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*Corresponding Author: Abd Rabou Hamed, Cardiology NHI, Egypt.
Citation: Abd Rabou Hamed, Ahmed Elkersh, Ahmed Hegab, Abdulaziz Aboshahba . (2022). Effect of Coronary Arterial Dominance Post Primary Percutaneous Coronary Artery Intervention (PCI) during Hospital Stay and at 3-Month Follow-up. J. Clinical Cardiology and Cardiovascular Interventions, 5(4); Doi:10.31579/2641-0419/246
Copyright: © 2022 Abd Rabou Hamed, 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: 17 January 2022 | Accepted: 18 March 2022 | Published: 28 March 2022
Keywords: coronary arterial dominance; percutaneous coronary artery intervention; hospital stay; follow up
Background: Coronary vessel dominance, defined by the coronary artery that supplies the posterior descending artery (PDA) and posterolateral branches, influences the relative contribution of the different coronary arteries to the total left ventricular blood flow. This work aimed to evaluate the prognostic value of coronary arterial dominance post primary PCI, during hospital stay and at 3-month follow-up, which include; cardiac mortality, heart failure, non-fatal myocardial infarction, re-vascularization, stroke/TIA and re-admission for ACS.
Methods: This prospective observational study included 100 patients a with STEMI who underwent successful primary percutaneous coronary intervention with TIMI III flow and without procedural complications. Patients were divided into 3 groups according to coronary dominance: Right coronary dominant group (RCD), left coronary dominant group (LCD) and balanced coronary dominant group (BCD). All patients were subjected to transthoracic echocardiogram and coronary angiography and Primary percutaneous coronary intervention.
Results: Ticagrelor and clopidogrel during hospital stay and on hospital discharge were significantly used more with RCA group than LCX group and LCX & RCA group (P=0.021, 0.012), (P=0.018, 0.014), respectively. GPIIB/IIIA was significantly more used during hospital stay with RCA group than LCX group and LCX & RCA group(P=0.014). Nitrates was significantly used more on hospital discharge with RCA group than LCX group and LCX & RCA group (P<0.001).
Conclusions: Coronary arterial domi¬nance showed significant prognostic value in cases of myocardial Infarction after PCI, heart failure in LCX cases and in revascularization, heart failure, and stroke/TIA cases in RCA. Further, readmission for ACS was the most common outcome in all groups after 3-months follow-up.
Coronary vessel dominance, defined by the coronary artery that supplies the posterior descending artery (PDA) and posterolateral branches, influences the relative contribution of the different coronary arteries to the total left ventricular blood flow [1].
In a right-dominant circulation, the right coronary artery (RCA) supplies the posterior portion of the inter-ventricular septum and gives off the posterior descending artery. This contrasts with a left-dominant circulation, in which the left circumflex (LCX) artery supplies this territory. In a co-dominant circulation, supply of the posterior inter-ventricular septum is shared by the RCA and LCX. The prevalence of left dominance is 8%, whereas co-dominance has 7% population prevalence, [1] and right dominant system has a reported prevalence of 82–89% [2, 3]. In patients with a left dominant system, 60% of the left ventricular myocardium is supplied by the posterolateral branches and PDA originating from the LCx [4]. This less well-balanced coronary circulation might have a negative influence on prognosis of patients with coronary artery disease (CAD). Currently, the prognostic importance of coronary vessel dominance in patients presenting with first ST-segment elevation myocardial infarction (STEMI) remains uncertain [4].
Variations in coronary circulation are common, particularly with regard to the supply of the posterior wall of the left ventricle. While a right dominant coronary artery is most commonly observed, a left dominant system is considered to be a normal variant of the coronary anatomy [2, 3]. At present, little is known about the clinical relevance of this anatomical variation. A study screening 1620 post-mortem angiograms showed that the prevalence of a left dominant system decreased with age, [3] suggesting a higher death rate among patients with a left dominant coronary artery system. An explanation could be that a larger amount of myocardium is at risk in these patients, resulting in more extensive myocardial infarction in case of a left coronary artery occlusion.
However, there is limited knowledge about the relation between coronary dominance patterns and the risk of various adverse clinical events that can occur following percutaneous coronary interventions (PCI). Previously, Goldberg et al. [5] showed that the presence of a left dominant system was associated with an increased mortality in patients presenting with acute coronary syndrome (ACS). Accordingly, a more recent registry (the Cath PCI registry) observed higher in-hospital mortality after PCI in patients with a left dominant system [1].
Left ventricular (LV) systolic dysfunction and remodeling have been strongly associated with short- and long-term outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PCI) [6]. Independent correlates of LV systolic dysfunction and remodelling after STEMI include infarct size, heart rate, and severity of coronary artery disease [7-9]. LV dysfunction affected by coronary arterial dominance, as Yip et al. [10] showed that a left dominant system was independently predictive of failed reperfusion in patients with LCx artery infarction. The effect of coronary arterial dominance on LV dysfunction and remodelling at follow-up is unclear [5].
The aim of this work was to evaluate the prognostic value of coronary arterial dominance post primary PCI, during hospital stay and at 3-month follow-up, which include; cardiac mortality, heart failure, non-fatal myocardial infarction, re-vascularization, stroke/TIA and re-admission for ACS.
Patients and Methods
This prospective observational study included 100 patients a with STEMI who underwent successful primary percutaneous coronary intervention with TIMI III flow and without procedural complications. Exclusion criteria: Prior coronary artery bypass graft to assess the effect of specific culprit vessel site without confounding by by-pass grafts, previous PCI, usuccessful PCI, cardiogenic shock, STEMI with mechanical complication, left main disease >50%, previous myocardial infarction, valvular heart disease, atrial dysrhythmias, end stage renal failure and abnormal liver function. Patients were divided into 3 groups according to coronary dominance: Right coronary dominant group, (RCD), left coronary dominant group, (LCD) and balanced coronary dominant group, (BCD).
Transthoracic echocardiogram
2-dimensional echocardiography was performed within 48 hours of admission and at 3-month follow-up. Routine Images were obtained at rest. M-mode, 2-dimensional, and Doppler images acquired. Systolic LV function was assessed. LV ejection fraction (LVEF) was calculated (226). Subsequently, the LV was divided into 16 segments to calculate the wall motion score index (WMSI). Every segment was individually assessed and scored based on its motion and systolic thickening as the following: Normokinesis or hyperkinesis =1, Hypokinesis =2, Akinesis =3, Dyskinesis =4 and Aneurysm = 5. WMSI was calculated as the sum of the segment scores divided by the number of segments visualized (226). WMSI classified as the following: 1 is norma1, 1-1.49 is mild impairment, 1.5-1.99 is moderate impairment and ≥ 2 is severe impairment.
Coronary angiography and Primary percutaneous coronary intervention
The images of the coronary angiography and PCI were obtained according to standardized angiographic projections [11]. During the analysis coronary vessel dominance, the culprit vessel and culprit lesion and severity of CAD were recorded. The extent of CAD was expressed as the presence of one-, two- or three-vessel disease (stenosis causing ≥ 70 % luminal narrowing). Complete revascularization were defined as treating all present significant coronary artery stenosis (≥ 70 % luminal narrowing) during primary PCI or during secondary revascularization before discharge. Angiographic success of PCI was defined as TIMI III flow with residual stenosis below 0%.
Angiographic assessment of Coronary arterial dominance [12]
Coronary arterial dominance was defined according to the following definition: Right coronary dominant if the PDA and at least one posterolateral branches originating from the right coronary artery (RCA). Left coronary dominant if the PDA and the posterolateral branches originating from the LCx. Balanced coronary dominant if the PDA originating from the RCA in combination with posterolateral branches originating from the LCx artery [12].
The Brain Natriuretic Peptide
Test used: We used Alere Triage® BNP Test is a rapid, point of care fluorescence immunoassay designed to be used with the Alere Triage® Meters for the quantitative measurement of B-type natriuretic peptide (BNP) in EDTA anticoagulated whole blood or plasma specimens. The test procedure involves the addition of several drops of an EDTA
Statistical Analysis
All variables were expressed as mean ± standard deviation. The Chi-square test was used to analyse categorical variables. Student's t test and analysis of variance were used for continuous variables. Univariate and multivariate analyses were performed to identify independent predictors of no-premature atherosclerosis. Statistical analysis were made using SPSS 19.0. A P value <0>
All patient’s characteristics, ECG STEMI were insignificantly different among the studied groups. There was insignificant difference in approach of catheterization (femoral or radial) between the three groups. [Error! Not a valid bookmark self-reference.]
Table 1: Patient’s characteristics, ECG STEMI and approach to catheterization among three groups
| LCX (n = 29) | RCA (n = 70) | LCX & RCA (n = 11) | P value | ||
Age (years) | Mean ± SD | 54.45 ± 10.54 | 54.70 ± 9.71 | 61.36 ± 7.68 | 0.099 | |
Range | 37 - 76 | 28 - 75 | 47 - 73 | |||
Gender | Male | 22 (75.86%) | 58 (82.86%) | 9 (81.82%) | 0.720 | |
Female | 7 (24.14%) | 12 (17.14%) | 2 (18.18%) | |||
Hypertension | 23 (79.31%) | 56 (80.00%) | 8 (72.73%) | 0.859 | ||
DM | 16 (55.17%) | 47 (67.14%) | 7 (63.64%) | 0.530 | ||
Smoker | 11 (37.93%) | 36 (51.43%) | 7 (63.64%) | 0.282 | ||
ECG STEMI | ||||||
Inferior | 22 (75.86%) | 52 (74.29%) | 8 (72.73%) | 0.976 | ||
Posterior | 9 (31.03%) | 16 (22.86%) | 2 (18.18%) | 0.604 | ||
| Approach to catheterization | ||||||
Femoral | 24 (82.76%) | 64 (91.43%) | 9 (81.82%) | 0.376 | ||
Radial | 5 (17.24%) | 6 (8.57%) | 2 (18.18%) | 0.376 | ||
LCX: Left Circumflex coronary artery, RCA: Right coronary artery, DM: Diabetes mellites
There is insignificant difference in CKMB, serum creatinine andtype of stent and wire (soft and DES) and its diameter, length, and number of stents used among the three groups [Error! Reference source not found.]
Table 2: CKMB, Serum creatine, troponin T and Type of stent and wire used in PCI among three groups
| LCX (n = 29) | RCA (n = 70) | BCD (n = 11) | P value | ||
CKMB |
Mean ± SD |
78.17 ± 17.01 |
82.39 ± 13.03 |
89.64 ± 11.29 |
0.070 | |
Range | 110 - 80 | 120 - 85 | 105 - 90 | |||
Serum Creatine |
Mean ± SD |
|
1.03 ± 0.16 |
1.13 ± 0.20 |
0.204 | |
Range | 0.8 - 1.3 | 0.7 - 1.3 | 0.8 - 1.4 | |||
Positive serum troponin T | 29 (100%) | 70 (100%) | 11 (100%) | --- | ||
Type of stent and wire used in PCI | ||||||
Soft | 3 (10.34%) | 10 (14.29%) | 2 (18.18%) | 0.785 | ||
DES | 26 (89.66%) | 60 (85.71%) | 9 (81.82%) | 0.785 | ||
Diameter |
Mean ± SD |
3.18 ± 0.49 |
3.20 ± 0.41 |
3.27 ± 0.45 |
0.666 | |
Range |
2 - 4 |
2.25 - 4 |
2.5 - 4 | |||
Length |
Mean ± SD |
45.66 ± 24.36 |
38.41 ± 16.28 |
41.82 ± 18.57 |
0.223 | |
Range | 15 - 96 | 15 - 86 | 18 - 78 | |||
Number of Stents |
Mean ± SD |
1.45 ± 0.57 |
1.26 ± 0.44 |
1.45 ± 0.52 |
0.17 | |
Range | 1 - 3 | 1 - 2 | 1 - 2 | |||
LCX: Left Circumflex coronary artery, RCA: Right coronary artery, CKMB: Creatine kinase-MB
Low-density lipoprotein was significantly higher in LCX & RCA group than RCA group and LCX group and was significantly higher in RCA group than LCX group (p <0>
High-density lipoprotein was significantly lower in LCX group than RCA group (p =0.021), but there was insignificant difference between LCX group and LCX & RCA group, and between RCA group and LCX & RCA group. [Table 3
EF was significantly higher in RCA group than LCX group and LCX & RCA group, and was significantly higher in LCX & RCA group than LCX group.
EF after 3 months was significantly different among the three groups (P =0.007). It was significantly higher in RCA group than LCX group and LCX & RCA group, and was significantly higher in LCX group than LCX & RCA group. [Table 3
LCX: Left Circumflex coronary artery, RCA: Right coronary artery, P1: Significance between LCX and RCA, P2: Significance between LCX and LCX & RCA, P3: Significance between RCA and LCX & RCA
BNP before discharge was significantly different among the three groups (P <0>[Table 4
LCX: Left Circumflex coronary artery, RCA: Right coronary artery, BNP: B-type natriuretic peptide, *Significant as p value <0>P1: between LCX and RCA P2: between LCX and LCX and RCA P3: between RCA and LCX and RCA
Ticagrelor and clopidogrel during hospital stay and on hospital discharge were significantly more used with RCA group than LCX group and LCX & RCA group( (P=0.021, 0.012), (P=0.018, 0.014) respectively). GPIIB/IIIA was significantly more used during hospital stay with RCA group than LCX group and LCX & RCA group(P=0.014). Nitrates was significantly more used on hospital discharge with RCA group than LCX group and LCX & RCA group (P<0>].
Table 5: Drugs received during hospital stay and on hospital discharge among the three groups
| LCX (n = 29) | RCA (n = 70) | LCX & RCA (n = 11) | P value | |
Nitrates | 29 (100%) | 70 (100%) | 11 (100%) | --- | |
BB | 29 (100%) | 70 (100%) | 11 (100%) | --- | |
ACI | 29 (100%) | 70 (100%) | 11 (100%) | --- | |
Ticagrelor | 25 (86.21%) | 43 (61.43%) | 5 (45.45%) | 0.021* | |
STAIN | 29 (100%) | 70 (100%) | 11 (100%) | --- | |
GPIIB/IIIA | 8 (27.59%) | 16 (22.86%) | 7 (63.64%) | 0.014* | |
Clopidogrel | 3 (10.34%) | 27 (38.57%) | 6 (54.55%) | 0.018* | |
| LCX (n = 29) | RCA (n = 70) | LCX & RCA (n = 11) | P value | |
BB
| 29 (100%)
| 70 (100%)
| 11 (100%)
| --- | |
ACEI
| 29 (100%)
| 70 (100%)
| 11 (100%)
| --- | |
Aspirin
| 29 (100%)
| 70 (100%)
| 11 (100%)
| --- | |
Ticagrelor
| 25 (86.21%) | 43 (61.43%) | 5 (45.45%) | 0.012* | |
STATIN
| 29 (100%)
| 70 (100%)
| 11 (100%)
| --- | |
Diuretics
| 7 (24.14%) | 30 (42.86%) | 7 (63.64%) | --- | |
Nitrates | 6 (20.69%) | 43 (61.43%) | 11 (100.00%) | <0>
| |
Clopidogrel | 4 (13.79%) | 31 (44.29%) | 6 (54.55%) | 0.014* |
LCX: Left Circumflex coronary artery, RCA: Right coronary artery, BB: Beta-blocker, ACEI: Angiotensin converting enzyme inhibitor, *Significant as p value <0>
Coronary artery dominance is associated with the extent of CAD with incidence and all‑cause mortality of AMI but not with atherosclerotic involvement. Research has suggested difference in post‑PCI outcome and mortality of patients with acute coronary syndrome (ACS) undergoing PCI based on their coronary artery dominance. Coronary artery dominance is also associated with 30‑day mortality and early reinfarction after STEMI [13-15].
In our study, there was an insignificant difference CKMB between the three groups.
Our results were not in consistent with [16]. They observed that median CK‑MB were significantly different, and the highest values were observed in LD group (195.79 U/L, respectively). Larger included sample size and ethnic consideration can explain this contradiction. However, [17] found that the peak level of CK-MB was significantly higher in LCX group than in RCA group. This difference could be justified by the large recruited sample size and excluding patients with codominant LCX & RCA.
In our study, there was insignificant difference in approach of catheterization (femoral or radial) between the three groups. Our findings were in agreement with [18] who observed no significant difference in catheterization (femoral or radial artery) between the right- or co-dominant anatomy (RD group) and those with left dominant anatomy (LD group).
In our study, there is insignificant difference in type of stent and wire (soft and DES) and its diameter, length, and number of stents used among the three groups.
In consistent with our results, [19] assessed two-year follow-up data of 1,387 patients from the randomized TWENTE trial. Based on the origin of the posterior descending coronary artery, coronary circulation was categorised into left and non-left dominance (i.e., right and balanced). This was in line with [16] results; as no significant difference was detected in terms of stent type, size, and number among right, left and Co‑dominant groups.
Moreover, [20] reported no significant difference between all studied group in stent length, number and diameter.
In the present study, EF before discharge was significantly different among the three groups (P <0>
Comparable to our findings, [17] found that EF was higher in RCA group than LCX group.
In our results, EF after 3 months was significantly different among the three groups (P =0.007). It was significantly higher in RCA group than LCX group and LCX & RCA group and was significantly higher in LCX group than LCX & RCA group.
Similarly, [21] conducted a study to compare the outcome of patients with CX versus right coronary artery (RCA) related STEMI. A total of 1683 consecutive patients with STEMI were studied. Patients who lacked STEMI were also included if they had persistent chest pain with signs of ischaemia or regional wall motion abnormalities on echocardiography. Coronary angioplasty was performed according to standard procedures. After the intervention, all patients received aspirin and clopidogrel or ticlopidine. The results showed that LVEF was significantly higher in patients with RCA- related MI treated by primary percutaneous intervention (PCI) when compared to LCX- related MI. Further, [17] results demonstrated that the left ventricular ejection fraction was notably lower in LCX group than RCA group after 30-Day. This difference could be related to the variety in duration of follow up.
In contrast, [20] found no significant difference in lower left ventricular ejection fraction after 3 months by both 2D and 3D echocardiography in patients with left dominant, right coronary dominant, and balanced coronary dominant groups.
Our findings were in line with [22] study which included one hundred fifty consecutive patients with acute inferior wall STEMI. Patients were divided into two groups according to the infarct related artery (LCX vs. RCA). All patients underwent routine adjunctive angioplasty after TLT during the index hospitalization and clinical characteristics and outcomes were compared. There was lower left ventricular ejection fraction (LVEF) (p= 0.01) in patients with LCX occlusion compared with RCA.
In the present study, EF after 3 months was significantly higher than before discharge in the groups (p <0>, [20] found that after 3 months follow-up a significantly lower left ventricular ejection fraction at admission was observed by both 2D and 3D echocardiography in patients with a left dominant system.
In our study, regarding in-hospital clinical outcome, the most common outcomes in the LCX group were myocardial Infarction after PCI and heart failure each occurred in 3 (10.34%) patients, the most common outcomes in the RCA group were revascularization, heart failure, and stroke/TIA each occurred in 3 (4.29%) patients, the most common outcome in the LCX & RCA group was Stroke/TIA occurred in 3 (27%) patients.
In consistent with our results, [17] study results demonstrated that the frequency of advanced congestive heart failure was remarkably higher in group LCX than in RCA group (all P < 0>
Furthermore, [23] conducted a prospective, observational, nonrandomized study and enrolled 200 consecutive patients with inferior wall STEMI. All patients were treated with emergency percutaneous coronary intervention during hospitalization and clinical characteristics and outcomes were compared. Group 1 included 100 patients presented with acute inferior wall STEMI caused by RCA occlusion and Group 2 included 100 patients presented with acute inferior wall STEMI caused by LCX occlusion. Total primary outcome in their study was higher in LCX group (p=0.048) that may be related to heart failure, stroke and bleeding which were more than RCA group.
Limitations: The study population was of limited size and the number of sites included in our registry. We only included patients with acute STEMI who were treated with primary PCI, which may have influenced the prevalence of CD pattern. Our findings must be interpreted in the context of acute STEMI treated with primary PCI, and they do not necessarily apply to all patients with acute STEMI.
Coronary arterial dominance showed significant prognostic value in cases of myocardial Infarction after PCI, heart failure in LCX cases and in revascularization, heart failure, and stroke/TIA cases in RCA. Further, readmission for ACS was the most common outcome in all groups after 3-months follow-up.
Nil
Conflict of Interest: Nil
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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.
