49 results on '"Ma, C.S."'
Search Results
2. Novel rockburst criterion based on the TBM tunnel construction of the Neelum–Jhelum (NJ) hydroelectric project in Pakistan
- Author
-
Ma, C.S., Chen, W.Z., Tan, X.J., Tian, H.M., Yang, J.P., and Yu, J.X.
- Published
- 2018
- Full Text
- View/download PDF
3. Dabigatran versus vitamin K antagonists for atrial fibrillation in clinical practice: final outcomes from Phase III of the GLORIA-AF registry
- Author
-
Huisman, M.V., Teutsch, C., Lu, S.H., Diener, H.C., Dubner, S.J., Halperin, J.L., Ma, C.S., Rothman, K.J., Lohmann, R., Gurusamy, V.K., Bartels, D.B., Lip, G.Y.H., and GLORIA-AF Investigators
- Subjects
Vitamin K ,Medizin ,Myocardial Infarction ,Administration, Oral ,Anticoagulants ,Hemorrhage ,General Medicine ,Atrial fibrillation ,Dabigatran ,Stroke ,Anticoagulation ,Clinical Trials, Phase III as Topic ,Fibrinolytic Agents ,Stroke prevention ,Humans ,Prospective Studies ,Registries ,Vitamin K antagonist ,Cardiology and Cardiovascular Medicine ,Aged - Abstract
Background Prospectively collected, routine clinical practice-based data on antithrombotic therapy in non-valvular atrial fibrillation (AF) patients are important for assessing real-world comparative outcomes. The objective was to compare the safety and effectiveness of dabigatran versus vitamin K antagonists (VKAs) in patients with newly diagnosed AF. Methods and results GLORIA-AF is a large, prospective, global registry program. Consecutive patients with newly diagnosed AF and CHA2DS2-VASc scores ≥ 1 were included and followed for 3 years. To control for differences in patient characteristics, the comparative analysis for dabigatran versus VKA was performed on a propensity score (PS)-matched patient set. Missing data were multiply imputed. Proportional-hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Between 2014 and 2016, 21,300 eligible patients were included worldwide: 3839 patients were prescribed dabigatran and 4836 VKA with a median age of 71.0 and 72.0 years, respectively; > 85% in each group had a CHA2DS2-VASc-score ≥ 2. The PS-matched comparative analysis for dabigatran and VKA included on average 3326 pairs of matched initiators. For dabigatran versus VKAs, adjusted HRs (95% confidence intervals) were: stroke 0.89 (0.59–1.34), major bleeding 0.61 (0.42–0.88), all-cause death 0.78 (0.63–0.97), and myocardial infarction 0.89 (0.53–1.48). Further analyses stratified by PS and region provided similar results. Conclusions Dabigatran was associated with a 39% reduced risk of major bleeding and 22% reduced risk for all-cause death compared with VKA. Stroke and myocardial infarction risks were similar, confirming a more favorable benefit-risk profile for dabigatran compared with VKA in clinical practice. Clinical trial registrationhttps://www.clinicaltrials.gov. NCT01468701, NCT01671007. Graphical abstract
- Published
- 2022
4. Erratum: Dominant-negative mutations in human IL6ST underlie hyper-IgE syndrome (J. Exp. Med. (2020) 217:6 Doi:10.1084/jem.20191804)
- Author
-
Charbonnier, L.-M., Boisson, B., Couderc, L.-J., Abel, L., Rosain, J., Burrage, L.C., Chen, Y.-H., Schmitz-Abe, K., Butte, M.J., de Bruyne, M., Renkilaraj, M.R.L.M., Fieschi, C., Haerynck, F., Chatila, T.A., Casanova, J.-L., Laurence, A., Béziat, V., Materna, M., Aschenbrenner, D., Puel, A., Gartner, L., Murdock, D.R., Vladikine, N., Kohn, L.A., Staal, J., Roels, L., Dai, H., Avettand-Fenoel, V., Tavernier, S.J., Esther, C.R., Jr., Dogu, F., Catherinot, É., Tcherakian, C., Tangye, S.G., Boutboul, D., Keles, S., Grimbacher, B., Amourette, J., Seeleuthner, Y., Gauvain, C., Uhlig, H.H., Worley, L., Vogel, T.P., Ikinciogullari, A., Ouachée-Chardin, M., Jeljeli, M., Milner, J.D., Haskologlu, S., Rosenfeld, J.A., Migaud, M., Lambrecht, B.N., Network, U.D., Freeman, A.F., Lebras, M.-N., Beyaert, R., Ma, C.S., Ciznar, P., Claes, K., Nammour, J., and van Braeckel, E.
- Abstract
The authors regret that in the original version of Table S1, the column for patient 12 was mistakenly duplicated in the column for patient 8. The online Table S1 PDF has been corrected. The error appears only in PDFs downloaded before June 4, 2020.
- Published
- 2020
- Full Text
- View/download PDF
5. Suppression of Polarization Dependence in the Design of a 11×11 Polymer/Si Arrayed Waveguide Grating
- Author
-
Zhao, Y., Ma, C.S., Wang, F., Zhang, D.M., Cui, Z.C., Guo, W.B., and Yi, M.B.
- Published
- 2004
- Full Text
- View/download PDF
6. Band structures and characteristics of InGaAs/InGaAsP strain-compensated quantum well lasers
- Author
-
Ma, C.S., Wang, L.J., and Liu, S.Y.
- Published
- 2001
- Full Text
- View/download PDF
7. Polymeric 1 × 32 arrayed waveguide grating multiplexer using cross-linkable fluorinated poly (ether ether ketone) at 1550 nm
- Author
-
Wang, F., Li, A.Z., Sun, W., Zhao, Y., Zhang, D.M., Ma, C.S., and Liu, S.Y.
- Published
- 2006
- Full Text
- View/download PDF
8. Comprehensive analysis of the cytokine-rich chromosome 5q31.1 region suggests a role for IL-4 gene variants in prostate cancer risk
- Author
-
Tindall, E.A., Severi, G., Hoang, H.N., Ma, C.S., Fernandez, P., Southey, M.C., English, D.R., Hopper, J.L., Heyns, C.F., Tangye, S.G., Giles, G.G., and Hayes, V.M.
- Published
- 2010
- Full Text
- View/download PDF
9. The Changing Landscape for Stroke Prevention in AF: Findings From the GLORIA-AF Registry Phase 2
- Author
-
Huisman, M.V., Rothman, K.J., Paquette, M., Teutsch, C., Diener, H.C., Dubner, S.J., Halperin, J.L., Ma, C.S., Zint, K., Elsaesser, A., Bartels, D.B., Lip, G.Y., and Hemels, M.E.
- Subjects
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] - Abstract
Item does not contain fulltext BACKGROUND: GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non-vitamin K antagonist oral anticoagulant (NOAC), became available. OBJECTIVES: This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. METHODS: During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients' baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. RESULTS: Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age >/=75 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score >/=2; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. CONCLUSIONS: The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701).
- Published
- 2017
10. Fabrication techniques for colymer/Si optical waveguide
- Author
-
Zhao, Y, Zhang, D.M, Wang, F, Cui, Z.C, Yi, M.B, Ma, C.S, Guo, W.B, and Liu, S.Y
- Published
- 2004
- Full Text
- View/download PDF
11. Safety and effectiveness of Dabigatran in patients with atrial fibrillation with and without prior stroke : Data from the Gloria-AF Registry Program
- Author
-
Diener, Hans Christoph, Teutsch, C., Huisman, M.V., Dubner, S.J., Ma, C.S., Rothmann, W.J., Lu, S., Paquette, M., Zint, K., and Franca, L.R.
- Subjects
Medizin - Published
- 2018
12. Scholarly publishing depends on peer reviewers
- Author
-
Fernandez-Llimos F., Berti A.D., Yeung D., Yusuff K.B., El Zowalaty M.E., Adane E.D., Al-Aqeel S., Al-Jumaili A.A., Alili-Idrizi E., Andelkovic M., Aranha A., Arief M., Arkaravichien W., Armoiry X., Attarabeen O.F., Ayoub N., Bajorek B.V., Beninger P., Billups S.J., Bowen J.F., Bouwmeester C., Campbell P., Chan V., Connor S.E., Danziger L.H., Dawood O.T., Dunnenberger M., Elrouby S., Fakih S., Abu Farha R.K., Figueiredo I.V., Foroutan N., Forsythe L.E., Frail C.K., Friesner D., Funk K., Gaither C., Gallimore C.E., Gan V., Garcia B.H., Gaskins J.L., Gastelurrutia M.A., Gatwood J., Genord C.K., Gilliam E., Goodbar N.H., Gossell-Williams M., Grundy Q., Guenette L., Hadi M.A., Hallit S., Hammond D.A., Hawasli R.S., Herdeiro M.T., Hermansyah A., Hincapie A.L., Hoehns J.D., Hossain L.N., Hudspeth B., Ibrahim M.I.B.M., Islahudin F., Jacobsen R., Jones M., Kälvemark Sporrong S., Kantelhardt P., Katangwe T., Katoue M.G., King S.R., Kinnear M., Kouladjian O'Donnell L., Kovacevic S.V., Krass I., Kraus S.K., Lakic D., Larson D., LeMay K., Loh B.C., Lowres N., Luetsch K., Lunghi C., Lyra D.P., Jr., Ma C.S., MacDonald E.A., Mancuso M.A., Mazhar F., McCarthy L., McComb M., McFarland M.S., Mehralian G., Merks P., Modun D., Mohammed M.A., Motulsky A., Mukattash T.L., Nabhani-Gebara S., Najafi S., Ni W., Nitadpakorn S., Ogbo P.U., Palaian S., Patel R.J., Payne M.H., Peaslee A.K., Pereira L.R., Perry T.D., Phan Y., Plage S., Prybylski J.P., Quffa L.H., Raka L., Ramos-Esquivel A., Ramsbottom H., Rayes I.K., Rodriguez J.V., Rosenthal M., Sadowski C.A., Sage A., Salgado T.M., Saw P.S., Schafer K.M., Schutte T., Shafie A.A., Shah R.M., Sharma A., Shehnaz S.I., Shiyanbola O.O., Siitonen P., Skinner I., Snyder M.E., Stewart D., Strang A., Stranges P.M., Sultana K., Surbhi S., Suzen H.S., Swieczkowski D., Tasaka C.L., Taylor A.M., Theberge C.R., Travlos D.V., Turner J.R., Vandenberk B., Wettergreen S.A., White C.M., Wietholter J.P., Wirth F., Young A., Zembles T., Pharmacy Practice 2017 peer reviewers, Fernandez-Llimos F., Berti A.D., Yeung D., Yusuff K.B., El Zowalaty M.E., Adane E.D., Al-Aqeel S., Al-Jumaili A.A., Alili-Idrizi E., Andelkovic M., Aranha A., Arief M., Arkaravichien W., Armoiry X., Attarabeen O.F., Ayoub N., Bajorek B.V., Beninger P., Billups S.J., Bowen J.F., Bouwmeester C., Campbell P., Chan V., Connor S.E., Danziger L.H., Dawood O.T., Dunnenberger M., Elrouby S., Fakih S., Abu Farha R.K., Figueiredo I.V., Foroutan N., Forsythe L.E., Frail C.K., Friesner D., Funk K., Gaither C., Gallimore C.E., Gan V., Garcia B.H., Gaskins J.L., Gastelurrutia M.A., Gatwood J., Genord C.K., Gilliam E., Goodbar N.H., Gossell-Williams M., Grundy Q., Guenette L., Hadi M.A., Hallit S., Hammond D.A., Hawasli R.S., Herdeiro M.T., Hermansyah A., Hincapie A.L., Hoehns J.D., Hossain L.N., Hudspeth B., Ibrahim M.I.B.M., Islahudin F., Jacobsen R., Jones M., Kalvemark Sporrong S., Kantelhardt P., Katangwe T., Katoue M.G., King S.R., Kinnear M., Kouladjian O'Donnell L., Kovacevic S.V., Krass I., Kraus S.K., Lakic D., Larson D., LeMay K., Loh B.C., Lowres N., Luetsch K., Lunghi C., Lyra D.P., Ma C.S., MacDonald E.A., Mancuso M.A., Mazhar F., McCarthy L., McComb M., McFarland M.S., Mehralian G., Merks P., Modun D., Mohammed M.A., Motulsky A., Mukattash T.L., Nabhani-Gebara S., Najafi S., Ni W., Nitadpakorn S., Ogbo P.U., Palaian S., Patel R.J., Payne M.H., Peaslee A.K., Pereira L.R., Perry T.D., Phan Y., Plage S., Prybylski J.P., Quffa L.H., Raka L., Ramos-Esquivel A., Ramsbottom H., Rayes I.K., Rodriguez J.V., Rosenthal M., Sadowski C.A., Sage A., Salgado T.M., Saw P.S., Schafer K.M., Schutte T., Shafie A.A., Shah R.M., Sharma A., Shehnaz S.I., Shiyanbola O.O., Siitonen P., Skinner I., Snyder M.E., Stewart D., Strang A., Stranges P.M., Sultana K., Surbhi S., Suzen H.S., Swieczkowski D., Tasaka C.L., Taylor A.M., Theberge C.R., Travlos D.V., Turner J.R., Vandenberk B., Wettergreen S.A., White C.M., Wietholter J.P., Wirth F., Young A., Zembles T., and Internal medicine
- Subjects
lcsh:RS1-441 ,Pharmaceutical Science ,Economic shortage ,Pharmacy ,030226 pharmacology & pharmacy ,lcsh:Pharmacy and materia medica ,03 medical and health sciences ,0302 clinical medicine ,Periodicals as topic ,Open access publishing ,Political science ,GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries) ,Original Research ,Final version ,business.industry ,Research ,mesh:Periodicals as Topic ,lcsh:RM1-950 ,mesh:Open Access Publishing ,Public relations ,lcsh:Therapeutics. Pharmacology ,Ask price ,Publishing ,030221 ophthalmology & optometry ,business - Abstract
The peer-review crisis is posing a risk to the scholarly peer-reviewed journal system. Journals have to ask many potential peer reviewers to obtain a minimum acceptable number of peers accepting reviewing a manuscript. Several solutions have been suggested to overcome this shortage. From reimbursing for the job, to eliminating pre-publication reviews, one cannot predict which is more dangerous for the future of scholarly publishing. And, why not acknowledging their contribution to the final version of the article published? PubMed created two categories of contributors: authors [AU] and collaborators [IR]. Why not a third category for the peer-reviewer? published
- Published
- 2018
13. Catheter ablation of left-sided accessory pathway with left superior vena cava
- Author
-
Ma, C.S., Hu, Dayi, Fang, Q., Shang, L.H., Wang, L.F., Belz, Michael K., and Wood, Mark A.
- Subjects
Congenital heart disease -- Care and treatment ,Cardiac catheterization -- Health aspects ,Vena cava -- Abnormalities ,Health - Published
- 1995
14. P2678Size of right atrial fails to predict arrhythmia recurrence after catheter ablation of persistent atrial fibrillation
- Author
-
Wen, S.N., primary, Liu, N., additional, Bai, R., additional, Ruan, Y.F., additional, Du, X., additional, Dong, J.Z., additional, and Ma, C.S., additional
- Published
- 2017
- Full Text
- View/download PDF
15. P2645Elevated homocysteine is associated with the risk of left atrial/left atrial appendage thrombus in atrial fibrillation
- Author
-
Yao, Y., primary, Du, X., additional, Dong, J.Z., additional, and Ma, C.S., additional
- Published
- 2017
- Full Text
- View/download PDF
16. P2665Incidence and significance of early recurrence of atrial tachyarrhythmia after catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy
- Author
-
Wen, S.N., primary, Liu, N., additional, Ruan, Y.F., additional, Bai, R., additional, Li, S.N., additional, Du, X., additional, Dong, J.Z., additional, and Ma, C.S., additional
- Published
- 2017
- Full Text
- View/download PDF
17. P4600Prescribing of dabigatran etexilate in accordance with the European label for stroke prevention in atrial fibrillation: Findings from the GLORIA-AF Registry
- Author
-
Lip, G.Y.H., primary, Teusch, C., additional, Huisman, M.V., additional, Diener, H.C., additional, Dubner, S.J., additional, Ma, C.S., additional, Rothman, K.J., additional, Elsaesser, A., additional, Paquette, M., additional, Zint, K., additional, Bartels, D., additional, and Halperin, J.L., additional
- Published
- 2017
- Full Text
- View/download PDF
18. P2664Fragmented QRS predicts arrhythmia recurrence after catheter ablation of atrial fibrillation in patients with hypertrophic
- Author
-
Wen, S.N., primary, Liu, N., additional, Bai, R., additional, Ruan, Y.F., additional, Li, S.N., additional, Du, X., additional, Dong, J.Z., additional, and Ma, C.S., additional
- Published
- 2017
- Full Text
- View/download PDF
19. Effect of enzymolytic soybean meal on growth performance, nutrient digestibility and immune function of growing broilers
- Author
-
Wang, J.P., primary, Liu, N., additional, Song, M.Y., additional, Qin, C.L., additional, and Ma, C.S., additional
- Published
- 2011
- Full Text
- View/download PDF
20. Electronegativity difference as a factor for evaluating the thermal stability of Al-rich metallic glasses
- Author
-
Ma, C.S., primary, Zhang, J., additional, Chang, X.C., additional, Hou, W.L., additional, and Wang, J.Q., additional
- Published
- 2008
- Full Text
- View/download PDF
21. Efficient atomic packing clusters and glass formation in ternary Al-based metallic glasses
- Author
-
Ma, C.S., primary, Zhang, J., additional, Hou, W.L., additional, Chang, X.C., additional, and Wang, J.Q., additional
- Published
- 2008
- Full Text
- View/download PDF
22. Polymeric 1×32 arrayed waveguide grating multiplexer using cross-linkable fluorinated poly (ether ether ketone) at 1550nm
- Author
-
Wang, F., primary, Li, A.Z., additional, Sun, W., additional, Zhao, Y., additional, Zhang, D.M., additional, Ma, C.S., additional, and Liu, S.Y., additional
- Published
- 2006
- Full Text
- View/download PDF
23. MILP optimal path planning for real-time applications
- Author
-
Ma, C.S., primary and Miller, R.H., additional
- Published
- 2006
- Full Text
- View/download PDF
24. Simple control strategy for balancing the DC-link voltage of neutral-point-clamped inverter at low modulation index
- Author
-
Kang, D.W., primary, Ma, C.S., additional, Kim, T.J., additional, and Hyun, D.S., additional
- Published
- 2004
- Full Text
- View/download PDF
25. Mixed Integer Linear Programming Trajectory Generation for Autonomous Nap-of-the-Earth Flight in a Threat Environment.
- Author
-
Ma, C.S. and Miller, R.H.
- Published
- 2005
- Full Text
- View/download PDF
26. A Fiber Optic Dynamic Riser Cable System for Deep Water Application
- Author
-
Ma, C.S., additional, Stix, R.K., additional, Rue, R.J., additional, and Gleason, R.F., additional
- Published
- 1998
- Full Text
- View/download PDF
27. Deep-level photoluminescence studies of undoped and tin-doped (LEC) InP
- Author
-
Ma, C.S., primary, Chan, P.W., additional, Lo, V.C., additional, Ong, C.W., additional, and Wong, S.P., additional
- Published
- 1994
- Full Text
- View/download PDF
28. Determination of Vitamin K3 by Cathodic Stripping Voltammetry
- Author
-
Wang, L.Z., primary, Ma, C.S., additional, Zhang, X.L., additional, and Xu, Y., additional
- Published
- 1994
- Full Text
- View/download PDF
29. A new method of determining of steel by means of single specimen
- Author
-
Lai, Z.H., primary, Chen, L.J., additional, Chang, C.M., additional, Ma, C.S., additional, and Chao, C.S., additional
- Published
- 1983
- Full Text
- View/download PDF
30. Determination of Vitamin K 3 by Cathodic Stripping Voltammetry
- Author
-
Wang, L.Z., Ma, C.S., Zhang, X.L., and Xu, Y.
- Published
- 1994
- Full Text
- View/download PDF
31. Standardized Definitions for Cardiogenic Shock Research and Mechanical Circulatory Support Devices: Scientific Expert Panel From the Shock Academic Research Consortium (SHARC).
- Author
-
Waksman R, Pahuja M, van Diepen S, Proudfoot AG, Morrow D, Spitzer E, Nichol G, Weisfeldt ML, Moscucci M, Lawler PR, Mebazaa A, Fan E, Dickert NW, Samsky M, Kormos R, Piña IL, Zuckerman B, Farb A, Sapirstein JS, Simonton C, West NEJ, Damluji AA, Gilchrist IC, Zeymer U, Thiele H, Cutlip DE, Krucoff M, and Abraham WT
- Subjects
- Humans, Shock, Cardiogenic therapy, Shock, Cardiogenic surgery, Research Design, Heart Valve Prosthesis Implantation, Heart-Assist Devices
- Abstract
The Shock Academic Research Consortium is a multi-stakeholder group, including representatives from the US Food and Drug Administration and other government agencies, industry, and payers, convened to develop pragmatic consensus definitions useful for the evaluation of clinical trials enrolling patients with cardiogenic shock, including trials evaluating mechanical circulatory support devices. Several in-person and virtual meetings were convened between 2020 and 2022 to discuss the need for developing the standardized definitions required for evaluation of mechanical circulatory support devices in clinical trials for cardiogenic shock patients. The expert panel identified key concepts and topics by performing literature reviews, including previous clinical trials, while recognizing current challenges and the need to advance evidence-based practice and statistical analysis to support future clinical trials. For each category, a lead (primary) author was assigned to perform a literature search and draft a proposed definition, which was presented to the subgroup. These definitions were further modified after feedback from the expert panel meetings until a consensus was reached. This manuscript summarizes the expert panel recommendations focused on outcome definitions, including efficacy and safety., Competing Interests: Disclosures Dr Waksman reports serving on the advisory boards of Abbott Vascular, Boston Scientific, Medtronic, Philips IGT, and Pi-Cardia Ltd.; consulting for Abbott Vascular, Biotronik, Boston Scientific, Cordis, Medtronic, Philips IGT, Pi-Cardia Ltd., Swiss Interventional Systems/SIS Medical AG, Transmural Systems Inc., and Venous MedTech; receiving institutional grant support from Amgen, Biotronik, Boston Scientific, Chiesi, Medtronic, and Philips IGT; and investing in MedAlliance and Transmural Systems Inc. Dr Morrow is a member of the Thrombolysis in Myocardial Infarction Study Group which has received institutional research grant support through Brigham and Women’s Hospital from Abbott, Abiomed, Amgen, Anthos Therapeutics, ARCA Biopharma, Inc., AstraZeneca, Bayer HealthCare Pharmaceuticals, Inc., Daiichi-Sankyo, Eisai, Intarcia, Ionis Pharmaceuticals, Inc., Janssen Research and Development, LLC, Merck, Novartis, Pfizer, Quark Pharmaceuticals, Regeneron Pharmaceuticals, Inc., Roche, Siemens Healthcare Diagnostics, Inc., Softcell Medical Limited, and Zora Biosciences. Dr Morrow has received consulting fees from Abbott Laboratories, ARCA Biopharma, Inflammatix, Merck & Co., Novartis, and Roche Diagnostics. Dr Spitzer reports institutional contracts for which he receives no direct compensation with Boston Scientific, Cardiawave, Edwards Lifesciences, Medtronic, Occlutech US, LLC, Shanghai Microport Medical Co. Ltd., NVT GmBH, Pie Medical Imaging, Siemens Healthcare GmBH. Dr Dickert receives research funding from the National Institutes of Health’s Agency for Healthcare Research and Quality and Data Safety Monitoring Board service for National Institutes of Health and Patient-Centered Outcomes Research Institute–funded studies. Dr Dickert reports consulting for and research funding from Abiomed, Inc. Dr Mebaaza reports receiving research grants, consulting, and receiving speaker fees from Roche Diagnostics and receiving speaker fees from Merck. Dr Fan reports personal fees from ALung Technologies, Aerogen, Baxter, GE Healthcare, Inspira, Vasomune, and Zoll Medical outside the submitted work. Dr Kormos is an employee (Division Vice President Global Medical Affairs Heart Failure) of Abbott Laboratories. Dr Proudfoot has received institutional funding from Abbott Vascular and BD Biosciences, all outside of the submitted work. Dr Simonton is an employee (Chief Medical Officer) of Abiomed, a Johnson & Johnson Company. Dr Damluji received a mentored patient-oriented research career development award from the National Heart, Lung, and Blood Institute (K23-HL153771-01). Dr Cutlip reports consulting for and research funding from Corvia Medical, MedAlliance, and Abiomed. Dr Nichol reports salary support from Medic One Foundation via the University of Washington; research funding from National Institutes of Health, Centers for Disease Control and Prevention, Abiomed Inc, Zoll Medical, RCE Technologies Inc., Zoll Circulation Inc., and Vapotherm Inc; and consulting for BrainCool AB, CPR Therapeutics Inc., Heartbeam Inc., Invero Health LLC, Kestra Medical Technologies Inc., and Orixha Inc.
- Published
- 2023
- Full Text
- View/download PDF
32. Development and Validation of the DOAC Score: A Novel Bleeding Risk Prediction Tool for Patients With Atrial Fibrillation on Direct-Acting Oral Anticoagulants.
- Author
-
Aggarwal R, Ruff CT, Virdone S, Perreault S, Kakkar AK, Palazzolo MG, Dorais M, Kayani G, Singer DE, Secemsky E, Piccini J, Tahir UA, Shen C, and Yeh RW
- Subjects
- Humans, Factor Xa Inhibitors, Dabigatran adverse effects, Rivaroxaban, Anticoagulants adverse effects, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy
- Abstract
Background: Current clinical decision tools for assessing bleeding risk in individuals with atrial fibrillation (AF) have limited performance and were developed for individuals treated with warfarin. This study develops and validates a clinical risk score to personalize estimates of bleeding risk for individuals with atrial fibrillation taking direct-acting oral anticoagulants (DOACs)., Methods: Among individuals taking dabigatran 150 mg twice per day from 44 countries and 951 centers in this secondary analysis of the RE-LY trial (Randomized Evaluation of Long-Term Anticoagulation Therapy), a risk score was developed to determine the comparative risk for bleeding on the basis of covariates derived in a Cox proportional hazards model. The risk prediction model was internally validated with bootstrapping. The model was then further developed in the GARFIELD-AF registry (Global Anticoagulant Registry in the Field-Atrial Fibrillation), with individuals taking dabigatran, edoxaban, rivaroxaban, and apixaban. To determine generalizability in external cohorts and among individuals on different DOACs, the risk prediction model was validated in the COMBINE-AF (A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation) pooled clinical trial cohort and the Quebec Régie de l'Assurance Maladie du Québec and Med-Echo Administrative Databases (RAMQ) administrative database. The primary outcome was major bleeding. The risk score, termed the DOAC Score, was compared with the HAS-BLED score., Results: Of the 5684 patients in RE-LY, 386 (6.8%) experienced a major bleeding event, within a median follow-up of 1.74 years. The prediction model had an optimism-corrected C statistic of 0.73 after internal validation with bootstrapping and was well-calibrated based on visual inspection of calibration plots (goodness-of-fit P =0.57). The DOAC Score assigned points for age, creatinine clearance/glomerular filtration rate, underweight status, stroke/transient ischemic attack/embolism history, diabetes, hypertension, antiplatelet use, nonsteroidal anti-inflammatory use, liver disease, and bleeding history, with each additional point scored associated with a 48.7% (95% CI, 38.9%-59.3%; P <0.001) increase in major bleeding in RE-LY. The score had superior performance to the HAS-BLED score in RE-LY (C statistic, 0.73 versus 0.60; P for difference <0.001) and among 12 296 individuals in GARFIELD-AF (C statistic, 0.71 versus 0.66; P for difference = 0.025). The DOAC Score had stronger predictive performance than the HAS-BLED score in both validation cohorts, including 25 586 individuals in COMBINE-AF (C statistic, 0.67 versus 0.63; P for difference <0.001) and 11 945 individuals in RAMQ (C statistic, 0.65 versus 0.58; P for difference <0.001)., Conclusions: In individuals with atrial fibrillation potentially eligible for DOAC therapy, the DOAC Score can help stratify patients on the basis of expected bleeding risk., Competing Interests: Disclosures R.A. is involved in research funded by the Bristol Myers Squibb-Pfizer alliance and a consultant for Lexicon Pharmaceuticals. C.R. is a member of the TIMI Study Group, which has received institutional research grant support through Brigham and Women’s Hospital from Abbott, Amgen, Anthos Therapeutics, ARCA Biopharma, Inc, AstraZeneca, Bayer HealthCare Pharmaceuticals, Inc, Daiichi-Sankyo, Eisai, Intarcia, Ionis Pharmaceuticals, Inc, Janssen Research and Development, LLC, MedImmune, Merck, Novartis, Pfizer, Quark Pharmaceuticals, Regeneron Pharmaceuticals, Inc, Roche, Siemens Healthcare Diagnostics, Inc, Softcell Medical Limited, The Medicines Company, and Zora Biosciences. Through his institution, he receives research grant support from Anthos, AstraZeneca, Daiichi Sankyo, Janssen, and Novartis. He receives honoraria for scientific advisory boards and consulting from Anthos, Bayer, Bristol Myers Squibb, Daiichi Sankyo, Janssen, and Pfizer. A.K.K. reports research grants from Bayer Pharma AG and Sanofi. He reports personal fees from Anthos Therapeutics, Bayer Pharma AG, and Sanofi SA. M.P. is a member of the TIMI Study Group, which has received institutional research grant support through Brigham and Woman’s Hospital from Abbott, Amgen, Anthos Therapeutics, ARCA Biopharma, Inc, AstraZeneca, Daiichi-Sankyo, Ionis Pharmaceuticals, Inc, Janssen Research and Development, LLC, MedImmune, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc, Roche, Softcell Medical Limited, The Medicines Company, and Zora Biosciences. D.E.S. has received research grants from Bristol Myers Squibb and has consulting agreements with Bristol Myers Squibb, Fitbit, Medtronic, and Pfizer. E.A.S. reports the following research grants to Beth Israel Deaconess Medical Center: National Institutes of Health/National Heart, Lung, and Blood Institute, Food and Drug Administration, BD, Boston Scientific, Cook, CSI, Laminate Medical, Medtronic, and Philips. He also endorses consulting/speaking with Abbott, Bayer, BD, Boston Scientific, Cook, Cordis, CSI, Inari, Medtronic, Philips, Shockwave, and VentureMed. J.P.P. receives grants for clinical research from Abbott, American Heart Association, Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, and Philips; and serves as a consultant to Abbott, Abbvie, Ablacon, Altathera, Biotronik, Boston Scientific, Bristol Myers Squibb, LivaNova, Medtronic, Milestone, ElectroPhysiology Frontiers, Pfizer, Sanofi, Philips, and Up-to-Date. C.S. reports that he is an employee of Biogen and owns Biogen stocks. R.W.Y. reports grants and consulting fees from Abbott Vascular, Boston Scientific, and Medtronic. The other authors report no conflicts.
- Published
- 2023
- Full Text
- View/download PDF
33. Genetic Effect on Body Mass Index and Cardiovascular Disease Across Generations.
- Author
-
Sarnowski C, Conomos MP, Vasan RS, Meigs JB, Dupuis J, Liu CT, and Leong A
- Subjects
- Middle Aged, Humans, Adult, Body Mass Index, Obesity epidemiology, Obesity genetics, Risk Factors, Cardiovascular Diseases epidemiology, Cardiovascular Diseases genetics, Diabetes Mellitus, Type 2
- Abstract
Background: Whether genetics contribute to the rising prevalence of obesity or its cardiovascular consequences in today's obesogenic environment remains unclear. We sought to determine whether the effects of a higher aggregate genetic burden of obesity risk on body mass index (BMI) or cardiovascular disease (CVD) differed by birth year., Methods: We split the FHS (Framingham Heart Study) into 4 equally sized birth cohorts (birth year before 1932, 1932 to 1946, 1947 to 1959, and after 1960). We modeled a genetic predisposition to obesity using an additive genetic risk score (GRS) of 941 BMI-associated variants and tested for GRS-birth year interaction on log-BMI (outcome) when participants were around 50 years old (N=7693). We repeated the analysis using a GRS of 109 BMI-associated variants that increased CVD risk factors (type 2 diabetes, blood pressure, total cholesterol, and high-density lipoprotein) in addition to BMI. We then evaluated whether the effects of the BMI GRSs on CVD risk differed by birth cohort when participants were around 60 years old (N=5493)., Results: Compared with participants born before 1932 (mean age, 50.8 yrs [2.4]), those born after 1960 (mean age, 43.3 years [4.5]) had higher BMI (median, 25.4 [23.3-28.0] kg/m
2 versus 26.9 [interquartile range, 23.7-30.6] kg/m2 ). The effect of the 941-variant BMI GRS on BMI and CVD risk was stronger in people who were born in later years (GRS-birth year interaction: P =0.0007 and P =0.04 respectively)., Conclusions: The significant GRS-birth year interactions indicate that common genetic variants have larger effects on middle-age BMI and CVD risk in people born more recently. These findings suggest that the increasingly obesogenic environment may amplify the impact of genetics on the risk of obesity and possibly its cardiovascular consequences.- Published
- 2023
- Full Text
- View/download PDF
34. Cross-Ancestry Investigation of Venous Thromboembolism Genomic Predictors.
- Author
-
Thibord F, Klarin D, Brody JA, Chen MH, Levin MG, Chasman DI, Goode EL, Hveem K, Teder-Laving M, Martinez-Perez A, Aïssi D, Daian-Bacq D, Ito K, Natarajan P, Lutsey PL, Nadkarni GN, de Vries PS, Cuellar-Partida G, Wolford BN, Pattee JW, Kooperberg C, Braekkan SK, Li-Gao R, Saut N, Sept C, Germain M, Judy RL, Wiggins KL, Ko D, O'Donnell CJ, Taylor KD, Giulianini F, De Andrade M, Nøst TH, Boland A, Empana JP, Koyama S, Gilliland T, Do R, Huffman JE, Wang X, Zhou W, Manuel Soria J, Carlos Souto J, Pankratz N, Haessler J, Hindberg K, Rosendaal FR, Turman C, Olaso R, Kember RL, Bartz TM, Lynch JA, Heckbert SR, Armasu SM, Brumpton B, Smadja DM, Jouven X, Komuro I, Clapham KR, Loos RJF, Willer CJ, Sabater-Lleal M, Pankow JS, Reiner AP, Morelli VM, Ridker PM, Vlieg AVH, Deleuze JF, Kraft P, Rader DJ, Min Lee K, Psaty BM, Heidi Skogholt A, Emmerich J, Suchon P, Rich SS, Vy HMT, Tang W, Jackson RD, Hansen JB, Morange PE, Kabrhel C, Trégouët DA, Damrauer SM, Johnson AD, and Smith NL
- Subjects
- Genetic Predisposition to Disease, Genome-Wide Association Study, Genomics, Humans, Polymorphism, Single Nucleotide, Quantitative Trait Loci, Thrombosis genetics, Venous Thromboembolism diagnosis, Venous Thromboembolism genetics
- Abstract
Background: Venous thromboembolism (VTE) is a life-threatening vascular event with environmental and genetic determinants. Recent VTE genome-wide association studies (GWAS) meta-analyses involved nearly 30 000 VTE cases and identified up to 40 genetic loci associated with VTE risk, including loci not previously suspected to play a role in hemostasis. The aim of our research was to expand discovery of new genetic loci associated with VTE by using cross-ancestry genomic resources., Methods: We present new cross-ancestry meta-analyzed GWAS results involving up to 81 669 VTE cases from 30 studies, with replication of novel loci in independent populations and loci characterization through in silico genomic interrogations., Results: In our genetic discovery effort that included 55 330 participants with VTE (47 822 European, 6320 African, and 1188 Hispanic ancestry), we identified 48 novel associations, of which 34 were replicated after correction for multiple testing. In our combined discovery-replication analysis (81 669 VTE participants) and ancestry-stratified meta-analyses (European, African, and Hispanic), we identified another 44 novel associations, which are new candidate VTE-associated loci requiring replication. In total, across all GWAS meta-analyses, we identified 135 independent genomic loci significantly associated with VTE risk. A genetic risk score of the significantly associated loci in Europeans identified a 6-fold increase in risk for those in the top 1% of scores compared with those with average scores. We also identified 31 novel transcript associations in transcriptome-wide association studies and 8 novel candidate genes with protein quantitative-trait locus Mendelian randomization analyses. In silico interrogations of hemostasis and hematology traits and a large phenome-wide association analysis of the 135 GWAS loci provided insights to biological pathways contributing to VTE, with some loci contributing to VTE through well-characterized coagulation pathways and others providing new data on the role of hematology traits, particularly platelet function. Many of the replicated loci are outside of known or currently hypothesized pathways to thrombosis., Conclusions: Our cross-ancestry GWAS meta-analyses identified new loci associated with VTE. These findings highlight new pathways to thrombosis and provide novel molecules that may be useful in the development of improved antithrombosis treatments.
- Published
- 2022
- Full Text
- View/download PDF
35. Estimation of DAPT Study Treatment Effects in Contemporary Clinical Practice: Findings From the EXTEND-DAPT Study.
- Author
-
Butala NM, Faridi KF, Tamez H, Strom JB, Song Y, Shen C, Secemsky EA, Mauri L, Kereiakes DJ, Curtis JP, Gibson CM, and Yeh RW
- Subjects
- Aged, Female, Humans, Male, Dual Anti-Platelet Therapy methods
- Abstract
Background: Differences in patient characteristics, changes in treatment algorithms, and advances in medical technology could each influence the applicability of older randomized trial results to contemporary clinical practice. The DAPT Study (Dual Antiplatelet Therapy) found that longer-duration DAPT decreased ischemic events at the expense of greater bleeding, but subsequent evolution in stent technology and clinical practice may attenuate the benefit of prolonged DAPT in a contemporary population. We evaluated whether the DAPT Study population is different from a contemporary population of US patients receiving percutaneous coronary intervention and estimated the treatment effect of extended-duration antiplatelet therapy after percutaneous coronary intervention in this more contemporary cohort., Methods: We compared the characteristics of drug-eluting stent-treated patients randomly assigned in the DAPT Study to a sample of more contemporary drug-eluting stent-treated patients in the National Cardiovascular Data Registry CathPCI Registry from July 2016 to June 2017. After linking trial and registry data, we used inverse-odds of trial participation weighting to account for patient and procedural characteristics and estimated a contemporary real-world treatment effect of 30 versus 12 months of DAPT after coronary stent procedures., Results: The US drug-eluting stent-treated trial cohort included 8864 DAPT Study patients, and the registry cohort included 568 540 patients. Compared with the trial population, registry patients had more comorbidities and were more likely to present with myocardial infarction and receive 2nd-generation drug-eluting stents. After reweighting trial results to represent the registry population, there was no longer a significant effect of prolonged DAPT on reducing stent thrombosis (reweighted treatment effect: -0.40 [95% CI, -0.99% to 0.15%]), major adverse cardiac and cerebrovascular events (reweighted treatment effect, -0.52 [95% CI, -2.62% to 1.03%]), or myocardial infarction (reweighted treatment effect, -0.97% [95% CI, -2.75% to 0.18%]), but the increase in bleeding with prolonged DAPT persisted (reweighted treatment effect, 2.42% [95% CI, 0.79% to 3.91%])., Conclusions: The differences between the patients and devices used in contemporary clinical practice compared with the DAPT Study were associated with the attenuation of benefits and greater harms attributable to prolonged DAPT duration. These findings limit the applicability of the average treatment effects from the DAPT Study in modern clinical practice.
- Published
- 2022
- Full Text
- View/download PDF
36. Association Between Industry Marketing Payments and Prescriptions for PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) Inhibitors in the United States.
- Author
-
Inoue K, Figueroa JF, DeJong C, Tsugawa Y, Orav EJ, Shen C, and Kazi DS
- Subjects
- Aged, Humans, Marketing, Prescriptions, Subtilisins, United States, Medicare, Proprotein Convertase 9
- Abstract
Background: Marketing payments from the pharmaceutical industry to physicians have come under scrutiny due to their potential to influence clinical decision-making. Two proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) were approved by the US Food and Drug Administration in 2015 for reducing low-density lipoprotein cholesterol in high-risk patients, but their initial uptake was limited due to their high-cost and stringent prior authorization requirements. We sought to investigate the association between industry marketing and early adoption of PCSK9i among US physicians., Methods: We used nationwide databases of primary care physicians, cardiologists, and endocrinologists treating Medicare beneficiaries to examine the association between PCSK9i-related marketing payments in 2016 and the number of filled PCSK9i prescriptions in 2017, after adjusting for physician characteristics. In subgroup analyses, we stratified our analyses by physician specialty and prior experience with prescribing PCSK9i., Results: Among 209 840 physicians included in this analysis, 49 341 (24%) physicians received 292 941 PCSK9i-related marketing payments in 2016. The total value of these payments was $19 million, with a median payment of $61 per physician (interquartile range, $25-$132). Most payments (95%) were for meals, with a median of $14 per meal. The receipt of PCSK9i-related payments in 2016 was associated with increased PCSK9i prescription in 2017 (adjusted risk ratio, 3.18 [95% CI, 2.95-3.42]). This association was larger among primary care physicians (adjusted risk ratio, 6.67 [95% CI, 5.87-7.57]) than cardiologists (adjusted risk ratio, 2.00 [95% CI, 1.84-2.16]) and endocrinologists (adjusted risk ratio, 4.06 [95% CI, 2.95-5.59]). The association was observed across all types of payments., Conclusions: At a time when few physicians had experience with prescribing PCSK9i under strict prior authorization requirements, industry marketing payments to physicians for PCSK9i, predominantly in the form of meals, were associated with increased PCSK9i prescription in the subsequent year.
- Published
- 2021
- Full Text
- View/download PDF
37. Covid-19 Vaccine Injuries - Preventing Inequities in Compensation.
- Author
-
Van Tassel K, Shachar C, and Hoffman S
- Subjects
- COVID-19 prevention & control, Emergencies, Humans, National Health Programs legislation & jurisprudence, United States, Vaccination Refusal, COVID-19 Vaccines adverse effects, Compensation and Redress legislation & jurisprudence
- Published
- 2021
- Full Text
- View/download PDF
38. Genetic Predisposition to Coronary Artery Disease in Type 2 Diabetes Mellitus.
- Author
-
van Zuydam NR, Ladenvall C, Voight BF, Strawbridge RJ, Fernandez-Tajes J, Rayner NW, Robertson NR, Mahajan A, Vlachopoulou E, Goel A, Kleber ME, Nelson CP, Kwee LC, Esko T, Mihailov E, Mägi R, Milani L, Fischer K, Kanoni S, Kumar J, Song C, Hartiala JA, Pedersen NL, Perola M, Gieger C, Peters A, Qu L, Willems SM, Doney ASF, Morris AD, Zheng Y, Sesti G, Hu FB, Qi L, Laakso M, Thorsteinsdottir U, Grallert H, van Duijn C, Reilly MP, Ingelsson E, Deloukas P, Kathiresan S, Metspalu A, Shah SH, Sinisalo J, Salomaa V, Hamsten A, Samani NJ, März W, Hazen SL, Watkins H, Saleheen D, Morris AP, Colhoun HM, Groop L, McCarthy MI, and Palmer CNA
- Subjects
- Case-Control Studies, Genome-Wide Association Study, Humans, Meta-Analysis as Topic, Polymorphism, Genetic, Risk Factors, Coronary Artery Disease complications, Coronary Artery Disease genetics, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 genetics, Genetic Predisposition to Disease
- Abstract
Background: Coronary artery disease (CAD) is accelerated in subjects with type 2 diabetes mellitus (T2D)., Methods: To test whether this reflects differential genetic influences on CAD risk in subjects with T2D, we performed a systematic assessment of genetic overlap between CAD and T2D in 66 643 subjects (27 708 with CAD and 24 259 with T2D). Variants showing apparent association with CAD in stratified analyses or evidence of interaction were evaluated in a further 117 787 subjects (16 694 with CAD and 11 537 with T2D)., Results: None of the previously characterized CAD loci was found to have specific effects on CAD in T2D individuals, and a genome-wide interaction analysis found no new variants for CAD that could be considered T2D specific. When we considered the overall genetic correlations between CAD and its risk factors, we found no substantial differences in these relationships by T2D background., Conclusions: This study found no evidence that the genetic architecture of CAD differs in those with T2D compared with those without T2D.
- Published
- 2020
- Full Text
- View/download PDF
39. Complex Arrhythmia Syndrome in a Knock-In Mouse Model Carrier of the N98S Calm1 Mutation.
- Author
-
Tsai WC, Guo S, Olaopa MA, Field LJ, Yang J, Shen C, Chang CP, Chen PS, and Rubart M
- Subjects
- Amino Acid Substitution, Animals, Disease Models, Animal, Heart Ventricles physiopathology, Humans, Male, Mice, Mice, Transgenic, Purkinje Fibers physiopathology, Sick Sinus Syndrome genetics, Sick Sinus Syndrome metabolism, Sick Sinus Syndrome physiopathology, Calmodulin genetics, Calmodulin metabolism, Heart Ventricles metabolism, Mutation, Missense, Myocytes, Cardiac metabolism, Purkinje Fibers metabolism, Sick Sinus Syndrome congenital
- Abstract
Background: Calmodulin mutations are associated with arrhythmia syndromes in humans. Exome sequencing previously identified a de novo mutation in CALM1 resulting in a p.N98S substitution in a patient with sinus bradycardia and stress-induced bidirectional ventricular ectopy. The objectives of the present study were to determine if mice carrying the N98S mutation knocked into Calm1 replicate the human arrhythmia phenotype and to examine arrhythmia mechanisms., Methods: Mouse lines heterozygous for the Calm1
N98S allele (Calm1N98S/+ ) were generated using CRISPR/Cas9 technology. Adult mutant mice and their wildtype littermates (Calm1+/+ ) underwent electrocardiographic monitoring. Ventricular de- and repolarization was assessed in isolated hearts using optical voltage mapping. Action potentials and whole-cell currents and [Ca2+ ]i , as well, were measured in single ventricular myocytes using the patch-clamp technique and fluorescence microscopy, respectively. The microelectrode technique was used for in situ membrane voltage monitoring of ventricular conduction fibers., Results: Two biologically independent knock-in mouse lines heterozygous for the Calm1N98S allele were generated. Calm1N98S/+ mice of either sex and line exhibited sinus bradycardia, QTc interval prolongation, and catecholaminergic bidirectional ventricular tachycardia. Male mutant mice also showed QRS widening. Pharmacological blockade and activation of β-adrenergic receptors rescued and exacerbated, respectively, the long-QT phenotype of Calm1N98S/+ mice. Optical and electric assessment of membrane potential in isolated hearts and single left ventricular myocytes, respectively, revealed β-adrenergically induced delay of repolarization. β-Adrenergic stimulation increased peak density, slowed inactivation, and left-shifted the activation curve of ICa.L significantly more in Calm1N98S/+ versus Calm1+/+ ventricular myocytes, increasing late ICa.L in the former. Rapidly paced Calm1N98S/+ ventricular myocytes showed increased propensity to delayed afterdepolarization-induced triggered activity, whereas in situ His-Purkinje fibers exhibited increased susceptibility for pause-dependent early afterdepolarizations. Epicardial mapping of Calm1N98S/+ hearts showed that both reentry and focal mechanisms contribute to arrhythmogenesis., Conclusions: Heterozygosity for the Calm1N98S mutation is causative of an arrhythmia syndrome characterized by sinus bradycardia, QRS widening, adrenergically mediated QTc interval prolongation, and bidirectional ventricular tachycardia. β-Adrenergically induced ICa.L dysregulation contributes to the long-QT phenotype. Pause-dependent early afterdepolarizations and tachycardia-induced delayed afterdepolarizations originating in the His-Purkinje network and ventricular myocytes, respectively, constitute potential sources of arrhythmia in Calm1N98S/+ hearts.- Published
- 2020
- Full Text
- View/download PDF
40. Doubly Robust Estimation of Causal Effect: Upping the Odds of Getting the Right Answers.
- Author
-
Li X and Shen C
- Subjects
- Abciximab therapeutic use, Confounding Factors, Epidemiologic, Coronary Artery Disease therapy, Humans, Multivariate Analysis, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention instrumentation, Percutaneous Coronary Intervention mortality, Platelet Aggregation Inhibitors therapeutic use, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors, Propensity Score, Risk Assessment, Risk Factors, Stents, Treatment Outcome, Causality, Models, Statistical, Observational Studies as Topic statistics & numerical data
- Abstract
Propensity score-based methods or multiple regressions of the outcome are often used for confounding adjustment in analysis of observational studies. In either approach, a model is needed: A model describing the relationship between the treatment assignment and covariates in the propensity score-based method or a model for the outcome and covariates in the multiple regressions. The 2 models are usually unknown to the investigators and must be estimated. The correct model specification, therefore, is essential for the validity of the final causal estimate. We describe in this article a doubly robust estimator which combines both models propitiously to offer analysts 2 chances for obtaining a valid causal estimate and demonstrate its use through a data set from the Lindner Center Study.
- Published
- 2020
- Full Text
- View/download PDF
41. Effect of Transdermal Testosterone and Oral Progesterone on Drug-Induced QT Interval Lengthening in Older Men: A Randomized, Double-Blind, Placebo-Controlled Crossover-Design Study.
- Author
-
Muensterman ET, Jaynes HA, Sowinski KM, Overholser BR, Shen C, Kovacs RJ, and Tisdale JE
- Subjects
- Administration, Cutaneous, Administration, Oral, Aged, Aged, 80 and over, Cross-Over Studies, Double-Blind Method, Electrocardiography, Female, Humans, Male, Placebos, Progesterone therapeutic use, Systole physiology, Testosterone therapeutic use, Torsades de Pointes epidemiology
- Published
- 2019
- Full Text
- View/download PDF
42. Joint Shock/Death Risk Prediction Model for Patients Considering Implantable Cardioverter-Defibrillators.
- Author
-
Reeder HT, Shen C, Buxton AE, Haneuse SJ, and Kramer DB
- Subjects
- Aged, Cause of Death, Clinical Decision-Making, Death, Sudden, Cardiac epidemiology, Electric Countershock mortality, Electric Injuries diagnosis, Electric Injuries mortality, Female, Health Services Research, Heart Failure diagnosis, Heart Failure mortality, Heart Failure physiopathology, Humans, Male, Middle Aged, Patient Selection, Randomized Controlled Trials as Topic, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Death, Sudden, Cardiac prevention & control, Decision Support Techniques, Defibrillators, Implantable, Electric Countershock adverse effects, Electric Countershock instrumentation, Electric Injuries epidemiology, Heart Failure therapy, Prosthesis Failure
- Abstract
Background: The risk of death or appropriate therapy varies widely among recipients of implantable cardioverter-defibrillators (ICDs). The goals of this study were to develop a risk prediction tool that jointly considers future outcome probabilities of ICD shock and death., Methods and Results: We performed a secondary analysis of patients receiving ICDs as part of the SCD-HeFT trial (Sudden Cardiac Death in Heart Failure Trial). We applied an illness-death regression model to jointly model both ICD shocks and death under the semi-competing risks framework, which predicts for each patient their probability of having received ICD shocks, dying, or both at any given point in time. Among 803 ICD recipients (mean age, 60 years; 23% women) followed for a median of 41.1 months, 430 (53.5%) patients completed the study without dying or receiving an ICD shock, 206 (25.7%) received at least 1 shock but survived, 113 (14.1%) died before experiencing a shock, and 54 (6.7%) received at least 1 shock and subsequently died. Predicted outcome probabilities based on baseline demographic and clinical variables reveal substantial heterogeneity in joint shock and death risks, both between patients at each time point and for each single patient across time. Overall, predictive performance for ICD shock and death individually was adequate, based on area under the curve at 5 years of 0.65 for shocks and of 0.79 for death., Conclusions: Our analysis of outcomes after ICD implantation provides an alternative predictive model for individual risk of death or ICD shocks. If validated, this may provide a useful tool for individualized counseling regarding likely outcomes after device implantation, while also informing the design of further studies to focus the clinical effectiveness and cost-effectiveness of ICD therapy., Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00000609.
- Published
- 2019
- Full Text
- View/download PDF
43. Pseudoblock of the Posterior Mitral Line With Epicardial Bridging Connections Is a Frequent Cause of Complex Perimitral Tachycardias.
- Author
-
Barkagan M, Shapira-Daniels A, Leshem E, Shen C, and Anter E
- Subjects
- Action Potentials, Aged, Atrial Fibrillation diagnosis, Atrial Fibrillation physiopathology, Atrial Flutter diagnosis, Atrial Flutter physiopathology, Cardiac Pacing, Artificial, Coronary Sinus physiopathology, Electrophysiologic Techniques, Cardiac, Female, Humans, Male, Middle Aged, Mitral Valve physiopathology, Prospective Studies, Pulmonary Veins physiopathology, Radiofrequency Ablation adverse effects, Time Factors, Treatment Outcome, Atrial Fibrillation surgery, Atrial Flutter surgery, Coronary Sinus surgery, Heart Rate, Mitral Valve surgery, Pulmonary Veins surgery, Radiofrequency Ablation methods
- Abstract
Background: The mitral isthmus is the critical element of perimitral reentrant tachycardias. Prolongation in transisthmus conduction time and differential pacing techniques are commonly used to determine block. However, these may not distinguish block from slow conduction or conduction via epicardial bridging connections. The aim of this study was to examine these standard criteria for mitral line block with endocardial and epicardial activation mapping., Methods: In 56 patients, posterior mitral line was performed using radiofrequency ablation. Conduction block was defined as transisthmus time (≥100 ms) and reversal of coronary sinus activation during pacing from the left atrial appendage. These results were compared with high-resolution activation mapping (Rhythmia) of the endocardium and epicardium via the coronary sinus., Results: Mitral block determined by pacing was achieved in 51 out of 56 (91%) patients. In 11 out of 51 (21.6%), activation mapping demonstrated residual endocardial (3/11; 27.2%) or epicardial (8/11; 72.7%) connections. Epicardial bridging connections were distant from the line (2.4±1.6 cm), inserting laterally at the proximal-middle coronary sinus and septally at the left atrial ridge. Patients with residual conduction were prone to complex circuits involving the epicardium (7/11; 63.6%). Mitral line block was achieved in 75% by targeting these insertion site(s). The transisthmus conduction time had limited predictive value for distinguishing block from pseudoblock., Conclusions: Standard criteria for posterior mitral line block may not distinguish block from pseudoblock. In particular, epicardial bridging connections can result in prolonged transisthmus conduction time and reversal in coronary sinus activation to falsely suggest block. These connections are a frequent cause for complex circuits, and their insertion site(s) can be targeted for ablation.
- Published
- 2019
- Full Text
- View/download PDF
44. Effect of Baseline Impedance on Ablation Lesion Dimensions: A Multimodality Concept Validation From Physics to Clinical Experience.
- Author
-
Barkagan M, Rottmann M, Leshem E, Shen C, Buxton AE, and Anter E
- Subjects
- Animals, Cardiac Catheters, Catheter Ablation adverse effects, Catheter Ablation instrumentation, Electric Impedance, Heart Atria pathology, Models, Animal, Muscle, Skeletal pathology, Necrosis, Steam, Sus scrofa, Therapeutic Irrigation adverse effects, Therapeutic Irrigation instrumentation, Catheter Ablation methods, Heart Atria surgery, Muscle, Skeletal surgery, Therapeutic Irrigation methods
- Abstract
Background: Radiofrequency ablation using irrigated catheters is performed using a power-controlled mode. However, lesion size is dependent on current delivery at a particular impedance, such that a power value alone may not reflect actual energy delivery, resulting in lesion size variability at similar power settings. We hypothesized that modulating baseline impedance at fixed power settings affects ablation lesion dimensions., Methods: In 20 ex vivo swine hearts, radiofrequency ablation was performed using an irrigated catheter at a fixed power setting of 30 W per 20 seconds and a multistepped impedance load (100-210Ω). In 4 in vivo thigh muscle preparations and right atria, ablation was performed using similar power settings at 3 baseline impedances: low (90-130Ω), intermediate (131-180Ω), and high (181-224Ω). The relationship between baseline impedance, current, and lesion dimensions was examined., Results: Baseline impedance had a strong negative correlation with current squared ( I
2 ) for all experimental models: ex vivo (R=-0.94; P<0.0001), thigh muscle (R=-0.93; P<0.0001), and right atria (R=-0.94; P<0.0001). Lesion dimensions at similar power settings were highly variable and directly related to I2 (width [R=0.853], depth [R=0.814]). In the thigh muscle, lesion depth was 8.2±0.7, 6.5±0.8, and 4.2±0.5 mm for low, intermediate, and high impedance, respectively ( P<0.0001). In right atria lines, low baseline impedance resulted in wider lines (7.2±1.4 mm) relative to intermediate (5.8±1.8 mm) and high impedance (4.7±1.7 mm; P<0.0001)., Conclusions: Radiofrequency ablation in a power control mode results in variable lesion dimensions that are partially related to differences in baseline impedance and current output. Ablation at a lower baseline impedance results in increased current output and lesion dimensions.- Published
- 2018
- Full Text
- View/download PDF
45. Activation Mapping With Integration of Vector and Velocity Information Improves the Ability to Identify the Mechanism and Location of Complex Scar-Related Atrial Tachycardias.
- Author
-
Anter E, Duytschaever M, Shen C, Strisciuglio T, Leshem E, Contreras-Valdes FM, Waks JW, Zimetbaum PJ, Kumar K, Spector PS, Lee A, Gerstenfeld EP, Nakar E, Bar-Tal M, and Buxton AE
- Subjects
- Aged, Aged, 80 and over, Algorithms, Belgium, Catheter Ablation, Female, Heart Atria surgery, Humans, Male, Middle Aged, Predictive Value of Tests, Proof of Concept Study, Prospective Studies, Reproducibility of Results, Retrospective Studies, Tachycardia, Supraventricular etiology, Tachycardia, Supraventricular physiopathology, Tachycardia, Supraventricular surgery, Time Factors, Treatment Outcome, United States, Action Potentials, Atrial Remodeling, Electrophysiologic Techniques, Cardiac, Heart Atria physiopathology, Heart Rate, Signal Processing, Computer-Assisted, Tachycardia, Supraventricular diagnosis
- Abstract
Background: Activation mapping of scar-related atrial tachycardias (ATs) can be difficult to interpret because of inaccurate time annotation of complex electrograms and passive diastolic activity. We examined whether integration of a vector map can help to describe patterns of propagation to better explain the mechanism and location of ATs., Methods: The investigational mapping algorithm calculates vectors and applies physiological constraints of electrical excitation in human atrial tissue to determine the arrhythmia source and circuit. Phase I consisted of retrospective evaluation in 35 patients with ATs. Phase II consisted of prospective validation in 20 patients with ATs. Macroreentry was defined as a continuous propagation in a circular path >30 mm; localized reentry was defined as a circular path ≤30 mm; a focal source had a centrifugal spread from a point source., Results: In phase I, standard activation mapping identified 28 of 40 ATs (70%): 25 macroreentry and 3 focal tachycardias. In the remaining 12 ATs, the mechanism and location could not be identified by activation and required entrainment or empirical ablation for termination (radiofrequency time, 17.3±6.6 minutes). In comparison, the investigational algorithm identified 37 of 40 (92.5%) ATs, including 5 macroreentry, 3 localized reentry, and 1 focal AT not identified by standard mapping. It also predicted the successful termination site of all 37 of 40 ATs. In phase II, the investigational algorithm identified 12 macroreentry, 6 localized reentry, and 2 focal tachycardias that all terminated with limited ablation (3.2±1.7 minutes). It identified 3 macroreentry, 3 localized reentry, and 1 focal AT not well characterized by standard mapping. The diagnosis of localized reentry was supported by highly curved vectors, resetting with increasing curve and termination with limited ablation (22±6 s)., Conclusions: Activation mapping integrating vectors can help determine the arrhythmia mechanism and identify its critical components. It has particular value for identifying complex macroreentrant circuits and for differentiating a focal source from a localized reentry.
- Published
- 2018
- Full Text
- View/download PDF
46. Role of Apamin-Sensitive Calcium-Activated Small-Conductance Potassium Currents on the Mechanisms of Ventricular Fibrillation in Pacing-Induced Failing Rabbit Hearts.
- Author
-
Yin D, Hsieh YC, Tsai WC, Wu AZ, Jiang Z, Chan YH, Xu D, Yang N, Shen C, Chen Z, Lin SF, Chen PS, and Everett TH 4th
- Subjects
- Action Potentials physiology, Animals, Cardiac Pacing, Artificial, Disease Models, Animal, Female, Rabbits, Up-Regulation, Apamin pharmacology, Heart Failure physiopathology, Small-Conductance Calcium-Activated Potassium Channels drug effects, Small-Conductance Calcium-Activated Potassium Channels metabolism, Ventricular Fibrillation physiopathology, Ventricular Fibrillation prevention & control
- Abstract
Background: Ventricular fibrillation (VF) during heart failure is characterized by stable reentrant spiral waves (rotors). Apamin-sensitive small-conductance calcium-activated potassium currents ( I
KAS ) are heterogeneously upregulated in failing hearts. We hypothesized that IKAS influences the location and stability of rotors during VF., Methods and Results: Optical mapping was performed on 9 rabbit hearts with pacing-induced heart failure. The epicardial right ventricular and left ventricular surfaces were simultaneously mapped in a Langendorff preparation. At baseline and after apamin (100 nmol/L) infusion, the action potential duration (APD80 ) was determined, and VF was induced. Areas with a >50% increase in the maximum action potential duration (ΔAPD) after apamin infusion were considered to have a high IKAS distribution. At baseline, the distribution density of phase singularities during VF in high IKAS distribution areas was higher than in other areas (0.0035±0.0011 versus 0.0014±0.0010 phase singularities/pixel; P =0.004). In addition, high dominant frequencies also colocalized to high IKAS distribution areas (26.0 versus 17.9 Hz; P =0.003). These correlations were eliminated during VF after apamin infusion, as the number of phase singularities (17.2 versus 11.0; P =0.009) and dominant frequencies (22.1 versus 16.2 Hz; P =0.022) were all significantly decreased. In addition, reentrant spiral waves became unstable after apamin infusion, and the duration of VF decreased., Conclusions: The IKAS current influences the mechanism of VF in failing hearts as phase singularities, high dominant frequencies, and reentrant spiral waves all correlated to areas of high IKAS . Apamin eliminated this relationship and reduced VF vulnerability., (© 2017 American Heart Association, Inc.)- Published
- 2017
- Full Text
- View/download PDF
47. Pathological correlations of [F-18]-AV-1451 imaging in non-alzheimer tauopathies.
- Author
-
Marquié M, Normandin MD, Meltzer AC, Siao Tick Chong M, Andrea NV, Antón-Fernández A, Klunk WE, Mathis CA, Ikonomovic MD, Debnath M, Bien EA, Vanderburg CR, Costantino I, Makaretz S, DeVos SL, Oakley DH, Gomperts SN, Growdon JH, Domoto-Reilly K, Lucente D, Dickerson BC, Frosch MP, Hyman BT, Johnson KA, and Gómez-Isla T
- Subjects
- Aged, Autoradiography, Brain diagnostic imaging, Brain metabolism, Fluorine Radioisotopes metabolism, Functional Neuroimaging, Humans, Male, Middle Aged, Mutation, Positron-Emission Tomography, Radioligand Assay, Supranuclear Palsy, Progressive diagnostic imaging, Supranuclear Palsy, Progressive pathology, Tauopathies diagnostic imaging, Tauopathies metabolism, Tritium metabolism, tau Proteins metabolism, Brain pathology, Carbolines metabolism, Tauopathies pathology, tau Proteins genetics
- Abstract
Objective: Recent studies have shown that positron emission tomography (PET) tracer AV-1451 exhibits high binding affinity for paired helical filament (PHF)-tau pathology in Alzheimer's brains. However, the ability of this ligand to bind to tau lesions in other tauopathies remains controversial. Our goal was to examine the correlation of in vivo and postmortem AV-1451 binding patterns in three autopsy-confirmed non-Alzheimer tauopathy cases., Methods: We quantified in vivo retention of [F-18]-AV-1451 and performed autoradiography, [H-3]-AV-1451 binding assays, and quantitative tau measurements in postmortem brain samples from two progressive supranuclear palsy (PSP) cases and a MAPT P301L mutation carrier. They all underwent [F-18]-AV-1451 PET imaging before death., Results: The three subjects exhibited [F-18]-AV-1451 in vivo retention predominantly in basal ganglia and midbrain. Neuropathological examination confirmed the PSP diagnosis in the first two subjects; the MAPT P301L mutation carrier had an atypical tauopathy characterized by grain-like tau-containing neurites in gray and white matter with heaviest burden in basal ganglia. In all three cases, autoradiography failed to show detectable [F-18]-AV-1451 binding in multiple brain regions examined, with the exception of entorhinal cortex (reflecting incidental age-related neurofibrillary tangles) and neuromelanin-containing neurons in the substantia nigra (off-target binding). The lack of a consistent significant correlation between in vivo [F-18]-AV-1541 retention and postmortem in vitro binding and tau measures in these cases suggests that this ligand has low affinity for tau lesions primarily made of straight tau filaments., Interpretation: AV-1451 may have limited utility for in vivo selective and reliable detection of tau aggregates in these non-Alzheimer tauopathies. ANN NEUROL 2017;81:117-128., (© 2016 American Neurological Association.)
- Published
- 2017
- Full Text
- View/download PDF
48. Wound complications of vertical expandable prosthetic titanium rib incisions.
- Author
-
Garg S, LaGreca J, St Hilaire T, Gao D, Glotzbecker M, Li Y, Smith JT, and Flynn J
- Subjects
- Child, Preschool, Databases, Factual, Female, Humans, Male, Respiratory Insufficiency surgery, Retrospective Studies, Risk Assessment, Thoracotomy adverse effects, Prostheses and Implants adverse effects, Prosthesis-Related Infections etiology, Ribs surgery, Spinal Diseases surgery, Surgical Wound Infection etiology, Titanium adverse effects
- Abstract
Study Design: Multicenter retrospective review., Objective: To compare the incidence of infection between vertical expandable prosthetic titanium rib (VEPTR) incision locations and determine if the infection risk increases in relation to presence of previous incisions and/or increased number of times incisions are opened., Summary of Background Data: Patients undergoing treatment for chest and spine deformity with VEPTR require multiple incisions that are opened repeatedly during expansion procedures., Methods: A prospective database (7 sites) and institutional database (2 sites), were queried to identify their 20 most recent patients with VEPTR with a minimum of 4 expansions for inclusion. A total of 103 patients were identified. Clinical and operative reports were reviewed to determine incision locations, number, and infection complications., Results: Twenty-five of 103 patients (24%) developed an infection during treatment. Six had multiple infections (range, 2-4), providing a total of 34 infection events. Patients averaged 6.4 expansion procedures and 13 total incisions. Infection rate at each incision site was not significantly different, in the range from 1% to 5%: paramedian (6 infections/23 patients with total 185 incisions, 3%), proximal midline (12/39; 224, 5%), thoracotomy (6/61; 455, 1%), iliac (5/37; 143, 4%), and distal midline (5/58; 148, 3%). Infection events occurred after an average of 3 times a particular incision was opened (95% confidence interval: 2.2-3.8). There was a trend toward higher infection rate with increased number of times a particular incision was opened. There was no increased infection rate in patients with surgical incisions prior to VEPTR (26%; 6/23) compared with patients not having prior incisions (24%; 19/80)., Conclusion: The incidence of infection in patients with 4 or more VEPTR lengthenings was 24% and did not differ across the various incision locations. Presence of prior surgical incisions was not a risk factor for infection. Surgeons should use the most appropriate incision in relation to their patient's pathology when using VEPTR while remaining vigilant for infection., Level of Evidence: 3.
- Published
- 2014
- Full Text
- View/download PDF
49. Increased burden of cardiovascular disease in carriers of APOL1 genetic variants.
- Author
-
Ito K, Bick AG, Flannick J, Friedman DJ, Genovese G, Parfenov MG, Depalma SR, Gupta N, Gabriel SB, Taylor HA Jr, Fox ER, Newton-Cheh C, Kathiresan S, Hirschhorn JN, Altshuler DM, Pollak MR, Wilson JG, Seidman JG, and Seidman C
- Subjects
- Adult, Aged, Apolipoprotein L1, Female, Genetic Predisposition to Disease ethnology, Genetic Predisposition to Disease genetics, Genetic Variation, Humans, Incidence, Male, Middle Aged, Renal Insufficiency, Chronic ethnology, Renal Insufficiency, Chronic genetics, Risk Factors, Black or African American genetics, Black or African American statistics & numerical data, Apolipoproteins genetics, Atherosclerosis ethnology, Atherosclerosis genetics, Lipoproteins, HDL genetics
- Abstract
Rationale: Two distinct alleles in the gene encoding apolipoprotein L1 (APOL1), a major component of high-density lipoprotein, confer protection against Trypanosoma brucei rhodesiense infection and also increase risk for chronic kidney disease. Approximately 14% of Americans with African ancestry carry 2 APOL1 risk alleles, accounting for the high chronic kidney disease burden in this population., Objective: We tested whether APOL1 risk alleles significantly increase risk for atherosclerotic cardiovascular disease (CVD) in African Americans., Methods and Results: We sequenced APOL1 in 1959 randomly selected African American participants in the Jackson Heart Study (JHS) and evaluated associations between APOL1 genotypes and renal and cardiovascular phenotypes. Previously identified association between APOL1 genotypes and chronic kidney disease was confirmed (P=2.4×10(-6)). Among JHS participants with 2 APOL1 risk alleles, we observed increased risk for CVD (50/763 events among participants without versus 37/280 events among participants with 2 risk alleles; odds ratio, 2.17; P=9.4×10(-4)). We replicated this novel association of APOL1 genotype with CVD in Women's Health Initiative (WHI) participants (66/292 events among participants without versus 37/101 events among participants with 2 risk alleles; odds ratio, 1.98; P=8.37×10(-3); JHS and WHI combined, P=8.5×10(-5); odds ratio, 2.12). The increased risk for CVD conferred by APOL1 alleles was robust to correction for both traditional CVD risk factors and chronic kidney disease., Conclusions: APOL1 variants contribute to atherosclerotic CVD risk, indicating a genetic component to cardiovascular health disparities in individuals of African ancestry. The considerable population of African Americans with 2 APOL1 risk alleles may benefit from intensive interventions to reduce CVD.
- Published
- 2014
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.