AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2641-0419/409
Clinique Louis Pasteur, Essey-lès-Nancy, France.
*Corresponding Author: Zukaï Chati, Clinique Louis Pasteur, Essey-lès-Nancy, France
Citation: Zukaï Chati, Samuel Tissier, Clemence Balaj, Nacima Benzaghou, Max Amor, et al, (2024), Stress CMR VS Stress Echo: Real-world multimodal cardiovascular imaging for myocardial ischemia screening. Insights from the first phase of “Nancy Ischemia Registry”, J Clinical Cardiology and Cardiovascular Interventions, 7(11); DOI: 10.31579/2641-0419/409
Copyright: © 2024, Zukaï Chati. 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: 09 September 2024 | Accepted: 24 September 2024 | Published: 01 October 2024
Keywords: stress cmr; stress echo; myocardial ischemia; real ischemia register; major adverse cardiovascular events
In a real world, the impact of different functional and anatomical imaging techniques is not really known.
Objectives
“Nancy Ischemia Registry” is a prospective registry, without inclusion or exclusion criteria, which analyzes the respective real impact and consequences of different functional and anatomical imaging techniques on major adverse cardiovascular events.
In a “first phase”, we compared two functional imaging techniques used in our center: Stress CMR and Stress Echo.
Materials & Methods
We consecutively included 169 patients in whom we performed Stress CMR and 687 patients in whom we performed Stress Echo.
Results
We detected myocardial ischemia in 59 patients by Stress CMR (35% of patients) and in 123 patients by Stress Echo (18% of patients).
Coronary angiography confirmed at least one significant lesion in 54 patients in the Stress CMR group (PPV 91%) and in 90 patients in the Stress Echo group (PPV 73%). In patients with at least one significant coronary lesion, coronary angioplasty was performed in 38 patients (64% of true positives) in the Stress CMR group versus 64 patients in the Stress Echo group (71 % of true positives).
Conclusion
Stress CMR has a better specificity than Stress Echo for the detection of myocardial ischemia. However, detection of myocardial ischemia by Stress Echo more often leads to coronary revascularization than by Stress CMR. This difference in this register is probably explained by a higher sensitivity of the Stress CMR for the detection of myocardial ischemia linked to less severe lesions, whereas the Stress Echo mainly detects more severe lesions.
Cardiovascular magnetic resonance (CMR), Major adverse cardiovascular events (MACE), CT coronary angiogram (CTCA), Coronary artery calcium score (CACS), Late gadolinium chelate enhancement (LGE), Fractional Flow Reserve (FFR), Left Anterior Descending (LAD), coronary artery disease (CAD).
Introduction
The presence of myocardial ischemia is a very important prognostic factor (1).
According to all European and American recommendations, anatomical and functional imaging is a recommended tool for the detection and management of myocardial ischemia (2-5).
We have many results from clinical trials that show the value of different techniques and the stratification of cardiovascular risk according to the presence of myocardial ischemia, the presence of myocardial sequelae or both (6-8).
However, most of these clinical trials, through inclusion and exclusion criteria, rule out short-term and long-term analyzes of certain patients, often the most severe (proximal coronary stenosis) or patients with little or no symptoms (9-11).
We wanted by "Ischemia Nancy Register", of consecutive patients without exclusion criteria, to analyze the results in current practice, real exercise, in the field of screening for myocardial ischemia. Through several phases, we will study, by longitudinal analysis, the different techniques for detecting myocardial ischemia (anatomical and functional imaging) and compare:
I- In a first phase (in this article), we compared two functional imaging techniques: Stress CMR and Stress Echo.
II- In the second phase, we will include the results using an anatomical imaging technique: CT coronary angiogram (CTCA) and coronary artery calcium score (CACS).
III- In a third phase, we wish to compare major adverse cardiovascular events (MACE) in all patients according to: 1- the presence of myocardial ischemia, 2- myocardial revascularization, and 3- the functional and anatomical detection technique.
Stress Echo has become an increasingly accessible modality for the detection of myocardial ischemia. According to the latest guidelines from European and American societies, Stress CMR has gained significant value as a functional imaging modality for screening for myocardial ischemia (4-6).
The constitution of a register “Nancy Ischemia Register” of consecutive patients could play an important role in the management of patients with chronic obstructive coronary artery disease.
In this article, we present the results of the first phase. We prospectively screened for the presence of myocardial ischemia by Stress CMR and Stress Echo in patients at high cardiovascular risk.
Study population
Between May 2021 and December 2022, we consecutively included 169 patients in whom we performed Stress CMR. the patients in this group were considered at “very high” cardiovascular risk because the majority were diabetics “with or without” a coronary history and in particular coronary angioplasty (high prevalence of myocardial Ischemia). Considering CMR stress as a very sensitive technique, in real practice, we have chosen in these very high-risk patients to benefit from optimal detection of myocardial ischemia. Stress CMR also allows us to stratify their prognosis (3).
Between January 2022 and December 2022, we consecutively included 687 patients in whom we performed a Stress Echo. patients in this group were considered at “high” cardiovascular risk; often diabetics with little coronary history (moderate prevalence of myocardial ischemia). In real practice, the detection of myocardial ischemia in this group was rather systematic, allowing us to better stratify their prognosis and intervene in the event of a positive or suspicious examination.
Stress CMR protocol:
Cine CMR sequences associated with first-pass perfusion and late enhancement form the basis of our stress CMR. All contrast-enhanced CMR studies were performed with a 3-T cardiac MRI unit (MAGNETOM Lumina, SIEMENS, Germany), and a twelve-element phased-array cardiac coil was used for signal reception. ECG gating and triggering were performed using the vector cardiographic method (Figure 1).
Figure 1: Stress CMR protocol
Patients were instructed not to drink coffee or tea and not to have oral β-blockers for at least 24 hours before the adenosine-induced stress MRI. The procedure is explained to the patient in detail with special emphasis on possible side effects of adenosine infusion (thoracic oppression / chest pain, dyspnea and anxiousness). Two I.V. lines are placed in each of the antecubital veins, one for adenosine and one for the gadolinium bolus connected separately.
Fast survey images were acquired first to determine the principal reference axis of the left ventricle.
The rest cine CMR is performed with cine sequences using steady-state free precession (slice thickness 8 mm, with 2 mm interslice gaps, matrix 448x448). These pulse sequences include slices covering the whole left ventricle (LV) in its short axis from base to apex and one to three long-axis slices of the LV and four-chamber views.
Perfusion CMR is based on a qualitative analysis of the enhancement of the myocardial signal during the first pass of a bolus injection of gadolinium chelate. Stress perfusion MR images were obtained with a gradient-echo sequence by using saturation recovery turbo flash sequence (TR, 158 ms; TE, 1 ms; inversion time, 95 ms; matrix, 172 x 192; section thickness, 10 mm) with movement correction. The acquisitions are performed under pharmacological stimulation during the last half of the adenosine infusion (0,14 mg/kg/min over 3 minutes) and right after injection of the bolus of gadolinium 0,1mmol/kg), ideally during a breath hold. Symptoms, heart rates and ECG activity were carefully monitored during the adenosine infusion and after imaging. The temporal resolution of perfusion sequences allows the acquisition of three to five slices within an R-R space... at least three slices in the short axis of the LV, and most often a slice in the vertical plane of the long axis and another in the horizontal plane of the long axis.
At the end of the Stress perfusion CMR acquisition, a second injection of gadolinium is done at the same dose and rate.
Late gadolinium chelate enhancement (LGE) Two-dimensional or three-dimensional phase-sensitive inversion recovery sequences can be used, 10-15 minutes after the injection of a total of 0.2 mmol/kg gadolinium chelate. Inversion time is optimized for each patient according to an inversion time scout image to optimize myocardial nulling. The slice thickness is 6 mm.
The total examination time is about 30 minutes.
Stress Echo protocol:
We used a standard protocol for stress echocardiography under dobutamine. A dose graduated from 10 to 40 µg/kg/min with four levels: rest, first level, peak, and recovery.
The heart rate had to reach 85% of the theoretical maximum rate. If needed, 0.5 to 1 mg has been given to further increase the heart rate. The recovery was gradual, and we never used a beta blocker. The criteria for positivity were based on the appearance of chest pain, ECG modification and the presence of segmental kinetics disorder of the left ventricle (≥ 3 segments). We use a Philips EPIQ CVx device (Seattle, Washington, USA) for all patients.
At this phase, our statistical data was simply performed with Microsoft Excel (Microsoft Corporation, Washington, USA). data were summarized with mean +/−95% confidence interval.
In the Stress CMR group of 169 patients, the examination was considered “positive” with suspicion of myocardial ischemia in 59 patients (35% of patients). In the Stress Echo group of 687 patients, the examination was considered “positive” with suspicion of myocardial ischemia in 123 patients (18% of patients). (table1)
Table 1: Presentation of the population of patients participating in the phase 1 registry.
Coronary angiography was performed in patients with suspected myocardial ischemia. Coronary angiography confirmed at least one significant lesion in 54 patients in the Stress CMR group (91% Positive Predictive Value) and in 90 patients in the Stress Echo group (73% Positive Predictive Value). (Figures 1, 2)
On coronary angiography, there was no lesion considered significant in 5 patients in the Stress CMR group (9% of patients: false positives) compared to 33 patients in the Stress Echo group (27% of patients: false positives). (Figure 2).
Figure 2: Presentation of the main results. comparison between Stress CMR and Stress Echo. The results are presented by the number of patients.
In patients with at least one significant coronary lesion (≥70% or FFR ≤ 0.80) coronary angioplasty was performed in 38 patients (64% of true positives) in the Stress CMR group versus 64 patients in the Stress Echo group (71 % of true positives). (Figure 3)
Figure 3: Comparison of the Positive Predictive Value of Stress CMR and Stress Echo and of the prediction of coronary angioplasty according to the two techniques.
The stratification of cardiovascular risk by Stress CMR plays a very important role (6).
Figure 4 presents the distribution by 4 groups of patients according to the presence or absence of myocardial ischemia and/or LGE and their
distribution within each group according to the completion of revascularization by coronary angioplasty or not.
Figure 4: Stratification by stress CMR according to the presence of ischemia and/or LGE and at the same time according to the follow-up by coronary revascularization or not. Group I: absence of ischemia and absence of LGE. Group II: presence of ischemia and absence of LGE. Group III: absence of ischemia and presence of LGE. Group IV: presence of ischemia and presence of LGE. Figure 5 shows a case of patients with extensive septal and anterior wall myocardial ischemia with extensive coronary lesions on coronary angiography.
Figure 5: Stress CMR images showing in a patient A, B, C: Antero-Septal wall perfusion defect.
Figure 6 shows the case of a patient with a very demonstrative Stress Echo. the patient presented apical dyskinesia under dobutamine which corresponded on coronary angiography to distal thrombosis of the distal Left Anterior Descending (LAD) Coronary.
Figure 6: Stress Echo images showing in the case of a patient A: at Rest, B: Apical dyskinesia with Stress Dobutamine, C: Distal Left Anterior Descending Coronary Thrombosis (Coronary Angiography).
We present the first results of phase 1 of the “Nancy Ischemia Registry”. The goal at this early stage is to compare two functional imaging methods and to see their specificity in detecting myocardial ischemia and the consequences on myocardial revascularization. These results reflect a real image of the patients we examine in our practice outside of clinical trials where patients are selected according to precise criteria and excluding a part, often with severe lesions, to respect a strategy fixed in advance.
Stress Echo plays an important role in the detection and management of myocardial ischemia (12-13). The stratification of cardiovascular risk by Stress CMR becomes a gold standard, screening for ischemia and late enhancement (6-8).
We usually use these two functional imaging techniques with some hindsight. Our results show that the two techniques have a good specificity in the detection of myocardial ischemia after verification by Coronary Angiography. We cannot comment on their sensitivities because we did not perform Coronary Angiography on patients without suspicion of myocardial ischemia. We are within the framework of a real register of daily practice. However, these results show, a priori, that Stress CMR can detect even small ischemic lesions (very good detector of myocardial ischemia). This ischemia probably corresponds to small coronary artery lesions or very distal lesions for which a revascularization procedure is not necessarily indicated.
In The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) included over 5,000 patients with stable coronary artery disease and moderate to severe myocardial ischemia, no differences were found in relevant clinical outcomes, including all-cause mortality, cardiovascular death, myocardial infarction (MI), heart failure and stroke, over a follow-up of 3.2 years (9).
The interim report of the ISCHEMIA-EXTEND study shows that there was no difference in all-cause mortality in 7 years, but there was a lower risk of 7-year cardiovascular (CV) mortality and a higher risk of non-CV mortality with the initial invasive strategy when compared with the initial conservative strategy (10). The higher rate of non-CV death in the invasive group was unexpected and remains unexplained, deserving further investigation. Overall, the trial’s extended follow-up provides much more robust evidence for the neutral effect on survival of the two strategies. When the ISCHEMIA trial was first designed, the goal of the trial was to determine whether a catheter-based strategy could ultimately reduce CV events like CV mortality and MI, and this seems to be the case: spontaneous MI at the earlier and CV death at the later time point being reduced by this strategy (10).
Our results show that Stress Echo can detect, when the test is positive, more severe coronary lesions, probably more proximal, which are more amenable to a revascularization procedure. In practice, Stress Echo is a “good detector” of myocardial ischemia while Stress CMR is a “very good detector” of myocardial ischemia. Stratification by stress CMR in our study according to the presence of ischemia and/or LGE and at the same time according to the follow-up by coronary revascularization or not (Figure 5) could have interesting consequences to know on the occurrence of MACE in the future.
The EVAREST study provides UK-wide data to evaluate “real-world” performance and accuracy of stress echocardiography (13). Stress echocardiography has high accuracy across UK-based hospitals and thus indicates stress echocardiography is being delivered effectively in real-world practice, reinforcing its role as a first-line investigation in the assessment of patients with stable chest pain. Stress echocardiography is widely used to identify obstructive coronary artery disease (13).
In the management of coronary patients, the choice between the two techniques is linked, in our practice, to the availability of the technique and to the patient's coronary history. For Stress Echo, in our registry, many patients were at high cardiovascular risk with little coronary history. While the population of patients who had a stress CMR was mainly with a coronary history. This heterogeneity of the two populations, Stress Echo and Stress CMR, reflects a real image of the patients encountered in practice without exclusion criteria. In a future analysis of the follow-up of these patients, it will be interesting to see the evolution of the MACE in each group according to the choice of screening test.
for the PROMISE Investigators (14), in symptomatic patients with suspected coronary artery disease (CAD) who required noninvasive testing, a strategy of initial Coronary Computed Tomography Angiography, as compared with functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography), did not improve clinical outcomes over a median follow-up of 2 years.
Generally, many specific criteria for inclusion and/or exclusion of randomized patients in many studies could modify their impact on the reality experienced by most patients. In the PROMISE study (14), additional inclusion criteria were an age of more than 54 years (in men) or more than 64 years (in women) or an age of 45 to 54 years (in men) or 50 to 64 years (in women), exclusion criteria were an unstable hemodynamic status or arrhythmias that required urgent evaluation for suspected acute coronary syndrome, a history of CAD or evaluation for CAD within the previous 12 months, or clinically significant congenital, valvular, or cardiomyopathic heart disease, or any reason that the patient could not be randomly assigned to either group safely.
we hope by “Nancy ischemia register” to be simpler and cover many patients.
For the management of coronary artery disease, when we receive a patient, it is imperative to make the most precise decision that brings us as close as possible to the diagnosis, and as quickly as possible. In all randomized studies, patient care is based on several inclusion and exclusion criteria to optimize the decision as much as possible. We are far from the real situation where the decision must be simpler and more practical. Our register tries to be more real and closer to current practice. However, in trying to be real, our patient data is less comprehensive and accurate. The groups of patients with different screening techniques for myocardial ischemia are heterogeneous (age, sex, coronary ATCD, medication, ...).
“Nancy Ischemia Register” is an ambitious work that brings together different screening techniques for myocardial ischemia. this registry attempts to cover most patients likely to present with myocardial ischemia in a real context and outside of randomized studies with numerous inclusion and/or exclusion criteria.
In its first phase of the register, the Stress CMR seems in real conditions more sensitive than the Stress Echo in detecting myocardial ischemia. However, Stress Echo appears to be more sensitive in detecting larger coronary lesions that further require myocardial revascularization.
In the next phases of “Nancy Ischemia Register”, we will see the impact of other anatomical imaging techniques (CTCA, CACS). We performed 2116 CT coronary angiogram and 1581 coronary artery calcium score in patients at “high” cardiovascular risk. The actual comparison between the different techniques could be very interesting.
In the last phase, we record MACE occurring in all 4553 patients during the years 2022-2023-2024. we compare groups and MACE according to:
1- the presence of myocardial ischemia or not, 2- Revascularization or not, 3- technique used for screening for myocardial ischemia. The comparison of MACE according to the initial examination (positive or negative) could have consequences on the choice of a particular technique as a means of detecting myocardial ischemia at the start of our investigations.
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.
