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Maio R, Perticone M, Suraci E, Sciacqua A, Sesti G, Perticone F. Endothelial dysfunction and C-reactive protein predict the incidence of heart failure in hypertensive patients. ESC Heart Fail 2020; 8:399-407. [PMID: 33236853 PMCID: PMC7835547 DOI: 10.1002/ehf2.13088] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023] Open
Abstract
Aims Endothelial dysfunction and heart failure are associated, but no prospective studies demonstrated that impaired endothelium‐dependent vasodilation predicts incident heart failure. We designed this study to test whether endothelial dysfunction is associated with incident heart failure in a group of hypertensives. Methods and results We enrolled 735 White never‐treated hypertensive outpatients free from heart failure, diabetes, chronic kidney disease, and previous cardiovascular events. Endothelium‐dependent vasodilation was investigated by intra‐arterial infusion of acetylcholine, and laboratory determinations were obtained by standard procedures. During the follow‐up [median 114 months (range 26–206)], there were 208 new cases of heart failure (3.1 events/100 patient‐years). Dividing the study population in progressors and non‐progressors, we observed that progressors were older, showed a higher prevalence of being female, and had a higher baseline heart rate, glucose, insulin, Homeostatic Model Assessment (HOMA), creatinine, and high‐sensitivity C‐reactive protein (hs‐CRP) mean values, while estimated glomerular filtration rate and maximal acetylcholine‐stimulated forearm blood flow were lower. In the multiple Cox regression analysis, female gender [hazard ratio (HR) = 1.454, 95% CI = 1.067–1.981], fasting glucose (HR = 1.186, 95% CI = 1.038–1.357), hs‐CRP (HR = 1.162, 95% CI = 1.072–1.259), HOMA (HR = 1.124, 95% CI = 1.037–1.219), acetylcholine‐stimulated forearm blood flow (HR = 0.779, 95% CI = 0.695–0.874), and estimated glomerular filtration rate (HR = 0.767, 95% CI = 0.693–0.849) maintained an independent association with the outcome. Successively, testing the interaction between forearm blood flow and hs‐CRP, we observed that patients who have hs‐CRP values above the median and forearm blood flow under the median show a higher risk of developing heart failure (HR = 7.699, 95% CI = 4.407–13.451). Conclusions The present data demonstrate that an impaired endothelium‐dependent vasodilation and hs‐CRP predict development of incident heart failure in hypertensives.
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Affiliation(s)
- Raffaele Maio
- Division of Geriatrics, Azienda Ospedaliero-Universitaria Mater Domini, Catanzaro, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Edoardo Suraci
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-La Sapienza, Rome, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
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Serum γ-Glutamyltransferase Concentration Predicts Endothelial Dysfunction in Naïve Hypertensive Patients. Biomedicines 2020; 8:biomedicines8070207. [PMID: 32664562 PMCID: PMC7400291 DOI: 10.3390/biomedicines8070207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/04/2020] [Accepted: 07/09/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Serum gamma-glutamyltransferase (γ-GT) is recognized as a risk factor for cardiovascular diseases (CV). Traditional cardiovascular risk factors mediate endothelial dysfunction. Aim: to evaluate a possible correlation between serum γ-GT and endothelium-dependent vasodilation in naïve hypertensives. Methods: We enrolled 500 hypertensives. Endothelial function was studied by strain-gauge plethysmography. Receiver operating characteristic (ROC) analysis was used to assess the predictive value of γ-GT and to identify the optimal cut-off value of the same variable for endothelial dysfunction. Results: At univariate linear analysis peak percent increase in acetylcholine (ACh)-stimulated vasodilation was inversely related to γ-GT (r = −0.587), alanine aminotransferase (ALT) (r = −0.559), aspartate aminotransferase (AST) (r = −0.464), age (r = −0.171), body mass index (BMI) (r = −0.152), and fasting glucose (r = −101). In the stepwise multivariate regression model, endothelium-dependent vasodilation was significantly related to γ-GT (β = −0.362), ALT (β = −0.297), AST (β = −0.217), estimated glomerular filtration rate (e-GFR) (β = 0.199), gender (β = 0.166), and smoking (β = −0.061). The ROC analysis demonstrated that the accuracy of γ-GT for identifying patients with endothelial dysfunction was 82.1%; the optimal γ-GT cut-off value for discriminating patients with this alteration was 27 UI/L. Conclusions: Serum γ-GT values, within the normal range, are significantly associated with endothelial dysfunction in hypertensives, and may be considered a biomarker of early vascular damage.
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Cimellaro A, Perticone M, Fiorentino TV, Sciacqua A, Hribal ML. Role of endoplasmic reticulum stress in endothelial dysfunction. Nutr Metab Cardiovasc Dis 2016; 26:863-871. [PMID: 27345757 DOI: 10.1016/j.numecd.2016.05.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/23/2016] [Accepted: 05/20/2016] [Indexed: 11/18/2022]
Abstract
AIM Endoplasmic reticulum (ER) stress is implicated in the pathogenesis of several human disorders, including cardiovascular disease (CVD). CVD recognizes endothelial dysfunction (ED) as its pathogenetic primum movens; interestingly a large body of evidence has identified the unchecked ER stress response as a main actor in vascular damage elicited by various cardio-metabolic risk factors. In the present Review, we summarize findings from experimental studies on the ER stress-related ED, focusing on the mechanisms underlying this association. DATA SYNTHESIS Different noxious agents, such as hyperhomocysteinemia, hyperlipidemia, hyperglycemia and chronic inflammation, induce ED promoting an amplified ER stress response as demonstrated by several studies in animal models, as well as in human primary and immortalized endothelial cells. ER stress represents therefore a key mediator of vascular damage, operating in a setting of increased inflammatory burden and oxidative stress, thus contributing to foster a vicious pathogenic cycle. CONCLUSIONS Experimental studies summarized in this Review strongly suggest that an unchecked ER stress response plays a central role in the pathogenesis of ED and, consequently, CVD. Counteracting ER stress may thus represent a promising, even if largely unexplored as-yet, therapeutic approach aimed to prevent vascular damage, slowing the progression from ED to cardiovascular events.
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Affiliation(s)
- A Cimellaro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - M Perticone
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - T V Fiorentino
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - A Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy
| | - M L Hribal
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, 88100, Italy.
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Protective effects of Astragalus polysaccharides against endothelial dysfunction in hypertrophic rats induced by isoproterenol. Int Immunopharmacol 2016; 38:306-12. [DOI: 10.1016/j.intimp.2016.06.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/22/2016] [Accepted: 06/17/2016] [Indexed: 11/21/2022]
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Perticone M, Maio R, Sciacqua A, Cimellaro A, Andreucci M, Tripepi G, Zoccali C, Sesti G, Perticone F. Serum phosphorus levels are associated with endothelial dysfunction in hypertensive patients. Nutr Metab Cardiovasc Dis 2016; 26:683-688. [PMID: 27105871 DOI: 10.1016/j.numecd.2016.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/02/2016] [Accepted: 02/05/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Recent data demonstrated that serum phosphorus, within the normal range, is an independent predictor of atherosclerotic cardiovascular disease, independently of renal function. Traditional cardiovascular risk factors are important mediators of endothelial dysfunction, the early step of atherosclerosis. We designed this study to evaluate a possible correlation between serum phosphorus and endothelium-dependent vasodilation, evaluated by the strain-gauge plethysmography, in naïve hypertensives. METHODS AND RESULTS We investigated by strain-gauge plethysmography, the relationship between forearm blood flow (FBF) response to acetylcholine (ACh) and serum phosphorus in 500 patients with uncomplicated, never-treated, essential hypertension, divided by phosphorus tertiles. There were no significant differences among tertiles with the exclusion of forearm blood flow (FBF). Phosphorus (β = -0.454; P = 0.0001), estimated-glomerular filtration rate (e-GFR, by CKD-EPI formula) (β = 0.261; P = 0.0001), gender (β = 0.215; P = 0.0001), BMI (β = -0.086; P = 0.018), HDL-cholesterol (β = 0.077; P = 0.036) were significantly related to endothelium-dependent vasodilation. In an additional analysis including serum high sensitivity C-reactive protein (hs-CRP) (measured in 400 patients) in the same model, the link between serum phosphorus and ACh-stimulated FBF did not change (β = -0.422; P = 0.0001). Clinically relevant, 0.1 mg of phosphorus increase is associated with a reduction of 22% of ACh-stimulated FBF. On multiple logistic regression analysis, the risk of endothelial dysfunction was about twice higher in patients in the second (OR = 1.754, 95% CI = 1.055-2.915; P = 0.030) and three-fold higher in the third tertile (OR = 2.939, 95% CI = 1.598-5.408; P = 0.0001) in comparison with those in the first tertile of phosphorus. CONCLUSION An impaired ACh-stimulated FBF is associated with serum phosphorus levels, within the normal range, in hypertensives.
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Affiliation(s)
- M Perticone
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Italy
| | - R Maio
- Azienda Ospedaliera Mater Domini, Catanzaro, Italy
| | - A Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
| | - A Cimellaro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
| | - M Andreucci
- Department of Health Sciences, University Magna Græcia of Catanzaro, Italy
| | - G Tripepi
- CNR-IBIM, National Research Council-Institute of Biomedicine, Reggio Calabria, Italy
| | - C Zoccali
- CNR-IBIM, National Research Council-Institute of Biomedicine, Reggio Calabria, Italy
| | - G Sesti
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
| | - F Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
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Cao C, Hu JX, Dong YF, Zhan R, Li P, Su H, Peng Q, Wu T, Huang X, Sun WH, Wu QH, Cheng XS. Association of Endothelial and Mild Renal Dysfunction With the Severity of Left Ventricular Hypertrophy in Hypertensive Patients. Am J Hypertens 2016; 29:501-8. [PMID: 26232035 DOI: 10.1093/ajh/hpv128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/13/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The association between impaired renal function and increase left ventricular mass was shown to be related to increase in arterial stiffness, which indicates that vascular homeostasis and remodeling may impact the left ventricular hypertrophy (LVH) in patients with renal dysfunction. METHODS We measured the peripheral arterial reactive hyperemia index (RHI) and estimated glomerular filtration rate (eGFR) in 317 hypertensive patients comprising 115 normal RHI (RHI > 1.67) and normal eGFR (eGFR ≥ 90ml/min per 1.73 m(2)), 136 low RHI (RHI ≤ 1.67), 27 low eGFR (60 ≤ eGFR < 90ml/min per 1.73 m(2)) and 39 low RHI combined with low eGFR. RESULTS Multivariate logistic regression analysis identified lg RHI (odds ratio (OR): 0.001, 95% confidence interval (CI): 10(-6) to 0.426, P = 0.024) and lg eGFR (OR: 0.009, 95% CI: 10(-4) to 0.414, P = 0.016) as independent factors correlated with LVH respectively in hypertensive patients. Compared with normal RHI and eGFR patients, the extent of LVH in patients with either low RHI (OR: 1.224 95% CI: 0.451 to 3.327, P = 0.691) or low eGFR (OR: 0.593 95% CI: 0.070 to 5.037, P = 0.632) did not significantly increase, while it increased significantly in patients with low RHI combined with low eGFR (OR: 4.629 95% CI: 1.592 to 13.458, P = 0.005). CONCLUSIONS The concurrence of endothelial and mild renal dysfunction was significantly associated with the severity of LVH in hypertensive patients.
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Affiliation(s)
- Cheng Cao
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Jian-Xin Hu
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Yi-Fei Dong
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China; Key Laboratory of Molecular Biology in Jiangxi Province, Nanchang City, Jiangxi Province, China.
| | - Rui Zhan
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Ping Li
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Hai Su
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Qiang Peng
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Tao Wu
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Wen-Hua Sun
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Qing-Hua Wu
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Xiao-Shu Cheng
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
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Additive Effect of Non-Alcoholic Fatty Liver Disease on Metabolic Syndrome-Related Endothelial Dysfunction in Hypertensive Patients. Int J Mol Sci 2016; 17:456. [PMID: 27023537 PMCID: PMC4848912 DOI: 10.3390/ijms17040456] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 12/20/2022] Open
Abstract
Metabolic syndrome (MS) is characterized by an increased risk of incident diabetes and cardiovascular (CV) events, identifying insulin resistance (IR) and endothelial dysfunction as key elements. Moreover, non-alcoholic fatty liver disease (NAFLD) is bidirectionally linked with MS as a consequence of metabolic and inflammatory abnormalities. We addressed the question if the evolution in NAFLD might worsen endothelium-dependent vasodilating response in MS hypertensives. We recruited 272 Caucasian newly-diagnosed never-treated hypertensive outpatients divided into three groups according to the presence/absence of MS alone or in combination with NAFLD. MS and NAFLD were defined according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) and non-invasive fatty liver index, respectively. We determined IR by using the homeostasis model assessment (HOMA) index. Vascular function, as forearm blood flow (FBF), was determined through strain-gauge plethysmography after intra-arterial infusion of acetylcholine (ACh) and sodium nitroprusside. MS+NAFLD+ group showed worse metabolic, inflammatory and vascular profiles compared with MS−NAFLD− and MS+NAFLD−. HOMA resulted in being the strongest predictor of FBF both in the MS+NAFLD− and in the MS+NAFLD+ groups, accounting for 20.5% and 33.2% of its variation, respectively. In conclusion, we demonstrated that MS+NAFLD+ hypertensives show a worse endothelium-dependent vasodilation compared with MS+NAFLD−, allowing for consideration of NAFLD as an early marker of endothelial dysfunction in hypertensives.
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Frequency of Left Ventricular Hypertrophy in Non-Valvular Atrial Fibrillation. Am J Cardiol 2015; 116:877-82. [PMID: 26183791 DOI: 10.1016/j.amjcard.2015.05.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/31/2015] [Accepted: 05/31/2015] [Indexed: 12/28/2022]
Abstract
Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 ± 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index ≤0.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc ≥2 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention.
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Regulator of G-protein signaling 6 (RGS6) in cardiology and oncology. Int J Cardiol 2015; 187:99-102. [PMID: 25828322 DOI: 10.1016/j.ijcard.2015.03.278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/19/2015] [Indexed: 02/06/2023]
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Patanè S. Regulator of G-protein signaling 2 (RGS2) in cardiology and oncology. Int J Cardiol 2014; 179:63-5. [PMID: 25464414 DOI: 10.1016/j.ijcard.2014.10.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 10/20/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy. patane-@libero.it
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Patanè S. M3 muscarinic acetylcholine receptor in cardiology and oncology. Int J Cardiol 2014; 177:646-9. [PMID: 25449471 DOI: 10.1016/j.ijcard.2014.09.178] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 09/27/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, Contrada Sirina, 98039 Taormina (Messina), Italy. patane-@libero.it
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Can the cold pressor test predict future cardiovascular events in patients without demonstrated ischemic heart disease by SPECT? Int J Cardiol 2014; 175:226-32. [DOI: 10.1016/j.ijcard.2014.04.202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 04/15/2014] [Accepted: 04/19/2014] [Indexed: 11/18/2022]
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