AUCTORES
Globalize your Research
Research article | DOI: https://doi.org/10.31579/2641-0419/233
1Department of Cardiology, National University Hospital Center Aristide le Dantec of Dakar; Faculty of Medicine, Pharmacy and Odontology-DAKAR (SENEGAL).
2Cheick Anta Diop University of Dakar / Doctoral School of Life Sciences, Health and Environment (ED-SEV) / Biology, Nutrition and Human Pathology.
3Department of Cardiology, Idrissa Pouye General Hospital of Dakar; Faculty of Medicine, Pharmacy and Odontology -DAKAR (SENEGAL)
*Corresponding Author: Paul Coffi HESSOU, Departments of Cardiology, Aristide le Dantec National University Hospital Center; and Idrissa Pouye General Hospital of Dakar (SENEGAL)
Citation: Joseph S. MINGOU., Maboury DIAO, Fatou AW LEYE, Mouhamadou B. NDIAYE., Simon A. SARR., et all (2022). Stable Angina Pectoris: One-Year Outcomes of Patients with Obstructive Coronary Artery Disease: Multicenter Sutdy in Dakar (Senegal). J. Clinical Cardiology and Cardiovascular Interventions, 5(1); Doi:10.31579/2641-0419/233
Copyright: © 2022 Paul Coffi HESSOU, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 29 October 2021 | Accepted: 29 December 2021 | Published: 05 January 2022
Keywords: stable angina pectoris; obstructive coronary artery disease; coronary risk factors; clinical outcome; sub-Saharan Africa
Background: CAD management is important in prevention of disease progression. But we have very little study or research on the evolution of stable angina in amulatory patients without coronary antecedents and with obstructive coronary disease.
Purpose: The objective of our study was to analyze the clinical and angiographic profil of patients with stable chest pain and to assess their angina status one year outcomes.
Patients and methods: All patients who presented with symptomatic angina pectoris and/or signs of ischemia and first diagnosis of obstructive CAD in the Cardiology Departments of Idrissa Pouye General Hospital and Aristide Le Dantec National University Hospital Center of Dakar, from March 01, 2019 to December 31, 2020 were selected.
The clinical characteristics, initial angiographic findings, therapeutic strategy and outcome within the first year were analyzed.
Results: During the study period, 84 outpatients presenting with symptomatic stable chest pain and first obstructive coronary artery disease were selected. The mean age was 63.01± 9.37 years. Male preponderance was observed with 63(75%) patients; Clinical symptoms were dominated by typical pain with 46.4% (n=39) ; the risk factors were dominated by hypertension 61.9% (n=52); diabetes 41.7% (n=35) and dyslipidemia 33.3% (n=28).
During follow-up, 10 patients (11.90%) remained untraceable while 9 patients (10.71%) were not available for check-up; 3 patients (3.57%) died during follow-up. Only 62 patients (73.80) could be evaluated; among those who were alive and controlled, 26 patients (41.93%) with angina at baseline still had angina symptoms, 2 patients (3.22%) had undergone myocardial infarction; one (1.61%) had undergone urgent revascularization; one (1.61%) patient developed heart failure. Finally 32 patients (51.61%) were event-free and angina-free
Conclusion: The management of outpatients with stable chest pain and first obstructive CAD appears favourable, with good adherence to guideline-based therapies one year outcomes. Stable chest pain is not associated with an increased risk for adverse cardiovascular outcomes but there remains room for improvement in terms of risk factor control.
ACEI: Angiotensin Converting Enzyme Inhibitor
ARB: Angiotensin receptor blocker
CAD: Coronary artery disease
DAPT: Dual Antiplatelet Therapy
DVD: double-vessel disease
HDL-C : High-density lipoprotein cholesterol
LAD : Left artery descending
LBBB : Left bundle branch block
LCx: Left circumflex
LDL-C : Low-density lipoprotein cholesterol
LVEF : Left ventricular ejection fraction
LMCA: Left main coronary artery
MACE: Major adverse cardiac events
PCI: Percutaneous coronary intervention
RBBB : Right bundle branch block
RCA: Right coronary artery
STEMI: ST-Elevation Myocardial Infarction
SVD: Single-vessel disease
TVD: Three-vessel disease
Introduction
Stable angina pectoris is defined as episodes of chest pain precipitated by physiologic situations of increased oxygen demands to the heart. It occurs most commonly during or immediately after exercise. Indeed stable angina is characterized by chest discomfort or angina equivalent that is provoked with exertion and alleviated at rest or with nitroglycerin [1, 2]. This is often one of the first manifestations or warning signs of underlying coronary disease. Therefore the recognition and appropriate management of stable angina is critical in reducing the risks of future complications [3]. The most important complication of stable angina is the possibility of progression to acute coronary syndrome. Stable angina is also associated with an average annual risk of 3% to 4% for myocardial infarction or death [4].
As outlined in Societies of Cardiology guidelines, management strategies include lifestyle modification, risk factor reduction, pharmacological, and invasive management if significant obstructive CAD is present [1]. Several studies have explored the prognostic impact of stable angina in patients with CAD [5, 6, 7, 8].
Lifelong treatment and monitoring are required in patients with coronary artery disease. The clinical course of these patients may be benign over time but also fraught with cardiovascular complications that can be treated during follow-up.
This study was, therefore, aimed to evaluate the clinical and coronary angiographic profile of outpatients with symptomatic stable chest pain and first obstructive CAD, their treatment, and to assess one-year outcomes.
Patients and Method
2-1. Study design and patients
This was an observational, descriptive, and analytical study conducted from March 1, 2019 to October 31, 2021, in Cardiology Departments of General Hospital Idrissa Pouye and Aristide Le Dantec National University Hospital Center of Dakar.
We had included in our study all outpatients with symptomatic stable angina or ischemic equivalent (dyspnea, palpitations, blockpnea ...) after non-invasive test and who had significant coronary lesions at coronary angiography. All patients with known coronary artery disease (history of STEMI, PCI, and coronary artery bypass surgery) were excluded.
2-2. Baseline characteristics of study population
Information on demographic characteristics, cardiovascular risk factors, symptoms, and noninvasive test results was collected before coronary angiography was performed. Some patients had been contacted for additional information. Hypertension was defined as a systolic blood pressure ≥ 140 mmHg and/or a diastolic blood pressure ≥ 90 mmHg; diabetes was defined as chronic hyperglycemia. It is confirmed if the fasting blood glucose level is ≥ 1.26 g/l during two successive tests; Hypercholesterolemia was defined by a total cholesterol > 2 g/l, an HDL-cholesterol < 0> 1.6 g/l; Obesity was defined by a body mass index (BMI) > 30kg/m2 ; normal weight 18-24,9 kg/m2 and overweight, 25-29 kg/m2
The presence of angina was recorded at baseline and annual check-up, and was defined as chest pain during physical exertion or equivalent symptoms necessitating occasional or permanent use of antianginal drugs in the judgment of the cardiologist.
Symptoms were classified as typical angina, atypical chest pain, ischemic equivalent, or no symptoms. Typical angina was defined as [1] chest pain or substernal discomfort that is [2] caused by exertion or emotional stress and [3] relieved by rest and/or nitroglycerin. Atypical chest pain included patients with atypical angina (only two of the above criteria) and those with non-angina chest pain (one or none of the above criteria). Ischemic equivalents were considered any collection of clinical signs (dyspnea, dizziness, arrhythmias, blockpnea).
The suspicion of CAD was based on the presence and characteristics of chest pain symptoms and the presence of noninvasive test results (ECG, Exercise ECG, Echocardiography, and Stress Echocardiography).
We assessed the left ventricular ejection fraction by the Simpson biplane method. It was considered normal for values above 50%.
2-3. Assessment of angiographic CAD
All patients underwent coronary angiography according to the standard Judkin's technique. Coronary angiography was performed through the femoral or radial approach and coronary was assessed in multiple projections by two experienced operators. Angiographic findings were collected from the electronic coronary angiography report.
The severity of coronary lesions was assessed by the degree of stenosis (the percentage reduction of the arterial lumen): In our study we have considered Non-significant lesions as stenosis < 50>
To assess the consequences of angina evolution on cardiovascular outcomes, patients were categorized into 3 groups according to the evolution of angina between baseline and 1 year: persistence, complications and disappearance.
Predefined endpoints for angina progression included symptoms, results of noninvasive tests at 1 year (ECG, echocardiography, stress echocardiography) and major adverse cardiac events (all-cause mortality, nonfatal myocardial infarction, unstable angina hospitalization or revascularization, heart failure hospitalization, and cerebrovascular event) at subsequent follow-up.
2-4. Statistical analysis
All variables in study were entered in SPSS version 16 for windows statistical software and analyzed; Descriptive statistics were generated with percentages for discrete variables; means and standard deviations for continuous variables. The Chi-square test was used and considered significant for p < 0>.
2-5. Ethical aspects
The study was done in accordance with the Declaration of Helsinki. All patients who agreed to participate had given their consent freely. Furthermore, according to the protocol in our cardiology departments, patients gave always written informed consent before the different diagnostic tests.
This study was also approved by the Research Ethics Committee (REC) of the Cheikh Anta Diop University of Dakar (Protocol Number 0407/2019/CER/UCAD).
3-1. Demographic and clinical characteristics
During the study period, 1137 patients were admitted in both department of Cardiology for coronary angiography. Of these, 143 were suspected for stable angina pectoris; 59 patients (41.26%) had normal coronaries while 84 patients (59.74%) had significant lesions of CAD and constituted the study group.
The baseline clinical characteristics of patients are given in table 1. There was a male preponderance with 63 patients (75%); the mean age was 63.01± 9.37 years, with extremes of 31 and 81 years. The most representative age ranges was [60-69[years with 38 patients (45.24%).
Clinical symptoms were dominated by typical pain, 46.4% (n=39); 7 patients (8.3%) had presented with dyspnoea. There were not significative difference between both symptoms following the number of disease vessels (p=0.07).
The prevalence of hypertension was 61.9% (n=52); diabetes was 41.7% (n=35); dyslipidemia was 33.3% (n=28). The table 2 shows the biological parameters of study population.
In our study, at least one noninvasive test was performed in all patients. These tests were mainly resting Electrocardiogram and resting echocardiography with 100% (n=84) and 86.9% (n=73) respectively.
On electrocardiogram, repolarization disorders were dominated by ST segment sub-shift and negative T waves with 17.92% (n=15) and 25% (n=21) respectively.
Abnormalities of the systolic function of the left ventricle with an Ejection Fraction < 50>
3-2. Angiographic characteristics
Coronary angiography revealed that 27 patients (32.14%) had single-vessel; 28 patients (33.33%) had double vessel disease; and 29 patients (34.52%) had triple vessel disease. The right radial approach was the most used with 84.52% (n=71). Coronary angiography revealed 324 coronary lesions. According to the degree of coronary artery obstruction, tight lesions were the most important with 48.14% (n=156) followed by significant lesions with 23.14% (n=75).
Amongst the vessels involvement the most common was the left anterior descending (LAD) with 39.20% (n=127), followed by the right coronary artery (RCA), 28.08% (n=91) and the Left Circumflex (LCx) 25% (n=81). All angiographic findings are summarized in table 3.
Out of the 84 patients with obstructive coronary artery disease, 37 patients (44.05%) had recommended for angioplasty, and 47 patients (55.95%) for medical management only.
The number of angioplasties performed was 43. The procedure were mostly related to LAD and RCA with 57.14% (n=25) and 30.95% (n=13) respectively. The direct stenting technique was used in 45.24% (n=19) of cases. Active stents were used in the majority of cases with 80.95% (n=35). There were no major incidents during the procedures. However, we noted one [1] patient with defective desobtruction of the right coronary and one patient [1] had the right coronary ostium dissection. There was no death during the procedure.
The table 4 summarizes the characteristics of angioplasty and medical treatment. Aspirin was the most frequently used drug (90.48% of patients); Dual antiplatelet therapy (DAPT) was used in 46.23% of patients. The use of lipid-lowering drugs was also high overall, with a significantly frequent rate (69.05%), whereas angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) were used more frequently (76.20%) ; Ninety-one point sixty-seven percent patients (89.5%) were taking beta blockers. Only 55.95% of patients took calcium antagonists, whereas use of other antianginal drugs (25%) and oral anticoagulants (28.57%) was lower.
ACEI: Angiotensin Converting Enzyme Inhibitor; ARB: Angiotensin receptor blocker; DAPT: Dual Antiplatelet Therapy
3-3.One-year outcomes of patients with obstructive coronary artery disease
During follow-up, 10 (11.90%) patients remained untraceable while 9 (10.71%) were not available for check-up; 3 (3.57%) patients died during follow-up. Only 62 (73.80) patients could be evaluated; among those who were alive and controlled, 26(41.93%) with angina at baseline still had angina symptoms, 2(3.22%) had undergone myocardial infarction; one (1.61%) had undergone urgent revascularization; one (1.61%) patient developed heart failure. Only 32(51.61%) patients were event-free and angina-free. These findings are summarized in figure 1.
This study showed that patients with stable chest pain and obstructive CAD were older and predominantly male. This finding was consistent with other studies results but with and advanced age in certain study populations [9, 10]. This shows that the onset of stable angina with obstructive coronary artery disease in sub-Saharan African is early. This disparity could be explained on the one hand by the much higher life expectancy in these countries. On the other hand, the low awareness of the population on the relationship between lifestyle and cardiorespiratory diseases could be another explanatory factor of this difference.
In the current study we further tried to elucidate the risk factors. Among our patients the most prevalent risk factors associated to obstructive CAD were hypertension, diabetes, dyslipidemia and physical inactivity. Although these patients constituted a heterogeneous group, modifiable risk factors frequencies were important and suggested the need for heightened efforts for preventive strategies in our study cohort. The low proportion observed for smoking in our study could be explained by cultural and religious constraints which would influence massive consumption.
Typical angina and atypical were the most important symptom observed; however there were not significative difference between both symptoms following the number of diseased vessels.
Coronary angiography revealed that 27 patients (32.14%) had single-vessel; 28 (33.33%) patients had double vessel disease; and 29 (34.52%) patients had triple vessel disease. The literature does not provide any specific data on the coronary status of the patient with stable angina.
The right radial approach was the most used for coronary angiography with 84.52% (n=71).This approach has the advantage of reducing haemorrhagic complications as observed in the RIVAL study [11] and overall mortality according to the MATRIX study [12].
In our study 62 (73.80%) patients were recommended for angioplasty. Only 37 (59.68%) had done it. This is due to the high cost of this procedure in relation to the limited resources of the patients and also to the lack of systematic health coverage for this kind of therapeutic invasive procedure.
The majority of patients (83.33%) had received an active stent as recommended in the guidelines [13, 14]. Active stents, compared to bare-metal stents, bring a decrease in the rate of restenosis and new revascularization procedures, but without a decrease in death or myocardial infarction. The direct stenting technique performed in 45.24%. The advantage of direct stenting is to reduce the procedure time, the amount of contrast injected, the radiation time and the cost. Overs investigators further notes that direct stenting would reduce the peri-procedural mortality rate [15]. Our success rate was 97.67%, similar to the rates reported in the literature [16]. These success rates are related to both accumulated experience and technical progress.
In patients with stable coronary syndromes revascularization reduces cardiovascular death and MI compared with conservative treatment. In our study revascularization was performed in 44.27% of patients but we did not observe a significant difference in angina status between these patients and those who received optimal medical treatment.
However, controversy exists over the benefit of revascularization in patients with chronic stable CAD compared with medical management [17, 18]. Results from the COURAGE study implicated that PCI did not reduce risk of death, MI and other cardiovascular events when added to current medical treatment in patients with stable CAD [19]. In contrast, a large meta-analysis resulted in a benefit of revascularization. The positive effects of revascularization are clearly shown in patients with angina symptoms. In these cases, PCI or CABG more effectively relieve angina, reduce treatment with anti-angina drugs as well as improve physical resilience and quality of life [4, 20]. In this context, the latest ESC guidelines recommend revascularization on the basis of the presence of significant coronary artery stenosis, the severity of ischemia and the expected benefit for prognosis [1]. Indeed, the individual benefit/risk ratio must always be evaluated and revascularization considered only if its expected benefit outweighs its potential risk [1, 4].
The goals of management of stable angina due to obstructive CAD are to reduce symptoms and prevent future adverse events [1, 3]. Our study shows a low rate of MACE and mortality while disappearance of angina was observed in 51, 62%. Several studies have explored the prognostic impact of stable angina in patients with CAD [5, 6, 7, 8, 21, 22]. In the Multinational CLARIFY Study, among 7212 (22.1%) patients who reported angina at baseline, angina disappeared (without coronary revascularization) in 39.6% at 1 year [5].
Our results were different with those observed in these studies. The discrepancy in outcomes might be explained by differences in inclusion criteria, adverse outcome definitions, different methodology and length of follow-up time.
Conclusion
In our study population the management of outpatients with symptomatic chest pain and first obstructive CAD appears favourable, with good adherence to guideline-based therapies one year outcomes. Stable chest pain is not associated with an increased risk for adverse cardiovascular outcomes but there remains room for improvement in terms of risk factor control.
Limitations of the Study
The study cohort was relatively small, especially the patient population with angina symptoms and obstructive coronary artery disease; 22.62% of patients were lost to follow-up. Thus, for a better understanding of the management and outcome of stable CAD in Sub-Saharan population, studies with larger numbers of patients are needed.
In addition we did not repeat the analysis of cardiovascular risk factors after the follow-up period. This would have made it possible to assess the effect of treatment on modifiable risk factors.
Declaration of interest: the authors declare that they have no interest.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
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 journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
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.
