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Nobre Menezes M, Silva B, Silva JL, Rodrigues T, Marques JS, Guerreiro C, Guedes JP, Oliveira-Santos M, Oliveira AL, Pinto FJ. Segmentation of X-ray coronary angiography with an artificial intelligence deep learning model: Impact in operator visual assessment of coronary stenosis severity. Catheter Cardiovasc Interv 2023; 102:631-640. [PMID: 37579212 DOI: 10.1002/ccd.30805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/01/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Visual assessment of the percentage diameter stenosis (%DSVE ) of lesions is essential in coronary angiography (CAG) interpretation. We have previously developed an artificial intelligence (AI) model capable of accurate CAG segmentation. We aim to compare operators' %DSVE in angiography versus AI-segmented images. METHODS Quantitative coronary analysis (QCA) %DS (%DSQCA ) was previously performed in our published validation dataset. Operators were asked to estimate %DSVE of lesions in angiography versus AI-segmented images in separate sessions and differences were assessed using angiography %DSQCA as reference. RESULTS A total of 123 lesions were included. %DSVE was significantly higher in both the angiography (77% ± 20% vs. 56% ± 13%, p < 0.001) and segmentation groups (59% ± 20% vs. 56% ± 13%, p < 0.001), with a much smaller absolute %DS difference in the latter. For lesions with %DSQCA of 50%-70% (60% ± 5%), an even higher discrepancy was found (angiography: 83% ± 13% vs. 60% ± 5%, p < 0.001; segmentation: 63% ± 15% vs. 60% ± 5%, p < 0.001). Similar, less pronounced, findings were observed for %DSQCA < 50% lesions, but not %DSQCA > 70% lesions. Agreement between %DSQCA /%DSVE across %DSQCA strata (<50%, 50%-70%, >70%) was approximately twice in the segmentation group (60.4% vs. 30.1%; p < 0.001). %DSVE inter-operator differences were smaller with segmentation. CONCLUSION %DSVE was much less discrepant with segmentation versus angiography. Overestimation of %DSQCA < 70% lesions with angiography was especially common. Segmentation may reduce %DSVE overestimation and thus unwarranted revascularization.
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Affiliation(s)
- Miguel Nobre Menezes
- Structural and Coronary Heart Disease Unit, Cardiovascular Center of the University of Lisbon, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Departamento de Coração e Vasos, Serviço de Cardiologia, CHULN Hospital de Santa Maria, Lisboa, Portugal
| | - Beatriz Silva
- Structural and Coronary Heart Disease Unit, Cardiovascular Center of the University of Lisbon, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Departamento de Coração e Vasos, Serviço de Cardiologia, CHULN Hospital de Santa Maria, Lisboa, Portugal
| | | | - Tiago Rodrigues
- Structural and Coronary Heart Disease Unit, Cardiovascular Center of the University of Lisbon, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Departamento de Coração e Vasos, Serviço de Cardiologia, CHULN Hospital de Santa Maria, Lisboa, Portugal
| | - João Silva Marques
- Structural and Coronary Heart Disease Unit, Cardiovascular Center of the University of Lisbon, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Departamento de Coração e Vasos, Serviço de Cardiologia, CHULN Hospital de Santa Maria, Lisboa, Portugal
| | - Cláudio Guerreiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - João Pedro Guedes
- Unidade de Hemodinâmica e Cardiologia de Intervenção, Serviço de Cardiologia, Centro Hospitalar Universitário do Algarve, Hospital de Faro, Faro, Portugal
| | - Manuel Oliveira-Santos
- Unidade de Intervenção Cardiovascular, Serviço de Cardiologia do Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Pólo das Ciências da Saúde, Unidade Central, Azinhaga de Santa Comba, Celas, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - Fausto J Pinto
- Structural and Coronary Heart Disease Unit, Cardiovascular Center of the University of Lisbon, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Departamento de Coração e Vasos, Serviço de Cardiologia, CHULN Hospital de Santa Maria, Lisboa, Portugal
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Lake P, Halbach M, Kardasch M, Mauri V, Baldus S, Adam M, Wienemann H. Comparison of vessel fractional flow reserve with invasive resting full-cycle ratio in patients with intermediate coronary lesions. Int J Cardiol 2023; 377:1-8. [PMID: 36693476 DOI: 10.1016/j.ijcard.2023.01.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Vessel fractional flow reserve (vFFR) is a novel angiography-derived index for the assessment of myocardial ischemia without the need for pressure wires and hyperemic agents. vFFR has demonstrated very good diagnostic performance compared with the hyperemic index fractional flow reserve (FFR). The aim of this study was to compare vFFR to the non-hyperemic pressure ratio resting full-cycle ratio (RFR). METHODS This was a retrospective, observational, single-center study of an all-comer cohort undergoing RFR assessment. Invasive coronary angiography was obtained without a dedicated vFFR acquisition protocol, and vFFR calculation was attempted in all vessels interrogated by RFR (1483 lesions of 1030 patients). RESULTS vFFR could be analyzed in 986 lesions from 705 patients. Median diameter stenosis was 37% (interquartile range (IQR): 30.0-44.0%), vFFR 0.86 (IQR: 0.81-0.91) and RFR 0.94 (IQR: (0.90-0.97). The correlation between vFFR and RFR was strong (r = 0.70, 95% confidence interval (CI): 0.66-0.74, p < 0.001). Using RFR ≤0.89 as reference, the sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy for vFFR were 77%, 93%, 77%, and 92% and 89%. vFFR yielded a high area under the curve (AUC) of 0.92 (95% CI: 0.90-0.94). The good diagnostic performance of vFFR was confirmed among subgroups of patients with diabetes, severe aortic stenosis, female gender and lesions located in the left anterior descending artery. CONCLUSION vFFR has a high diagnostic performance taking RFR as the reference standard for evaluating the functional significance of coronary stenoses.
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Mejía-Rentería H, Wang L, Chipayo-Gonzales D, van de Hoef TP, Travieso A, Espejo C, Núñez-Gil IJ, Macaya F, Gonzalo N, Escaned J. Angiography-derived assessment of coronary microcirculatory resistance in patients with suspected myocardial ischaemia and non-obstructive coronary arteries. EUROINTERVENTION 2023; 18:e1348-e1356. [PMID: 36534493 PMCID: PMC10068857 DOI: 10.4244/eij-d-22-00579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/06/2022] [Indexed: 04/05/2023]
Abstract
BACKGROUND Myocardial ischaemia with non-obstructive coronary arteries (INOCA) represents a challenging and frequent, but largely underdiagnosed, condition. AIMS We aimed to investigate the feasibility and diagnostic value of angiography-derived coronary microcirculatory resistance in patients with INOCA syndrome. METHODS This is an investigator-driven, prospective and blinded study. The diagnostic yield of angiography-derived index of coronary microcirculatory resistance (angio-IMR) was investigated against thermodilution-derived IMR (thermo-IMR) in patients with clinically indicated coronary angiography due to suspected myocardial ischaemia and angiographically normal or non-obstructive coronary arteries. The angio-IMR was derived from resting angiograms (contrast-flow angio-IMR [cAngio-IMR]) by an expert analyst blinded to the thermo-IMR. An independent, blinded, physiology core laboratory analysed the raw intracoronary physiology data and provided the final thermo-IMR values. RESULTS A total of 104 patients (108 coronary vessels) were analysed after fulfilling predefined inclusion criteria. Most patients were female (67%). Obstructive epicardial disease was angiographically (percent diameter stenosis <50%) and physiologically (fractional flow reserve>0.80) ruled out in all cases. Median thermo-IMR and cAngio-IMR were 16.6 (12.7, 23.0) and 16.8 (12.8, 23.1) units, respectively (median difference -0.31, 95% confidence interval: -1.53 to 1.00; p=0.654). cAngio-IMR showed good correlation (Pearson coefficient 0.76; p<0.001), agreement (mean bias 0.4), discriminatory power (area under the curve from the receiver operator characteristics 0.865; p<0.001) and accuracy (85%), compared to thermo-IMR (≥25 U). CONCLUSIONS Evaluating coronary microcirculatory resistance in patients with INOCA syndrome using cAngio-IMR is feasible and accurate. By circumventing the need of coronary instrumentation and hyperaemic drugs, this method may facilitate the assessment of coronary microcirculatory resistance in patients with suspected INOCA. CLINICALTRIALS gov: NCT04827498.
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Affiliation(s)
- Hernán Mejía-Rentería
- Department of Cardiology, Hospital Clínico San Carlos IdISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Lin Wang
- Department of Cardiology, Hospital Clínico San Carlos IdISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - David Chipayo-Gonzales
- Department of Cardiology, Hospital Clínico San Carlos IdISSC and Universidad Complutense de Madrid, Madrid, Spain
| | | | - Alejandro Travieso
- Department of Cardiology, Hospital Clínico San Carlos IdISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Carolina Espejo
- Department of Cardiology, Hospital Clínico San Carlos IdISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos IdISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Fernando Macaya
- Department of Cardiology, Hospital Clínico San Carlos IdISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Department of Cardiology, Hospital Clínico San Carlos IdISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos IdISSC and Universidad Complutense de Madrid, Madrid, Spain
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Monsuez JJ, Gatzov P, Ferreira-Gonzalez I, Alfonso F, Gatzov P, Aschermann M, Badran HM, Cardim N, Cohen A, De La Torre Hernandez JM, Erol C, Held C, Heusch G, Lancellotti P, Piek J, Sanchis J, Undas A, Ural D, Alfonso F, Ferreira-Gonzalez I. Coronary interventions 2021: insights from the National Societies of Cardiology Journals of the European Society of Cardiology. Eur Heart J 2023; 44:251-253. [PMID: 36478051 DOI: 10.1093/eurheartj/ehac679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jean-Jacques Monsuez
- Cardiology, Hôpital René Muret, Hôpitaux Universitaires de Paris Seine Saint-Denis, Avenue du docteur Schaeffner, France
| | - Plamen Gatzov
- Department of Cardiology, Medical University of Pleven, 1, Kl. Ohridski Street, Pleven, Bulgaria
| | - Ignacio Ferreira-Gonzalez
- Cardiology Department, Vall d'Hebron Hospital, and Universitat Autònoma de Barcelona, CIBERESP, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Spain
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Ikeda K, Kobayashi M, Chikamori T, Yanaka Y, Takagi R, Kani J, Oshima O, Yamada S, Hokama Y, Tanaka N. Comparison between the diagnostic performance of vessel fractional flow reserve and nonhyperemic pressure ratio for functionally significant coronary stenosis severity as assessed by fractional flow reserve. Catheter Cardiovasc Interv 2023; 101:72-78. [PMID: 36480810 DOI: 10.1002/ccd.30511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs) have been widely used to assess the functional severity of coronary stenosis. However, their measurement requires using a pressure wire, making their use in all patients difficult. The recently developed vessel fractional flow reserve (vFFR), derived from three-dimensional quantitative coronary angiography, is expected to serve as a surrogate for pressure wire assessment. METHODS This retrospective study was conducted on patients with intermediate coronary stenosis who underwent FFR and NHPR measurements. The vFFR and NHPR values were compared for diagnosing coronary stenosis as defined by an FFR of ≤0.80, and the number of patients not requiring wire-based assessment was estimated. RESULTS In a total of 90 lesions from 74 patients (median [SD] age 75 [12] years; men 80%), the median FFR was 0.78 (0.72-0.84), and 57% of these lesions (N = 51) exhibited an FFR of ≤0.80. vFFR provided high discrimination for coronary stenosis (area under the curve 0.80, 95% confidence interval 0.70-0.90), which was comparable to that of NHPRs (p = 0.42). High diagnostic accuracy was consistently observed across a variety of clinical presentations (i.e., old age, diabetes, target coronary artery, and left ventricular hypertrophy) (pinteraction > 0.05). In total, 55 lesions (61%) demonstrated positive or negative likelihood of coronary stenosis when vFFR was <0.73 (specificity 90%) or >0.87 (sensitivity 88%), respectively. CONCLUSION vFFR demonstrated excellent diagnostic performance for detecting functionally significant coronary stenosis as evaluated by FFR. vFFR may be used as a surrogate for pressure wire assessment.
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Affiliation(s)
- Kazumasa Ikeda
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Masatake Kobayashi
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | | | - Yohei Yanaka
- Central Clinical Laboratory Division, Tokyo Medical University Hachiouji Medical Center, Tokyo, Japan
| | - Ryu Takagi
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Junya Kani
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Outaro Oshima
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Satoshi Yamada
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Yohei Hokama
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
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Wienemann H, Ameskamp C, Mejía-Rentería H, Mauri V, Hohmann C, Baldus S, Adam M, Escaned J, Halbach M. Diagnostic performance of quantitative flow ratio versus fractional flow reserve and resting full-cycle ratio in intermediate coronary lesions. Int J Cardiol 2022; 362:59-67. [PMID: 35662563 DOI: 10.1016/j.ijcard.2022.05.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/23/2022] [Accepted: 05/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a novel angiography-derived index aimed to assess the functional relevance of coronary stenoses without pressure wires and adenosine. Good diagnostic yield with the hyperemic fractional flow reserve (FFR) have been reported, while data on the comparison of QFR to non-hyperemic pressure ratios (NHPR) are scarce. METHODS In this retrospective, observational and single-center study with a large population representative of the real practice, we assessed and compared the diagnostic performance of contrast flow (cQFR) and fixed flow (fQFR) QFR against the NHPR resting full-cyle ratio (RFR) using FFR as reference standard. RESULTS A total of 626 lesions from 544 patients were investigated. Mean diameter stenosis, FFR, cQFR, fQFR and RFR were 44.8%, 0.842, 0.847, 0.857 and 0.912, respectively. The correlation between cQFR and FFR was stronger (r = 0.830, P < 0.001) compared to that between FFR and RFR (r = 0.777, P < 0.001) and between cQFR and RFR (r = 0.687, P < 0.001). Using FFR ≤0.80 as reference, the sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy for cQFR were 82%, 95%, 87%, 92%, and 91%, respectively. cQFR displayed a higher area under the curve (AUC) than fQFR and RFR (0.938 vs. 0.891 vs. 0.869, P < 0.01). The good diagnostic yield of cQFR appeared to be maintained in different clinical subsets including female gender, aortic valve stenosis and atrial fibrillation, and in different anatomical subsets including focal and non-focal lesions. CONCLUSION cQFR has a high and better diagnostic performance than the NHPR RFR in predicting FFR-based functional significance of coronary stenoses.
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Affiliation(s)
- Hendrik Wienemann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 61, 50937 Cologne, Germany
| | - Christopher Ameskamp
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 61, 50937 Cologne, Germany
| | - Hernán Mejía-Rentería
- Department of Cardiology, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Victor Mauri
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 61, 50937 Cologne, Germany
| | - Christopher Hohmann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 61, 50937 Cologne, Germany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 61, 50937 Cologne, Germany
| | - Matti Adam
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 61, 50937 Cologne, Germany
| | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Marcel Halbach
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 61, 50937 Cologne, Germany.
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Fontes-carvalho R, Moraes de Oliveira GM, Gonçalves-teixeira P, Eduardo Rochitte C, Cardim N. 2021 top 10 articles in the Arquivos Brasileiros de Cardiologia and the Revista Portuguesa de Cardiologia. Rev Port Cardiol 2022; 41:611-620. [DOI: 10.1016/j.repc.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
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Fontes-Carvalho R, Oliveira GMMD, Gonçalves-Teixeira P, Rochitte CE, Cardim N. 2021 Top 10 Articles in the Arquivos Brasileiros de Cardiologia and the Revista Portuguesa de Cardiologia. Arq Bras Cardiol 2022; 119:113-123. [PMID: 35830110 PMCID: PMC9352128 DOI: 10.36660/abc.20220312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ricardo Fontes-Carvalho
- Departamento de Cardiologia - Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia/Espinho - Portugal.,Cardiovascular Research Center (UniC), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Gláucia Maria Moraes de Oliveira
- Faculdade de Medicina - Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil.,Instituto do Coração Edson Saad - Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
| | - Pedro Gonçalves-Teixeira
- Departamento de Cardiologia - Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia/Espinho - Portugal.,Cardiovascular Research Center (UniC), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.,Hospital do Coração (HCOR), São Paulo, SP - Brasil
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Calé R. Coronary physiology in clinical practice in Portugal: A problem of technology or a question of attitude? Rev Port Cardiol 2021; 40:783-784. [PMID: 34857117 DOI: 10.1016/j.repce.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Rita Calé
- Serviço de Cardiologia do Hospital Garcia de Orta, Almada, Portugal.
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Calé R. Coronary physiology in clinical practice in Portugal: A problem of technology or a question of attitude? Rev Port Cardiol 2021; 40:S0870-2551(21)00352-8. [PMID: 34509333 DOI: 10.1016/j.repc.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rita Calé
- Serviço de Cardiologia do Hospital Garcia de Orta, Almada, Portugal.
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