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Review Article | DOI: https://doi.org/10.31579/2641-0419/523
¹Department of Cardiology, Hitit University Erol Olçok Education and Research Hospital, Corum, Turkey.
2Department of Cardiology, Facult of Medicine, Hitit University, Corum, Turkey.
*Corresponding Author: Macit Kalcik, Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey.
Citation: Ömer B. Çelik, Macit Kalçik, Mucahit Yetim, Muhammet C. Çelik, Lütfü Bekar, et al, (2025), Diagnostic and Prognostic Significance of Exercise-Induced Left Bundle Branch Block in Stress Testing, J Clinical Cardiology and Cardiovascular Interventions, 7(12); DOI: 10.31579/2641-0419/523
Copyright: © 2025, Macit Kalcik. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 02 October 2025 | Accepted: 30 October 2025 | Published: 10 November 2025
Keywords: exercise-induced left bundle branch block; coronary artery disease; stress testing; cardiac conduction abnormalities; prognosis
Exercise-induced left bundle branch block (EI-LBBB) is a rare but clinically relevant phenomenon observed during exercise stress testing. Unlike pre-existing LBBB, which complicates electrocardiographic interpretation from the outset, EI-LBBB appears transiently during exercise and raises unique diagnostic and prognostic challenges. Its reported prevalence is low, yet it has been associated with both significant coronary artery disease and intrinsic conduction system abnormalities. The onset of EI-LBBB at lower heart rates is often linked to obstructive coronary lesions, whereas high-rate onset may indicate rate-dependent conduction delay in structurally normal hearts. The prognostic implications of EI-LBBB remain controversial. Some studies demonstrate a strong association with adverse cardiovascular outcomes, including myocardial infarction and death, while others report relatively benign courses in patients without coronary artery disease. Diagnostic evaluation is challenging because LBBB masks ischemic ST-segment changes, reducing the utility of standard exercise electrocardiography. For this reason, adjunctive imaging modalities such as stress echocardiography, myocardial perfusion imaging, and cardiac magnetic resonance imaging are recommended to clarify underlying pathology and risk. Management of EI-LBBB requires an individualized approach, incorporating symptom assessment, risk stratification, and additional diagnostic testing. Long-term follow-up is essential, as EI-LBBB may progress to permanent conduction system disease or contribute to ventricular dysfunction over time. Despite decades of recognition, major gaps remain regarding its natural history, optimal diagnostic strategies, and treatment implications. Future prospective studies are needed to define evidence-based recommendations for this rare but important clinical entity.
Left bundle branch block (LBBB) represents a significant disturbance of the normal conduction pathway of the heart, characterized by delayed activation of the left ventricle and distinctive electrocardiographic features. It is traditionally associated with structural heart disease, ischemia, and degenerative changes of the conduction system [1]. Exercise stress testing remains a cornerstone in the diagnostic evaluation of suspected coronary artery disease (CAD), providing valuable information regarding ischemia, exercise tolerance, and prognosis [2].
However, the occurrence of new-onset LBBB during exercise testing, often referred to as exercise-induced left bundle branch block (EI-LBBB), poses a unique diagnostic and clinical challenge. Unlike pre-existing LBBB, which complicates interpretation of the exercise electrocardiogram, EI-LBBB is relatively rare, with a reported prevalence ranging from 0.2% to 1.1% of patients undergoing exercise stress testing [3,4]. Its precise mechanisms remain incompletely understood, but proposed etiologies include rate-related conduction delay, myocardial ischemia, and underlying conduction system disease [5].
The prognostic implications of EI-LBBB are controversial. Some studies suggest that EI-LBBB is frequently associated with significant CAD and adverse cardiovascular outcomes [6]. while others report its occurrence in patients without obstructive coronary disease, potentially reflecting intrinsic conduction system abnormalities [7]. This heterogeneity highlights the need for a systematic assessment of the available evidence.
Given the increasing use of exercise stress testing in both outpatient and inpatient settings, recognition of EI-LBBB and understanding its implications is of growing clinical importance. This review aims to summarize current knowledge regarding the pathophysiology, diagnostic considerations, prognostic significance, and management strategies of exercise-induced LBBB, with a focus on identifying gaps in the literature and directions for future research.
Pathophysiology of Exercise-Induced LBBB
The mechanisms underlying exercise-induced left bundle branch block (EI-LBBB) are complex and multifactorial. One proposed explanation is rate-related conduction delay, in which the left bundle branch fails to conduct when the heart rate exceeds a critical threshold. This phenomenon is often reversible, as conduction may normalize once the heart rate decreases, suggesting a functional rather than structural abnormality in some patients [8].
Another important mechanism is myocardial ischemia. During exercise, increased myocardial oxygen demand can unmask conduction abnormalities within the left bundle branch, particularly in the presence of underlying coronary artery disease [9]. Ischemia may impair conduction through the His-Purkinje system, resulting in transient bundle branch block. Some studies have reported a strong association between EI-LBBB and significant obstructive lesions of the left anterior descending or left main coronary arteries, highlighting ischemia as a key contributor in certain cases [10].
Degenerative disease of the conduction system also plays a role. Patients with structurally normal coronary arteries may still develop EI-LBBB due to intrinsic disease of the bundle branches, often age-related fibrosis or idiopathic degeneration. In these cases, EI-LBBB may represent an early manifestation of conduction system disease, potentially progressing to permanent bundle branch block or advanced atrioventricular block over time [11].
Autonomic influences and electrolyte shifts during exercise have also been considered as contributing factors, although evidence supporting these mechanisms is limited. Ultimately, EI-LBBB is likely a heterogeneous condition, with ischemia, rate-related conduction delay, and intrinsic conduction disease variably contributing depending on the patient population (Table 1).
| Mechanism | Description | Clinical Clues |
| Rate-related conduction delay | Left bundle fails to conduct once heart rate exceeds a threshold | Appears at higher heart rates, often not associated with CAD |
| Myocardial ischemia | Increased oxygen demand unmasks conduction abnormality | More frequent at lower heart rates, linked to LAD/LMCA lesions |
| Degenerative conduction disease | Age-related fibrosis or idiopathic bundle branch disease | Occurs even without CAD, may progress to permanent LBBB |
| Autonomic/electrolyte effects | Exercise-induced changes may contribute | Evidence limited |
Table 1: Proposed Mechanisms of Exercise-Induced Left Bundle Branch Block (EI-LBBB)
Abbreviations: EI-LBBB: Exercise-Induced Left Bundle Branch Block, CAD: Coronary Artery Disease, LAD: Left Anterior Descending Artery, LMCA: Left Main Coronary Artery
Diagnostic Challenges
The occurrence of exercise-induced left bundle branch block presents several diagnostic challenges in clinical practice. A major difficulty arises from the fact that the presence of LBBB itself alters ventricular depolarization and repolarization, leading to secondary ST-segment and T-wave changes on the electrocardiogram. These alterations often mimic or obscure ischemic patterns, making conventional interpretation of exercise stress testing unreliable in such patients [12].
Because of these limitations, the diagnostic accuracy of exercise electrocardiography in patients with LBBB is significantly reduced. Standard ischemic criteria based on ST-segment depression are not valid in this setting, and the risk of both false-positive and false-negative results is high [13]. Consequently, alternative diagnostic modalities are recommended when evaluating patients with suspected coronary artery disease who develop EI-LBBB during stress testing.
Stress imaging techniques, such as stress echocardiography and myocardial perfusion scintigraphy, provide valuable adjunctive information by assessing wall motion abnormalities and perfusion defects, respectively. However, even these modalities may have technical limitations in patients with baseline conduction abnormalities. Cardiac magnetic resonance imaging has also been proposed as a promising option, particularly for tissue characterization and precise evaluation of regional contractility [14].
Another challenge is distinguishing between ischemia-induced EI-LBBB and rate-related or idiopathic forms. A careful evaluation of patient characteristics, coronary risk profile, and associated symptoms during the onset of LBBB is crucial. For example, EI-LBBB occurring at low workloads or heart rates is more often associated with significant coronary artery disease, whereas onset at higher heart rates may favor rate-dependent conduction delay without ischemia [15].
These diagnostic uncertainties highlight the importance of individualized assessment and the need for integrating multiple diagnostic tools to accurately interpret EI-LBBB in the context of stress testing (Table 2).
| Challenge | Effect | Recommended Solution |
| ST-segment alterations masking ischemia | Reduces diagnostic accuracy of ECG | Stress echocardiography, myocardial perfusion imaging, CMR |
| Differentiating ischemic vs. rate-related block | Impacts clinical management | Consider onset heart rate, risk profile, and symptoms |
| High false positive/negative rates | Limits reliability of exercise ECG | Integrate multimodality assessment |
Table 2: Diagnostic Challenges and Solutions in EI-LBBB
Abbreviations: EI-LBBB: Exercise-Induced Left Bundle Branch Block, ECG: Electrocardiogram, CMR: Cardiac Magnetic Resonance Imaging, CAD: Coronary Artery Disease
Literature Review and Clinical Evidence
Reports of exercise-induced left bundle branch block (EI-LBBB) first appeared in the early 1970s, with Narula and colleagues describing its occurrence in otherwise healthy individuals as well as in patients with coronary artery disease [7]. Since then, multiple observational studies have attempted to define its prevalence, mechanisms, and prognostic significance. Although rare, EI-LBBB has consistently been reported with a prevalence of less than 1% in patients undergoing exercise stress testing [3,4].
The association between EI-LBBB and coronary artery disease has been a major focus of investigation. Several studies have shown that EI-LBBB is often linked with significant obstructive coronary lesions, particularly in the left anterior descending and left main arteries (9,10). In these cohorts, the onset of EI-LBBB during exercise has been interpreted as a marker of ischemia and associated with higher rates of adverse cardiovascular events, including myocardial infarction and cardiac death [6,13]. Importantly, the onset of EI-LBBB at lower heart rates, typically below 120 beats per minute, has been correlated with more severe underlying coronary artery disease [15,16].
Conversely, other reports have identified patients who develop EI-LBBB in the absence of obstructive coronary artery disease. In these cases, EI-LBBB has been attributed to rate-dependent conduction delay or idiopathic conduction system disease, suggesting that not all occurrences carry the same prognostic weight (11,17]. This heterogeneity has complicated efforts to establish clear clinical guidelines, as outcomes vary depending on the patient population and underlying pathology.
Long-term follow-up studies have provided additional insights. Grady et al. demonstrated that patients with EI-LBBB had a significantly higher risk of mortality and major adverse cardiac events compared with matched controls [6]. In contrast, Biagini et al. reported that the prognosis was more favorable in patients without significant coronary artery disease, indicating that the prognostic significance of EI-LBBB is strongly influenced by the presence or absence of CAD [13].
Taken together, the evidence suggests that EI-LBBB is a heterogeneous entity. When associated with significant coronary artery disease, it represents an important risk marker for adverse outcomes. In patients without obstructive CAD, however, EI-LBBB may reflect intrinsic conduction system abnormalities with a more variable prognosis (Table 3).
| Study | Population | Findings | Prognosis |
| Vasey et al. | Exercise test patients | Association between EI-LBBB and CAD | Linked to adverse outcomes |
| Grady et al. | Long-term follow-up | Higher mortality and MACE in EI-LBBB | Poor prognosis |
| Biagini et al. | Patients without CAD | Some cases benign | Heterogeneous outcomes |
| Stein et al. | General population | Prevalence 0.2–1.1% | Rare but significant |
Table 3: Literature on Prognostic Significance of EI-LBBB
Abbreviations: EI-LBBB: Exercise-Induced Left Bundle Branch Block, CAD: Coronary Artery Disease, MACE: Major Adverse Cardiac Events
Guidelines and Expert Opinions
Current international guidelines provide limited specific recommendations regarding exercise-induced left bundle branch block (EI-LBBB). The European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association (ACC/AHA) guidelines recognize that the presence of baseline LBBB complicates interpretation of exercise stress testing, but they do not address EI-LBBB as a distinct clinical entity [2,18]. Instead, both guidelines suggest that in patients with LBBB—whether pre-existing or exercise-induced—diagnostic reliance should shift from standard electrocardiography to adjunctive imaging techniques, such as stress echocardiography, myocardial perfusion imaging, or cardiac MRI.
Expert opinion papers and smaller consensus statements emphasize that EI-LBBB should not be dismissed as a benign phenomenon. When EI-LBBB develops at lower workloads or heart rates, it is more likely associated with significant coronary artery disease and warrants further evaluation, often with coronary angiography [15,16,19]. In contrast, onset at higher heart rates without evidence of ischemia may represent rate-dependent conduction block and could be monitored more conservatively, although long-term follow-up is still advised due to the potential progression to permanent conduction abnormalities [11,17].
Some electrophysiology experts argue that EI-LBBB may represent an early marker of conduction system disease even in the absence of ischemia. This perspective suggests a broader role for long-term rhythm monitoring and periodic reassessment of left ventricular function in these patients [20]. However, these recommendations are based largely on observational data rather than randomized controlled trials.
Overall, while guidelines provide general direction on the limitations of exercise testing in the presence of LBBB, they leave significant gaps regarding the optimal evaluation and management of EI-LBBB. Expert consensus fills some of these gaps but highlights the need for further systematic research.
Clinical Approach and Management
The detection of exercise-induced left bundle branch block (EI-LBBB) during stress testing should prompt a careful and systematic evaluation. The first step is to determine whether the onset is associated with clinical symptoms such as chest pain, dyspnea, or syncope. Symptomatic patients, especially when EI-LBBB develops at relatively low workloads or heart rates, should be considered at higher risk for underlying coronary artery disease (9,15,19). In such cases, invasive coronary angiography or non-invasive imaging with high diagnostic accuracy, such as coronary computed tomography angiography, should be pursued to rule out significant obstructive lesions.
In asymptomatic individuals or in those where EI-LBBB appears only at higher heart rates, a more conservative approach may be reasonable. Nevertheless, adjunctive imaging is often recommended since the presence of EI-LBBB itself reduces the diagnostic reliability of exercise electrocardiography. Stress echocardiography, myocardial perfusion scintigraphy, and cardiac MRI can provide complementary information to identify ischemia and assess left ventricular function [14,18].
Long-term follow-up is an essential component of management. Several studies suggest that patients with EI-LBBB, even in the absence of obstructive coronary artery disease, are at risk of progression to permanent LBBB, atrioventricular block, or cardiomyopathy related to electrical dyssynchrony [11,17,20]. Therefore, periodic reassessment with electrocardiography and echocardiography is advisable.
For patients who develop symptomatic heart failure or reduced ejection fraction in the context of persistent or progressive LBBB, cardiac resynchronization therapy (CRT) should be considered, in accordance with established guidelines for heart failure management (20,21). Additionally, optimization of cardiovascular risk factors, including hypertension, diabetes, and dyslipidemia, remains a cornerstone of therapy for all patients presenting with EI-LBBB, regardless of the underlying mechanism.
Ultimately, the clinical approach to EI-LBBB should be individualized, integrating the onset characteristics (heart rate and workload), symptomatology, coronary risk profile, and the results of further diagnostic testing. This tailored strategy ensures that patients at high risk for ischemic heart disease receive timely intervention, while those with non-ischemic conduction disease are closely monitored for disease progression (Table 4).
| Clinical Situation | Suggested Management |
| Symptomatic, low heart-rate onset | High risk of CAD → Coronary angiography or CTA |
| Asymptomatic, high heart-rate onset | Likely rate-related block → Conservative follow-up + imaging |
| Non-ischemic but persistent EI-LBBB | Long-term monitoring with ECG/echo |
| Progression to permanent LBBB with LV dysfunction | Consider cardiac resynchronization therapy (CRT) |
| All patients | Optimize risk factor control (HT, DM, dyslipidemia) |
Table 4: Clinical Approach and Management of EI-LBBB
Abbreviations: EI-LBBB: Exercise-Induced Left Bundle Branch Block, CAD: Coronary Artery Disease, CTA: Computed Tomography Angiography, ECG: Electrocardiogram, LV: Left Ventricle / Left Ventricular, CRT: Cardiac Resynchronization Therapy, HT: Hypertension, DM: Diabetes Mellitus
Future Directions and Research Gaps
Despite decades of observation, exercise-induced left bundle branch block (EI-LBBB) remains an under-investigated clinical phenomenon. Much of the existing knowledge is derived from case reports, small observational studies, or retrospective analyses, which limits the generalizability of findings [7,13,16]. Several important gaps persist in our understanding.
First, the true prevalence and natural history of EI-LBBB are uncertain. Most available data come from stress test cohorts, which may not represent the broader population undergoing cardiac evaluation. Prospective, multicenter studies with larger sample sizes are required to clarify incidence, risk factors, and outcomes [3,4,10].
Second, the prognostic significance of EI-LBBB remains controversial. While some studies suggest a strong association with coronary artery disease and adverse outcomes [6,9,19], others demonstrate that EI-LBBB can occur in the absence of obstructive lesions, possibly reflecting intrinsic conduction disease with more benign implications [11,17]. Future research should aim to stratify patients according to onset characteristics, such as heart rate thresholds and accompanying symptoms, to better predict which individuals are at higher risk.
Third, diagnostic strategies in the context of EI-LBBB require further refinement. Although current guidelines recommend adjunctive imaging modalities [18,21], there is little evidence directly comparing the accuracy and prognostic value of different techniques in this specific population. Comparative trials involving stress echocardiography, myocardial perfusion imaging, and cardiac MRI could provide much-needed clarity.
Finally, therapeutic implications remain poorly defined. It is unknown whether early identification and management of EI-LBBB in asymptomatic patients alter long-term outcomes, or whether these individuals should simply be monitored. The potential role of advanced rhythm monitoring, electrophysiological studies, and early intervention strategies such as prophylactic pacing or resynchronization therapy has yet to be systematically evaluated [20,21].
Addressing these gaps will require collaborative research efforts, ideally integrating electrophysiological, imaging, and clinical outcome data. Such studies have the potential not only to clarify the prognostic implications of EI-LBBB but also to inform evidence-based management strategies tailored to individual patient profiles.
Exercise-induced left bundle branch block (EI-LBBB) is an uncommon but clinically significant finding during exercise stress testing. Although its prevalence is low, its occurrence often raises important diagnostic and prognostic questions. Evidence suggests that EI-LBBB is a heterogeneous entity: in some patients, it reflects underlying obstructive coronary artery disease and carries an increased risk of adverse outcomes, while in others it represents rate-dependent or idiopathic conduction system disease with more variable prognosis [6,9,11,17,19].
Diagnostic interpretation is complicated by the fact that LBBB itself masks ischemic electrocardiographic changes, limiting the utility of conventional stress testing. For this reason, adjunctive imaging modalities such as stress echocardiography, myocardial perfusion imaging, and cardiac magnetic resonance imaging are strongly recommended when EI-LBBB occurs [14,18,21].
From a management perspective, patients who develop EI-LBBB should undergo individualized evaluation based on symptomatology, coronary risk profile, and onset characteristics. Those with evidence of ischemia or low-threshold onset require more aggressive diagnostic and therapeutic strategies, whereas others may be monitored with careful long-term follow-up. Importantly, all patients remain at potential risk of progression to permanent LBBB, conduction system disease, or heart failure, underscoring the need for periodic reassessment. Future studies must focus on clarifying the prognostic value of EI-LBBB, refining diagnostic pathways, and defining optimal management strategies. Until more robust evidence is available, a cautious and tailored approach remains essential in clinical practice.
All of the authors contributed planning, conduct, and reporting of the work. All authors had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
No financial funding was received for this study.
All of the authors have no conflict of interest.
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Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
