AUCTORES
Globalize your Research
Case Report
*Corresponding Author: Xiaozu Liao, Binfei Li, Department of Anesthesiology, Zhongshan City People’s Hospital, Zhongshan, China.
Citation: Xiaozu Liao, Miaoyun Guo, Shi Zhong, Junlin Wen, Binfei Li (2023), Application of Myocardial Contrast-Enhanced Ultrasound in Heart Transplantation in Patients with Acute Myocardial Infarction：A Case Report, J Thoracic Disease and Cardiothoracic Surgery, 4(2); DOI:10.31579/2693-2156/053
Copyright: © 2023, Xiaozu Liao. 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: 28 March 2023 | Accepted: 06 April 2023 | Published: 17 April 2023
Keywords: mce; ecmo; heart transplantation
Background: MCE is a safe and effective myocardial perfusion assessment technique; it is used for the assessment of post MI viability.
Case Presentation: A 52-year-old male with cardiogenic shock caused by secondary acute myocardial infarction and successful coronary stent implantation with ECMO, IABP and ventilator assistance and with no significant recovery of postoperative cardiac function. The result of MCE was also reported. The allograft was successfully performed 8 days after ECMO-assisted support. The patient was successfully transferred to the general ward 8 days after surgery and successfully discharged on day 86 of admission.
Conclusions: ECMO provides effective mechanical assistance support for patients with end-stage heart failure, buys time for heart transplantation surgery, and was an effective cardiopulmonary support treatment. An evaluation of myocardial perfusion and survival quantity was an important reference for emergency heart transplantation.
The mortality rate in patients with cardiogenic shock due to acute myocardial infarction is up to 50% [1]. In patients with refractory cardiogenic shock, Extracorporeal membrane oxygenation (ECMO) provides hemodynamic support to reduce secondary organ damage and for early revascularisation to rescue the myocardium with ECMO assistance, thereby improving patient survival [2]. However, although some patients underwent revascularisation, cardiac function was still severely impaired and even separated from ECMO,he patients needed heart transplantation. Therefore, when patients have been assisted with ECMO for a long time, evaluating their myocardial functional status to determine the indications for performing heart transplantation is needed. Myocardial contrast echocardiography evaluation (MCE) is a safe and effective myocardial perfusion assessment technique; it is used for the assessment of post myocardial infarction(MI) viability [3]. In this report, a patient with cardiac shock caused by secondary acute myocardial infarction successfully underwent coronary stent implantation assisted by ECMO and ventilator with no significant recovery of postoperative cardiac function. The end-stage cardiac failure and successful heart transplantation diagnosed by combined MCE was reported.
The patient is a 52-year-old male who was admitted to the hospital. He presented with chest distress for 2 years and another half-hour episode with psychiatric change. Results of physical examination after admission showed the following: blurred mind, passive position, thick breathing in both lungs, dry and wet rales, Heart rate 96 beats per minute, and blood pressure of 63/43 mmHg; N-terminal pro brain natriuretic peptide (NT-pro BNP): 2,425 (pg/ml); Highly sensitive troponin T (TnT-HS): 10,000 (ng/L); Creatine kinase (CK): 14,147 (U/L); And creatine kinase isoenzyme (CK-MB): 587 (U/L). ECG showed that: sinus tachycardia and acute anterior and lateral myocardial infarction (Figure 1).
Figure 1: ECG change at disease onset (acute inferior wall and posterior wall myocardial infarction ECG change; old and extensive anterior wall infarction ECG change)
Cardiac colour ultrasound indicated that the left ventricular wall activity was generally weakened. The following were observed: left atrial and LV enlargement, incomplete mitral valve closure (mild-moderate) and ejection fraction EF: 0.18. So the patient was diagnosed acute myocardial infarction and cardiogenic shock . The patient was given a 0.2 ug/kg.min dose of adrenaline and norepinephrine at 0.2 ug/kg.min to Pump injection. The blood pressure was 63/43 mmHg. The lactate was 6 mmol/L. The patient’s limbs were wet and cold, and he was unconscious. The patient was intubated and mechanically ventilation, then he was immediately given ECMO assistance.
In venous-arterial ECMO oxygenation (V-A ECMO) mode, the right femoral artery-venous catheterisation was performed, and the following were used: systemic heparin sodium (1 mg/kg), 17Fr femoral arterial catheter (Medtronic) with a depth of 15 cm and 21Fr femoral venous catheter (Medtronic) with a depth of 45 cm. An 8Fr end-end reperfusion catheter was inserted to prevent ischemia of the lower limbs. After the ECMO establishment was completed, we ran the ECMO perfusion system (Medtronic) with a flow rate of 3.5 L/min and MAP of 80 mm Hg. The ECMO was fully established, and the patient underwent interventional therapy.
The patient had acute myocardial infarction 2 years ago, the coronary angiography showed that: about 40%–50% left trunk stenosis, anterior descending branch opening-proximal stenosis, recent acute occlusion and distal flow grade TIMI 0; and about 40%–60% distal branch stenosis, about 50%–70% OM opening-proximal stenosis and distal flow grade TIMI (Figure 2).
Figure 2: 2 years ago, coronary angiography (Figure a: 40%–50% left trunk stenosis, anterior descending opening-proximal stenosis, immediate acute occlusion, distal flow grade TIMI 0; about 40%–60%, 50%–70% OM opening-proximal stenosis, distal flow grade TIMI 3. Figure b: Angiography after coronary artery vessel treatment.)
Descending stenting and IABP implantation were performed, and the patient was successfully discharged 30 days later. In this operation, the coronary angiography showed that: the left main trunk, three vessel lesions and the cyclotron branch were acute occlusion, stent implantation and IABP implantation. The operation process was smooth (see Figure 3).
Figure 3: Coronary angiography after onset in this patient (Figure a: left coronary angiography: left trunk-anterior descending open implanted stent patency, without significant intimal hyperplasia. Middle-distal slender, blood flow grade TIMI 3. The middle section of the spiral branch was acutely blocked, with no forward flow, blood flow grade TIMI 0. Figure b: Angiography after coronary artery vessel treatment.)
After surgery, he was transferred to the intensive care unit for fluid expansion, and the infusion of red blood cells was performed to improve anaemia. The infusion of blood products and other blood products was performed to improve coagulation function, piperacillin tazobactam sodium anti-infection and haemostasis.
After 7 days of ECMO-assisted support and active treatment, the patient showed no significant recovery of cardiac function. After re-examination of NT-proBNP: 33553 (pg/ml), chest X-ray indicated that the texture of both lungs was slightly thickened and blurred, the heart shadow was enlarged. Cardiac insufficiency was considered. Cardiac colour ultrasound suggested the following: weak left ventricular wall activity, left atrial and left ventricular enlargement, mild mitral valve closure, poor left ventricular systolic function and ejection fraction EF of 0.19. Mechanical assistance needed to continue for patient survival. Left ventricular MCE was performed, and the contrast filling defect in the anterior left ventricular wall, anterior interstitial wall and apex myocardium was found in segments 7, 8, 13, 14 and 15 (Section 17) (Figure 4).
Figure 4: Left ventricular Myocardogram (Figure a. For apical view, contrast filling defect in segments 13 and 14 of the LV wall. graph b. Paraosternal four cavity, contrast filling defect in segment 17 of the LV wall. graph c. For apical view, contrast filling defect in segments 13 and 14 of the LV wall. graph d. Horizontal papillary muscle of the LV with contrast filling defect in segments 8 and 10 of the LV wall. graph e. Paraosternal four cavity, contrast filling defect in segment 8 of the LV wall. graph f. At the apex, contrast filling defects in segments 14, 15, and 17 of the LV wall.)
End-stage heart failure was diagnosed with indications for heart transplantation, and orthotopic allotransplantation was decided after multidisciplinary consultation in the whole hospital. On day 8 of admission, the patient underwent heart transplantation. The procedure was smooth, and the patient returned to the intensive care unit. ECMO, IABP auxiliary support, balaliximab anti-rejection, vancomycin and meropenem anti-infection procedures were continued. Erythrocyte infusion was performed to alleviate anaemia and improve coagulation function, haemostasis and sedation. Extensive myocardial ischemic necrosis and thrombosis were seen (see Figure 5).
Figure 5 : Left ventricular myocardial specimen (arrow indicated: extensive myocardial ischemia and necrosis and thrombosis.)
Myocardial pathology was determined, and results showed the following: large coagulative necrosis in microscopic myocardial tissue; nuclear fragmentation and disappearance; red-dyed cytoplasm or irregular coarse granular appearance; formation of a contractile zone; interstitial oedema; scattered surrounding neutrophils infiltration; and congested bleeding zone in the infarct area. The left ventricle was predominant, and a small focal infarct area appeared in the right ventricle (see Figure 6).
Figure 6: Cardiopathy pathology (Figure a: left ventricular myocardial pathology, Figure b: Right ventricular myocardial pathology. Under the microscope, the myocardial tissue shows large coagulative necrosis, nuclear fragmentation, disappearance and red-dyed cytoplasm or irregular coarse granular, formation of a contractile zone, interstitial oedema, scattered surrounding neutrophils and hyperhaemorrhagic zone in the infarct area. The left ventricle is predominant, and a small focal infarct area is present in the right ventricle.)
On the first postoperative day. The patient had stable respiratory and stable circulation, and the IABP assistance was removed. Review of cardiac colour ultrasound indicated the following: the left ventricular systolic function was normal; ejection fraction EF was 0.62; cardiac function was good; and stable hemodynamic status. ECMO assistance was removed, and the respiratory circulation was stable after withdrawal. On the eighth postoperative day, the patient’s respiratory function was normal. The oxygenation index was normal after shutdown. The tracheal tube was removed, and the breathing was smooth after extubation. On the eleventh day, the patient had stable vital signs and was transferred to the general ward. The patient was successfully discharged after 86 days of hospitalisation.
Discussion
ECMO is an effective auxiliary means for patients with cardiopulmonary failure. In patients with acute myocardial infarction and cardiogenic shock, ECMO support and rapid coronary recanalisation are important ways to rescue the surviving myocardium. The earlier the myocardial reperfusion is, the smaller the infarct area and the better the prognosis will be [4]. After this case experienced the secondary acute myocardial infarction, the cardiac function was seriously damaged. Such damage could lead to partial myocardial ischemia and necrosis after the first acute myocardial infarction. The infarction area could expand after the secondary myocardial infarction, which would ultimately affect the cardiac function. Some studies suggested that the recurrence rate of myocardial infarction, coronary heart disease events and mortality in males are higher than those in females [5]. The patient’s heart function was severely impaired. The patient required mechanical assistance, and heart transplantation was the treatment choice. The evaluation of myocardial survival is a critical step in determining whether a heart transplant needs to be performed. However, the recovery of myocardial function in AMI patients ultimately depends on the perfusion at the level of the myocardial microcirculation. At present, the commonly used detection methods for surviving myocardium are based on the characteristics of surviving cells, including myocardial metabolic imaging, myocardial perfusion imaging, ventricular wall motion observation (cardiac ultrasound, magnetic resonance), myocardial ultrasound angiography, body surface electrocardiogram and others. MCE by containing small bubbles with coronary angiography perfusion to the myocardial tissue, through the principle of the contrast backscattering signal stronger than myocardial perfusion range, is an important method for the clinical evaluation of interventional infarction-related artery myocardial fusion or no reflux. It is the evaluation method used for determining survival after myocardial infarction [3]. Tang et al. proved that when AMI patients have poor myocardial microcirculation perfusion after PCI, their left systolic function is weakened, and the left indoor diameter is enlarged. Early MCE detection helps evaluate long-term left ventricular systolic function changes and left ventricular remodelling [6].The present case had two acute myocardial infarction, with a TIMI flow grade of grade 0 in the anterior descending and spiral branches, as well as severe myocardial ischemia. Even in the patients with coronary recanalisation TIMI flow grade 3, myocardial no reflow phenomenon could occur [7]. Thus, there is a difference between the subepicardial coronary flow and the capillary level myocardial perfusion after PCI treatment. However, the recovery of myocardial function in AMI patients ultimately depends on the perfusion at the level of the myocardial microcirculation [8]. The MCE before transplantation in this case indicated that the patient’s left ventricular myocardial perfusion was severely impaired. A combination of the cardiac systolic function and hemodynamic conditions indicated that the patient had a low probability of cardiac recovery. The pathology of the postoperative myocardium has also demonstrated little cardiac surviving myocardium.
The long hospital stay in this case may be related to the patient's emergency heart transplant. Patients with ECMO assistance have many systemic pipelines and a high risk of infection, especially after experiencing cardiopulmonary bypass again during the process of heart transplantation. The inflammatory reaction caused by the cardiopulmonary bypass damages the body.
In conclusion, patients with secondary acute myocardial infarction are prone to severe heart failure. The myocardial angiography ultrasound imaging can evaluate myocardial perfusion and predict myocardial survival. It can serve as an important reference for emergency heart transplantation. But the existing MCE relies on the human visual assessment, a qualitative assessment is poorly reproducible, and the diagnosis procedure is highly dependent on the experience of the clinician.
List of abbreviations
MI : Myocardial infarction
MCE :Myocardial contrast echocardiography evaluation
TnT-HS Troponin T
CK: Creatine kinase
CK-MB : Creatine kinase isoenzyme:
ECMO : Extracorporeal membrane oxygenation
Veno-artery ECMO:VA ECMO.
Informed consent has been obtained from the patient and the hospital ethics Committee.
Not applicable.
Not applicable
The authors declare that they have no competing interests.
There was no funding for this study.
Xiaozu Liao ，Drafting article
Miaoyun Guo ，Data collection
ShI Zhong , Data collection
Junlin Wen ，Data analysis
Binfei Li ，Design
Informed consent was obtained from the patient in this case
Not applicable.
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
