and quality of life, improving prognosis and preventing cardiovascular (CV) events. The consensus statement was devised with the help of multiple meetings held across India. Ten regional advisory board e-meetings were held in Mumbai, Delhi, Chennai, Kolkata, Ahmedabad, Cochin, Trivandrum, Lucknow, Bhopal and Varanasi. These meetings were attended by ten eminent experts from the field of cardiology from each region. Extensive literature review, intense discussions, and feedback from the cardiologists led to the development of the following consensus statements on definition, diagnosis, and management of angina, which have been reported in this article.


Assuntos
Doença da Artéria Coronariana , Qualidade de Vida , Angina Pectoris/diagnóstico , Angina Pectoris/terapia , Consenso , Humanos , Índia
4.
Agri ; 33(1): 46-49, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34254655

RESUMO

In addition to medical approaches, laser revascularization, transmyocardial laser revascularization, angiogenesis, growth factor gene therapy, thoracic epidural anesthesia, and spinal cord simulation are used to treat chronic refractory angina pectoris. A unilateral left stellate ganglion block is another alternative. It may particularly be considered as a palliative intervention in patients with a short life span. Described here is the case of a 66-year-old male patient for whom a unilateral left stellate ganglion blockade was used to treat chronic refractory angina pectoris.


Assuntos
Bloqueio Nervoso Autônomo , Terapia a Laser , Idoso , Angina Pectoris/terapia , Humanos , Masculino , Revascularização Miocárdica , Gânglio Estrelado
5.
Am Heart J ; 241: 38-49, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34224684

RESUMO

BACKGROUND: Patients with refractory angina (RA) have poor quality of life and new therapies are needed. XC001 is a novel adenoviral vector expressing multiple isoforms of vascular endothelial growth factor (VEGF) promoting an enhanced local angiogenic effect. METHODS: The Epicardial Delivery of XC001 Gene Therapy for Refractory Angina Coronary Treatment (EXACT) trial is a 6-month (with 6-month extension) phase 1/2, first-in-human, multicenter, open-label, single-arm, dose-escalation study to evaluate the safety, tolerability, and preliminary efficacy of XC001 in patients with RA. The trial will enroll 33 patients in an initial (n = 12) ascending dose-escalation phase (1 × 109, 1 × 1010, 4 × 1010, and 1 × 1011 viral particles), followed by phase 2 (n = 21) assessing the highest tolerated dose. Patients must have stable Canadian Cardiovascular Society (CCS) class II-IV angina on maximally tolerated medical therapy without options for conventional revascularization, demonstrable ischemia on stress testing, and angina limiting exercise tolerance. XC001 will be delivered directly to ischemic myocardium via surgical transthoracic epicardial access. The primary outcome is safety via adverse event monitoring through 6 months. Efficacy assessments include difference from baseline to month 6 in time to 1 mm of ST segment depression, time to angina, and total exercise duration; myocardial blood flow at rest, and stress and coronary flow reserve by positron emission tomography; quality of life; CCS functional class; and angina frequency. CONCLUSIONS: The EXACT trial will determine whether direct intramyocardial administration of XC001 in patients with RA is safe and evaluate its effect on exercise tolerance, myocardial perfusion, angina and physical activity, informing future clinical investigation. CLINICAL TRIAL REGISTRATION: NCT04125732.


Assuntos
Angina Pectoris , Terapia Genética/métodos , Fatores de Crescimento do Endotélio Vascular , Adenoviridae , Idoso , Angina Pectoris/diagnóstico , Angina Pectoris/fisiopatologia , Angina Pectoris/terapia , Indutores da Angiogênese/farmacologia , Fármacos Cardiovasculares/uso terapêutico , Ensaios Clínicos Fase II como Assunto , Sistemas de Liberação de Medicamentos/métodos , Tolerância ao Exercício , Feminino , Vetores Genéticos , Humanos , Masculino , Dose Máxima Tolerável , Pericárdio/cirurgia , Resultado do Tratamento , Fatores de Crescimento do Endotélio Vascular/genética , Fatores de Crescimento do Endotélio Vascular/farmacologia
6.
Rev Port Cardiol (Engl Ed) ; 40(5): 371-382, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34187640

RESUMO

Refractory angina is defined as persistent angina (≥3 months) despite optimal medical and interventional therapies. It is increasing in frequency, due to the success of current medical and interventional therapies in improving the prognosis of coronary artery disease. Long-term mortality is similar to that of patients with asymptomatic stable disease, but it affects patients' quality of life, and has a significant impact on health care resources. Several therapeutic targets have been investigated, most with disappointing results. Many of the techniques have been abandoned because of lack of efficacy, safety issues, or economic and logistic limitations to wider applicability. The primary focus of this review is the coronary sinus Reducer, supporting evidence for which, although scarce, is promising regarding safety and efficacy in improving anginal symptoms and quality of life. It is also accessible to virtually all interventional cardiology departments.


Assuntos
Doença da Artéria Coronariana , Seio Coronário , Angina Pectoris/terapia , Doença da Artéria Coronariana/terapia , Humanos , Qualidade de Vida , Resultado do Tratamento
7.
Int J Cardiovasc Imaging ; 37(8): 2483-2490, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34037889

RESUMO

External Counterpulsation (ECP) is one of the therapeutic options in patients with refractory angina inadequately controlled by medical, interventional, or surgical therapy. The 2D Speckle Tracking Echocardiography (2D-STE) method is considered superior in assessing clinical improvement. We would like to evaluate any improvement of myocardial intrinsic function using 2D-STE in patients underwent standard ECP protocol (35 sessions). We conducted a double-blind randomized controlled trial. Patients with refractory angina who could not be revascularized conventionally were randomized into two groups: (1) the ECP group (300 mmHg) and (2) the Sham/control group (75 mmHg). ECP standard therapy was given for 35 sessions (1 h/day/session). The 2D-STE data, including longitudinal strain and post systolic index (PSI) were obtained before and after therapy. 43 subjects were analyzed, with 22 subjects in ECP group and 21 control subjects (Sham group). A homogenous baseline strain was found either globally (12.42 ± 4.55 vs 12.00 ± 4.92 [- %]; P = 0.774) or segmentally/regionally (12.63 (0.01-25.16) vs 12.43 (0.01-27.20) [- %]; P = 0.570). There was no statistically significant improvement between groups in the left ventricle longitudinal strain globally (P = 0.535) and segmentally/regionally (P = 0.434). PSI parameters showed improvement in the ECP group (P = 0.049), and segments with PSI ≥ 20% seemed to improve longitudinal strains in the ECP group after therapy (P = 0.042). In conclusion, 35 ECP therapy sessions did not improve either global or segmental/regional left ventricular mechanical function in patients with refractory angina. However, the mechanical function of myocardial segments with PSS tends to improve after ECP therapy.


Assuntos
Contrapulsação , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/terapia , Ecocardiografia , Humanos , Valor Preditivo dos Testes , Função Ventricular Esquerda
8.
ESC Heart Fail ; 8(3): 2316-2319, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33792203

RESUMO

A 72-year-old man daily suffered from a refractory angina consecutive to a diffuse coronary artery disease despite optimal medical management. Revascularization could not be performed because of a severe thrombopenia. He was referred to our outpatient cardiac rehabilitation programme where he was candidate for 20 sessions, three times a week, of high-intensity aerobic interval training involving brief episodes of regressive myocardial ischaemia. After 7 weeks, exercise capacity (+28.5%), VO2 peak (35.7%), and ischaemic threshold increased while clinical status and quality of life improved. No adverse effect was reported. Aerobic interval training with myocardial ischaemia might be a therapeutic alternative in refractory angina.


Assuntos
Reabilitação Cardíaca , Doença da Artéria Coronariana , Isquemia Miocárdica , Idoso , Angina Pectoris/diagnóstico , Angina Pectoris/terapia , Humanos , Masculino , Isquemia Miocárdica/complicações , Qualidade de Vida
12.
Indian Heart J ; 73(1): 135-137, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33714401

RESUMO

RESULTS: of the efficAcy and safety of Trimetazidine in patients with angina pectoris having been treated by Percutaneous Coronary Intervention (ATPCI) study showed no significant difference in the incidence of primary endpoint events between trimetazidine and placebo group in angina patients who recently underwent percutaneous coronary intervention. However, the study had limitations specific to both, design and selection of patient population. Here, we present some explanations for the null effects of trimetazidine in the ATPCI study and their relevance in routine clinical practice.


Assuntos
Angina Pectoris/terapia , Intervenção Coronária Percutânea/métodos , Trimetazidina/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Vasodilatadores/farmacologia
13.
Circ Cardiovasc Interv ; 14(2): e009002, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33541098

RESUMO

The combination of an aging population and improved survival rates among patients with coronary artery disease has resulted in an increase in the number of patients with refractory angina or anginal equivalent symptoms despite maximal medical therapy. Patients with refractory angina are often referred to the cardiac catheterization laboratory; however, they have often exhausted conventional revascularization options; thus, this population is often deemed as having "no options." We review the definition, prevalence, outcomes, therapeutic options, and treatment considerations for no-option refractory angina patients and focus on novel therapies for this complex and challenging population. We propose a multidisciplinary team approach for the evaluation and management of patients with refractory angina, ideally in a designated clinic. The severe limitations and symptomatology experienced by these patients highlight the need for additional research into the development of innovative treatments.


Assuntos
Angina Pectoris , Doença da Artéria Coronariana , Idoso , Angina Pectoris/diagnóstico , Angina Pectoris/epidemiologia , Angina Pectoris/terapia , Humanos
14.
Clin Cardiol ; 44(3): 424-428, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33605473

RESUMO

BACKGROUND: Coronary sinus (CS) narrowing by reducer implantation has emerged as a safe and effective therapy for patients suffering from refractory angina. However, data regarding the clinical benefit of this treatment over time is lacking. METHODS: Patients undergoing successful reducer implantation were enrolled prospectively to clinical registries at three medical centers. Those with more than 2-years of follow-up were included in the present analysis. Peri-procedural data, data regarding adverse events, and current evaluation of angina severity (Canadian Cardiovascular Society [CCS] class) were collected. RESULTS: Overall, 99 consecutive patients (77% males, mean age 69.8 ± 9.4) with severe angina were enrolled between September 2010 and October 2017 and included in the present analysis. No procedure-related complications were recorded. During a median follow up time of 3.38 years (IQR 2.95-4.40), 15.1% of the patients died, 9% experienced myocardial infarction (MI) and 21% underwent percutaneous coronary intervention (PCI). Mean CCS class was 3.1 ± 0.5 at baseline, improved to 1.66 ± 0.8 at 1 year (p < .001), and remained low through 2-years and at last follow up (1.72 ± 0.8 and 1.71 ± 0.8, p > 0.5 for both, in comparison to 1 year). At baseline 91% of patients reported severe disabling angina (CCS class 3-4), at 1 year only 17.9% suffered from disabling angina, p < .001, and this portion remained low overtime (19% at last follow up). CONCLUSION: Long-term mortality of patients undergoing reducer implantation is similar to that reported for patients with stable coronary artery disease. The previously reported short-term efficacy of the reducer, reflected by significant improvement of angina symptoms, is maintained over time.


Assuntos
Seio Coronário , Intervenção Coronária Percutânea , Idoso , Angina Pectoris/diagnóstico , Angina Pectoris/terapia , Canadá , Seio Coronário/diagnóstico por imagem , Seio Coronário/cirurgia , Feminino , Humanos , Masculino , Intervenção Coronária Percutânea/efeitos adversos , Resultado do Tratamento
16.
Pain Med ; 22(4): 1005-1009, 2021 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-33624815

RESUMO

BACKGROUND: The Seattle Angina Questionnaire (SAQ) is a self-administered questionnaire used in cardiac patients to quantify angina based on five scales: physical limitation scale, anginal stability scale, anginal frequency scale, treatment satisfaction scale, and the disease perception scale. Here we report the use of the SAQ to assess angina symptoms in 18 patients who underwent spinal cord stimulation (SCS) for refractory angina pectoris (RAP) at the Mayo Clinic. METHODS: Electronic health records were searched to find patients who underwent SCS for the treatment of RAP at a single institution from 2003 to 2018. Eligible patients were asked to participate in a phone survey that included the SAQ. RESULTS: Out of 13 patients who still had their implant, six (46%) had minimal physical limitations. Ten patients (76.9%) had favorable anginal frequency scores, defined as minimal or mild. Out of the five patients who had their device removed, one (20%) had minimal physical limitations and three (60%) had favorable anginal frequency scores. There was a high treatment satisfaction score for both those with their implant in place and those with the device removed. CONCLUSION: The SAQ is useful as a comprehensive measure specific to patients with RAP assessing function, pain, and satisfaction. The utilization of this tool pre- and post-operatively may provide additional information to analyze the effectiveness of SCS for RAP.


Assuntos
Estimulação da Medula Espinal , Angina Pectoris/terapia , Humanos , Qualidade de Vida , Medula Espinal , Inquéritos e Questionários
17.
Medicine (Baltimore) ; 100(3): e24080, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546012

RESUMO

INTRODUCTION: Patients with angina pectoris (AP) often experience heavy psychological distress, especially anxiety and depression, which results in poorer quality of life, shorter survival time. Acupoint therapies, including massage, acupuncture, acupoints injection, acupressure, and moxibustion, showed clinical and long-lasting benefits for AP, but the efficiency of acupoint therapies was poorly evaluated. The current review is attempted to evaluate the efficacy and safety of the different acupoint-based therapies for AP. METHODS AND ANALYSIS: A literature search will be conducted in MEDLINE, EMBASE, Web of Science, Cochrane Library, Web of Science, PubMed, Science Direct, Wan Fang Data Knowledge Service Platform, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database), and China National Knowledge Infrastructure (CNKI). Observational studies regarding the association between liver cancer and depression and anxiety written in English or Chinese will be included. Study inclusion, data extraction, and quality assessment will be performed independently by 2 reviewers. We will use RevMan V.5.0 and STATA V.12.0 software for statistical analysis. The I2 test will be used to identify the extent of heterogeneity. Publication bias will be assessed by generating a funnel plot and performing the Begg and Egger test. The quality of the systematic review will be evaluated using the Measurement Tool to Assess Systematic Reviews (AMSTAR) and Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria. With the permitted numeric data, we will carry out a meta-analysis. RESULTS: This study will provide a high-quality synthesis of pain VAS and functional disability or the quality of life, the success treatment rate, the recurrent rate and the complications rate to assess the effectiveness and safety of acupoint for AP patients. This systematic review will provide evidence to judge whether acupoint is an effective intervention for patients with AP. CONCLUSION: This systematic review and meta-analysis will provide evidence to judge whether acupoint is an effective intervention for patients with AP and provide evidence for designing early targeted interventions for high-risk survivors that can attenuate negative reactions. PROSPERO REGISTRATION NUMBER: 10.17605/OSF.IO/VNXWE.


Assuntos
Pontos de Acupuntura , Angina Pectoris/terapia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
18.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563688

RESUMO

We describe a case of a compartment syndrome after transulnar coronary intervention. As far as we are aware of, this is the first report of such a complication after a transulnar approach described in the literature. Compartment syndrome is a very rare but possibly devastating complication of coronary angiography and percutaneous coronary interventions. We retrospectively observed an incidence rate of 0.007% after 13,948 coronary angiographies or 0.013% after 7532 interventions performed through the wrist in our centre in the last 5 years. Rapid recognition and treatment of this rare complication may prevent long-term morbidity and are thus of utmost importance. General measures should be taken to reduce this incidence of this serious complication.


Assuntos
Angina Pectoris/terapia , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Artéria Ulnar , Angina Pectoris/diagnóstico , Biomarcadores/sangue , Síndromes Compartimentais/diagnóstico por imagem , Diagnóstico Diferencial , Stents Farmacológicos , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Sutura , Ultrassonografia
19.
Am J Cardiol ; 144: 26-32, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33385348

RESUMO

Extracorporeal shockwave myocardial revascularization (ESMR) is a therapy for refractory angina pectoris. Our aim was to assess the efficacy and safety of ESMR in the management of patients with stable coronary artery disease (CAD) and heart failure as well as its effects on inflammation and angiogenesis. In this single-arm prospective trial, we included 48 patients with CAD, myocardial ischemia assessed by radionuclide imaging, echocardiographic evidence of left ventricular systolic dysfunction and without revascularization options. Changes in angina grading score, myocardial perfusion, left ventricular ejection fraction, and six-minute walk test after ESMR therapy were used for efficacy assessment. Changes of inflammation and angiogenesis biomarkers were also evaluated. ESMR therapy was performed using a commercially available cardiac shockwave generator system (Cardiospec; Medispec). After 9 weeks of ESMR therapy, a significant improvement was found regarding the initial angina class, severity of ischemia, left ventricular ejection fraction, and six-minute walk test in most patients. No deleterious side effects after treatment were detected. Regarding biomarkers, endothelial progenitor cells and angiopoietin-3 were significantly increased whereas IL-18 and TGF-ß were significantly decreased after ESMR in the total group. Notably, VEGF, IL-1ß, and lipoxin A4 levels were significantly increased only in patients with myocardial ischemia improvement. In conclusion, ESMR therapy is safe and effective in most but not all patients with CAD and heart failure. ESMR is associated with increased markers of angiogenesis and decreased markers of inflammation. Myocardial ischemia improvement after ESMR is associated with increased markers of angiogenesis and pro-resolving mediators.


Assuntos
Angina Pectoris/terapia , Doença da Artéria Coronariana/terapia , Tratamento por Ondas de Choque Extracorpóreas/métodos , Insuficiência Cardíaca/fisiopatologia , Revascularização Miocárdica/métodos , Disfunção Ventricular Esquerda/fisiopatologia , Idoso , Angina Pectoris/complicações , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/metabolismo , Proteínas Semelhantes a Angiopoietina/metabolismo , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/metabolismo , Citocinas/metabolismo , Células Progenitoras Endoteliais , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/metabolismo , Humanos , Interleucina-18/metabolismo , Interleucina-1beta/metabolismo , Lipoxinas/metabolismo , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio , Estudos Prospectivos , Índice de Gravidade de Doença , Volume Sistólico , Fator de Crescimento Transformador beta/metabolismo , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/metabolismo , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/metabolismo , Teste de Caminhada
20.
Clin Cardiol ; 44(2): 160-167, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33400292

RESUMO

BACKGROUND: Enhanced external counterpulsation (EECP) is a noninvasive treatment that can decrease limiting symptoms in patients with refractory angina pectoris (RAP). Identifying responders to EECP is important as EECP is not widely available and relatively time intensive. HYPOTHESIS: The effect of EECP treatment on physical capacity in patients with RAP can be predicted from baseline patient characteristics and clinical factors. METHODS: This explorative study includes all patients from a cardiology clinic who had finished one EECP treatment and a 6 min walk test pre and post EECP. Clinical data, including Canadian Cardiovascular Society (CCS) classification and left ventricular ejection fraction (LVEF), were assessed before treatment. If patients increased their 6 min walking distance (6MWD) by 10% post EECP, they were considered responders. RESULTS: Of the 119 patients (men = 97, 40-91 years), 49 (41.2%) were responders. Multinomial regression analysis showed that functional status (i.e., CCS class ≥3) (OR 3.10, 95% CI 1.12-8.57), LVEF <50% (OR 2.82, 95% CI 1.02-7.80), and prior performed revascularization (i.e., ≤ 1 type of intervention) (OR 2.77, 95% CI 1.06-7.20) were predictors of response to EECP (p < .05, Accuracy 63.6%). Traditional risk factors (e.g., gender, smoking, and comorbidities) did not predict response. CONCLUSIONS: EECP treatment should be considered preferentially for patients that have a greater functional impairment, evidence of systolic left ventricular dysfunction, and exposure to fewer types of revascularization, either PCI or CABG. Improvement in 6MWD post EECP could imply improvement in physical capacity, which is a likely contributor to improved well-being among patients with RAP.


Assuntos
Contrapulsação , Intervenção Coronária Percutânea , Angina Pectoris/diagnóstico , Angina Pectoris/terapia , Canadá , Seguimentos , Humanos , Masculino , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
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