AUCTORES
Globalize your Research
Re-Print-Research Article
*Corresponding Author: Gary L. Murray, The Heart and Vascular Institute, Germantown - USA
Citation: Gary L. Murray., Colombo J. (2020) Ranolazine Improves Autonomic Balance in Heart Failure when added to Guideline-Driven Therapy. Clinical Cardiology and Cardiovascular Interventions, 3(2); Doi:10.31579/2641-0419/045
Copyright: © 2020 Gary L. Murray, 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: 22 January 2020 | Accepted: 28 January 2020 | Published: 04 February 2020
Keywords: cardiovascular autonomic neuropathy; congestive heart failure; major adverse cardiac events; parasympathetic function; patient outcomes; ranolazine, sympathetic function
Background: The effect of ranolazine (RAN) on cardiac autonomic balance in congestive heart failure (CHF) was studied.
Methods: Fifty-four CHF patients were randomized to (1) open-label RAN (RANCHF) added to usual therapy vs.
(2) usual therapy (NORANCHF). Parasympathetic and sympathetic (P&S) measurements were taken at baseline and at 12 months.
Results: A total of 16/27 (59%) patients in both groups had initially abnormal P&S measures, including high sympathovagal balance (SB), cardiovascular autonomic neuropathy (CAN) or both. High SB normalized in 10/12 (83%) RANCHF patients vs. 2/11 (18%) NORANCHF patients. SB became high in 5/11 (45%) NORANCHF vs. 1/11 (9%) RANCHF patients. CAN improved in 4/6 (67%) RANCHF patients vs. 5/7 (45%) NORANCHF patients. CAN developed in 1/11 (9%) RANCHF vs. 4/11 (36%) NORANCHF patients. Since improved P&S in RANCHF patients seemed independent of improved brain natriuretic peptide and impedance cardiography (BioZ) measurements, 5 day RAN was given to 30 subjects without CHF but with high SB or CAN. P&S improved in 90% of these subjects.
Conclusions: RAN improves unfavorable P&S activity in CHF possibly by a direct effect upon autonomic sodium channels.
In congestive heart failure (CHF), there is an increase in the myocardial late sodium current (INa) leading to an intra- cellular calcium (Ca++) overload that causes diastolic dysfunc-tion, microvascular ischemia and early after-depolarizations, increasing the risk of sudden death. In therapeutic concen- trations, ranolazine (RAN) decreases the rate of INa by 50%, thereby improving this Ca++-related mechanical and electrical dysfunction [1]. Therefore, RAN potentially could improve the mechanical and electrical dysfunction of CHF. Since neuronal sodium channel 1.7 (Nav1.7) is blocked in its open state in a strongly use-dependent manner by RAN at therapeutic con-centrations (2-6 μM) via the local anesthetic receptor [2, 3], it is possible that RAN can directly alter the function of the parasympathetic and sympathetic (P&S) branches of the au- tonomic nervous system (ANS). Consequently, an additional potential benefit of RAN in CHF could be improvement in the damaging autonomic dysfunction that it accompanies. This is the first study on changes in P&S measures in CHF patients treated with RAN added to guideline-driven therapy.
In 2006, 54 patients treated for CHF according to ACC/AHA guidelines [4] were randomized to (1) open-label RAN added to usual care (RANCHF, n = 27) or [2] continued usual care (NORANCHF, n = 27) (Table 1). Since patients were on maximally tolerated doses of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), only the diuretic dose was adjusted if needed. Diastolic CHF was defined as CHF with a left ventricular ejection frac- tion (LVEF) ≥0.40. At baseline, 2D echocardiograms, impedance cardiograms (BioZ, Cardio Dynamics, San Diego, CA) and brain natriuretic peptides (BNPs) were obtained. P&S function was assessed noninvasively using the ANSAR Medical Technologies, Inc. (Philadelphia, PA) software (ANX 3.0 autonomic function monitor) which computes simultaneous, independent mea- sures of P&S activity (P&S monitoring) based on continuous, Time–frequency analysis of heart rate variability (HRV) with concurrent, time–frequency analysis of continuous respiratory activity (RA). The following variables were recorded: seated resting (5 min) P&S activity (respiratory frequency area (RFa) and low-frequency area (LFa), respectively) was computed from P&S Monitoring [5-9]; exhalation/inhalation (E/I) ratio and RFa were computed in response to 1 min of deep breathing (paced breathing at 6 breaths/min) [9]; Valsalva ratio and LFa were computed in response to a series of short Valsalva maneuvers (≤15 sec); and BP, LFa, RFa and 30:15 ratio were computed in response to 5 min of head-up postural change (quick stand fol- lowed by 5 min of quiet standing). Sympathovagal balance (SB) is computed as LFa/RFa (reported means are averages of ratios, not ratio of averages). Cardiac autonomic neuropathy (CAN) was defined in standard fashion [10], reflecting very low para- sympathetic activity (RFa <0.1 bpm2). Parasympathetic activity (RFa) was defined as the spectral power within a 0.12 Hz-wide window centered on the fundamental respiratory frequency (FRF) in the HRV spectrum [5-9]. FRF was identified from time– frequency analysis of RA. Effectively, FRF is a measure of Vagal outflow, as it effects the heart. Sympathetic activity (LFa) was defined as the remaining spectral power, after computation of RFa, in the low-frequency window (0.04-0.15 Hz) of the HRV spectrum [5-9]. This method is valid regardless of challenge or patient state or history. Normal SB is 0.4< SB <3.0. High SB (>3.0) and CAN define high mortality risk, including silent myo- cardial infarction and sudden cardiac death [11-14]. The 30:15 ratio is the ratio of the 30th R-R interval after a quick head-up postural change (standing) to the 15th R-R interval after stand- ing. The 30:15 ratio reflects the reflex bradycardia upon stand- ing that is dependent upon sympathetic vasoconstriction. The Valsalva ratio is the ratio of the longest R-R interval to the short- est R-R during a 15 sec Valsalva maneuver. The E/I ratio is the ratio of the heart beat interval during peak exhalation over that during peak inhalation during paced breathing. The E/I ratio is a measure of, more or less, Vagal (parasympathetic) tone, as are the 30:15 and Valsalva ratios.
Table I lists the demographics of the RANCHF and NORANCHF populations. These two populations were well matched. CHF management guidelines [4] were strictly fol- lowed. Almost 100% of the patients were prescribed beta- blockers, 91% of the patients without chronic renal disease were prescribed an ACE inhibitor or ARB and 76% of the sys- tolic CHF patients had defibrillators. Over 60% of these popu- lations are diagnosed with diabetes.
Average changes in abnormal P&S measures in RANCHF vs. NORANCHF patients are presented in Table II. Individually, 16/27 RANCHF patients (59%, including 9 systolic and 7 diastolic CHF patients) had abnormal baseline P&S responses: 10 patients (37%) demonstrated high SB, 4 patients (15%) demonstrated CAN and 2 patients (7%) demonstrated both Of the NORANCHF patients, 16/27 (59%) had abnormal base- line P&S responses, 9 patients (33%) demonstrated high SB, 5 patients (19%) demonstrated CAN and 2 patients (7%) demonstrated both. Fifteen of 16 RANCHF patients (94%) with initially abnormal P&S responses improved, and 14/16 patients (88%) normalized high SB and corrected CAN as compared with only 7/16 NORANCHF patients (44%) (p = 0.0330). On average (Table. II), the RANCHF patients demonstrated a significant improvement in SB (from 15.9 to 1.90, p = 0.0330), indicating a relative reduction in sympathetic activity. This is not the case for the NORANCHF patients (SB from 7.02 to 8.27, p = 0.130), whose SB remained high, indicating a persistent relative, rest ing sympathetic excess. Only 8/16 NORANCHF patients (50%) with abnormal baseline P&S improved (p = 0.0560). Individually, of the NORANCHF patients, only 2/11 (18%) normalized their high SB, as compared with 10/12 RANCHF patients (83%, p = 0.0130). Four NORANCHF patients (15%) demonstrated SB responses that became abnormally high during the 12 months of no RAN therapy. Individually, of the NORANCHF patients, 5/7 (71%) corrected their CAN as compared with 4/6 (67%) RANCHF patients. On average (TABLE. II), the resting parasympathetic response (RFa) for the RANCHF patients was higher (0.50 bpm2) than that for the NORANCHF patients (0.38 bpm2, p = 0.0040).
As a control experiment, we investigated changes in ini- tially normal P&S measures in RANCHF vs. NORANCHF patients
(TABLE. III). Individually, 11/27 patients (41%) from both RANCHF and NORANCHF populations demonstrated normal, baseline P&S responses. However, only 1/11 RANCHF patients (9%) de- veloped high SB as compared with 5/11 NORANCHF patients (45%, p = 0.0170). Similarly, 1/11 RANCHF patients (9%) devel- oped CAN as compared with 4/11 NORANCHF patients (36%, p = 0.0160). On average (TABLE. III), RANCHF patients demon- strated a decrease in resting, sympathetic activity at 12-month follow-up (p = 0.0540) as compared with an increase in the resting, sympathetic activity in the NORANCHF patients (p = 0.0410). Conversely (TABLE. III), the RANCHF patients dem- onstrated an increase in resting, parasympathetic activity at 12-month follow-up (p = 0.0780) as compared with a decrease in resting, parasympathetic activity in the NORANCHF patients (p = 0.0160). The resulting average SB for RANCHF patients de- creased (p = 0.0170), as compared with an increase in average SB for the NORANCHF patients (p = 0.0200).
Changes in BioZ and BNP measures in RANCHF patients with initially abnormal P&S responses are presented in Table IV. The hemodynamic responses to RAN were not uni- form. In the initially abnormal P&S response for RANCHF patients, no improvement in BioZs and BNPs was found in 7/17 patients (41%). Importantly, despite this, abnormal P&S responses improved equally well as in the RANCHF pa- tients whose BioZ and BNP responses improved, suggesting a possible direct effect on nervous system Nav channels. To investigate this possibility (TABLE. V), 30 subjects without CHF or an indication for RAN who had “CHF-like” high SB or CAN were given RAN. On the 5th day of treatment, P&S responses improved in 27/30 of the subjects (90%), normalizing in 20/30 subjects (67%). Isolated high SB normalized in 16/25 subjects (64%). The one subject with CAN demonstrated an increase in resting parasympathetic activity, relieving the CAN. For 3/4 subjects (75%) demonstrating both high SB and CAN, both P&S measures normalized. After discontinuing RAN, P&S responses returned to baseline levels.
The patient populations have significant subpopulations diagnosed with diabetes. This reflects the general population of Memphis, TN, the region of our clinic. It is one of the most obese populations in the United States. While diabetic auto- nomic neuropathy (DAN) is a well-known precursor to CAN and may affect P&S measures, including SB, P&S measures are similarly effected in patients not diagnosed with diabetes prior to CAN. The precursor to CAN in nondiabetic patients is advanced autonomic dysfunction (AAD). AAD carries the same P&S criteria as DAN: abnormally low P&S activity at rest, with p≥0.1 bpm2, with similar symptoms.
RAN affects cardiac Nav function by binding to Nav ami- no acid F1760 [1]. The late INa is reduced by 50%. Since RAN blocks open neuronal Nav 1.7 in a strongly use-dependent manner via the local anesthetic receptor [2], RAN could have direct effects upon ANS Nav channels.
High sympathetic activity and CAN have been associated with major adverse cardiac events (MACE), including sudden death [5, 11, 12]. Since structural abnormalities also increase MACE [13], baseline 2D echocardiograms were obtained. In our systolic CHF patients, structural findings were consistent with high MACE risk. Mean values for left ventricular end dia- stolic diameter (TABLE. I) and left atrial diameter were 61 mm and 45 mm, respectively. CAN is associated with very low resting parasympathetic activity. In this study, the RANCHF patients demonstrated more parasympathetic activity (TABLE. II). More sympathetic activity is known to increase cardiovascular risk [14]. More parasympathetic activity at rest is cardioprotective [15]. These effects of RAN are borne out in the control patients. The RANCHF control patients demonstrated a decrease in ab- solute resting sympathetic activity and an increase in absolute resting parasympathetic activity, with a decrease in SB. The converse is true for the NORANCHF patients (TABLE. III).
Despite aggressive CHF management, 32/54 (59%) of our CHF patients had initially high SB, CAN or both (TABLE. II). Ninety- eight percent of patients were on a maximum tolerated dose of beta-blocker. That 23/54 (43%) of the CHF patients’ base-line P&S responses demonstrated high SB is consistent with the prevalence of adrenergic escape in systolic CHF cited in a recent 415 patient study [16]. RAN improved abnormal P&S measures in our CHF patients, including an average 88% re- duction in SB (TABLE. II, p = 0.0330), and SB normalized in 10/12 (83%) of baseline high SB RANCHF patients. CAN improved in 5/7 (71%) of the RANCHF patients.
Although P&S measures change with changing hemody- namics [17-19], RAN was associated with P&S changes even when no definite changes in BNP or BioZ measures were found. Although the mechanism is unknown, a direct effect on nervous system Nav channels is possible. This is supported by the results in the 30 subjects with “CHF-like” P&S responses who had neither CHF nor an indication for RAN. Five days of RAN improved high SB and CAN in 27/30 (90%), normal- izing SB and CAN in 20/30 (67%) of subjects (TABLE. V). P&S re- sponses returned to baseline after discontinuing RAN. That P&S function can change independently of hemodynamics has been established. For example, diabetes control [20] and alpha lipoic acid [21] affect P&S and HRV measures. Notably, despite the favorable hemodynamic effects of renin-angio- tensin-aldosterone antagonists in CHF, their impact on HRV measures has been mixed [11]; however, this may be due to the mixed nature of HRV as a P&S measure calculated from 24-hour Holter monitors.
As expected, hemodynamics did affect P&S function in our CHF patients. On average, cardiac index (CI) was lower in the initially abnormal P&S response group (2.35 l/mim/m2) than in the initially normal P&S response group (2.66 l/min/m2). However, resting hemodynamics could not always predict abnormal P&S responses, as NORANCHF patients with ini- tially abnormal P&S responses had higher CI and lower BNPs than RANCHF patients with normal P&S responses (2.55 vs.2.35 l/min/m2 and 293 vs. 480 l/min/m2, respectively). That RAN improved hemodynamics more in our diastolic CHF than systolic CHF patients is consistent with RAN’s proposed mechanism of action (1), and suggests RAN could impact greatly the dyspnea of diastolic CHF. Our diastolic RANCHF patients (LVEF 41-54%) typically had a ≥10 LVEF unit (EFU) increase by 12 months and 45% of RANCHF patients (both systolic and diastolic) increased LVEF by at least 6 EFUs, some doubling their baseline LVEF.
Whether improved P&S measures in CHF patients are a surrogate for reduced risks of sudden death, disease progres- sion and hospitalizations remains to be determined. Toward these ends, preliminary evidence from a 3-year study in our laboratory, focused on echocardiographic changes in 54 RANCHF patients (41 systolic, 13 diastolic) vs. 55 NORANCHF patients (43 systolic, 12 diastolic), revealed that 21/55 (38%) NORANCHF patients had 35 MACE (hospitalized for CHF, had pacing cardiac defibrillator therapy for VT/VF or died), as com- pared with 17/54 (31%) RANCHF patients having 21 MACE (p = 0.0614). Of these 109 patients, 95 were successfully test- ed for P&S function. RANCHF patients and patients from both groups without MACE had lower SB; the RANCHF group also had higher parasympathetic modulation (RFa).
Despite aggressive guideline-driven therapy in CHF pa- tients, a significant number have unfavorable P&S profiles, even while taking up to 50 mg Carvedilol bid, or 200 mg Metoprolol daily. RAN causes a dramatic improvement in abnormal P&S measures, apparently independent of the CI or BNP responses. This suggests a possible direct effect on autonomic Nav channel function. RAN blocks neuronal channel Nav1.7. Worsening P&S responses appear to predict MACE. Therefore, P&S monitoring could become an important management tool in CHF. Current management of CHF does not include P&S measurements, so that the effect of beta-blockers and ACE inhibitors or ARBs upon the neurohumoral paradigm of CHF in our patients is never quantitated.
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.
