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Otimização da Terapia de Reperfusão no Infarto Agudo do Miocárdio com Supradesnível do Segmento ST por Meio de Telemedicina Baseada no WhatsApp®
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Teixeira, Alessandra Batista

; Zancaner, Leonardo Fiaschi

; Ribeiro, Fernando Fonseca de França

; Pintyá, José Paulo

; Schmidt, André

; Maciel, Benedito Carlos

; Marin Neto, José Antônio

; Miranda, Carlos Henrique

Arquivos Brasileiros de Cardiologia

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mar 2022, Volume 118 N. 3 Pages 556 - 564

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento Cerca de 40% dos pacientes com infarto agudo do miocárdio com supradesnível do segmento ST (IAMCSST) no Brasil não recebem terapia de reperfusão. Objetivo A utilização de uma rede de telemedicina baseada no WhatsApp® poderia aumentar a porcentagem de pacientes que recebem terapia de reperfusão. Métodos Estudo transversal do tipo antes e depois da organização de uma rede de telemedicina para envio e análise do eletrocardiograma através do WhatsApp® dos pacientes suspeitos de IAMCSST oriundos dos 25 municípios integrantes do Departamento Regional de Saúde de Ribeirão Preto (DRS−XIII), para hospital terciário que poderia autorizar a transferência imediata do paciente utilizando o mesmo sistema. O desfechos analisados foram a porcentagem de pacientes que receberam terapia de reperfusão e a taxa de mortalidade intra-hospitalar. Considerou-se valor de p <0,05 como estatisticamente significativo. Resultados Foram comparados 82 pacientes antes desta rede (1º de fevereiro de 2016 a 31 de janeiro de 2018) com 196 pacientes depois da implantação da mesma (1º de fevereiro de 2018 a 31 de janeiro de 2020). Após a implantação da rede, houve aumento significativo da proporção de pacientes que receberam terapia de reperfusão (60% vs. 92%), risco relativo (RR): 1,594 [intervalo de confiança (IC) 95% 1,331 – 1,909], p <0,0001 e redução da mortalidade intra-hospitalar (13,4% vs. 5,6%), RR: 0,418 [IC 95% 0,189 – 0,927], p = 0,028. Conclusão Rede de telemedicina baseada no WhatsApp® associou-se a aumento da porcentagem de pacientes com IAMCSST que receberam terapia de reperfusão e a redução na mortalidade intra-hospitalar.

Abstract Background About 40% of patients with ST-segment elevation myocardial infarction (STEMI) in Brazil do not receive reperfusion therapy. Objective The use of a telemedicine network based on WhatsApp® could increase the percentage of patients receiving reperfusion therapy. Methods A cross-sectional study analyzed outcomes before and after the organization of a telemedicine network to send the electrocardiogram via WhatsApp® of patients suspected of STEMI from 25 municipalities that are members of the Regional Health Department of Ribeirão Preto (DRS−XIII) to a tertiary hospital, which could authorize immediate patient transfer using the same system. The analyzed outcomes included the percentage of patients who received reperfusion therapy and the in-hospital mortality rate. A p value < 0.05 was considered statistically significant. Results The study compared 82 patients before (February 1, 2016 to January 31, 2018) with 196 patients after this network implementation (February 1, 2018 to January 31, 2020). After implementing this network, there was a significant increase in the proportion of patients who received reperfusion therapy (60% vs. 92%), relative risk (RR): 1.594 [95% confidence interval (CI) 1.331 – 1.909], p < 0.0001 and decrease in the in-hospital mortality rate (13.4% vs. 5.6%), RR: 0.418 [95%CI 0.189 – 0.927], p = 0.028. Conclusion The use of WhatsApp®-based telemedicine has led to an increase in the percentage of patients with STEMI who received reperfusion therapy and a decrease in the in-hospital mortality rate.

https://doi.org/10.36660/abc.20201243

Prospective study of ventricular function and myocardial deformation related to survival in acute Chagas disease: an experimental animal model
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Vargas, Arthur Lauand

; Dias, Beatriz de Paula

; Moreira, Henrique Turin

; Oliveira Filho, Edgard Camilo de

; Tanaka, Denise Mayumi

; Simões, Marcus Vinicius

; Maciel, Benedito Carlos

; Schmidt, André

; Marin Neto, José Antônio

; Romano, Minna Moreira Dias

Revista do Instituto de Medicina Tropical de São Paulo

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2021, Volume 63 elocation e61

Abstract: En | Text: En | PDF: En

ABSTRACT Chagas disease (CD) has been changing from an endemic Latino-American disease to a condition found outside endemic regions, due to migratory movements. Although often subclinical, its acute phase can be lethal. This study aimed to assess survival during the acute phase of CD and its relationship with ventricular function in an experimental model. To this end, 30 Syrian hamsters were inoculated with Trypanosoma cruzi (IG) and other 15 animals received saline solution (CG). Groups were monitored daily and submitted to echocardiography in two moments: before the challenge and 15 days post-infection. Left ventricular ejection fraction (LVEF) and global longitudinal myocardial strain (GLS) of the LV were measured. The IG was divided into groups of animals with and without clinical signs of disease. ANOVA for mixed models was used to compare ventricular function parameters. Survival analysis was studied using Kaplan-Meier curves and the log-rank test. The follow-up lasted 60 days. LVEF in IG was reduced through time (53.80 to 43.55%) compared to CG (57.86 to 59.73%) (p=0.002). There was also a reduction of GLS (−18.97% to −12.44%) in the IG compared to CG (p=0.012). Twelve animals from IG died compared to one animal from CG. Eleven out of the 12 animals from the IG group died before presenting with clinical signs of infection. Survival was reduced in the IG compared to CG over time (p=0.02). The reduced survival during the acute phase of this experimental model of Chagas disease was related to the significant reduction of LV function. The mortality rate in the IG was higher in the group presenting with clinical signs of infection.

https://doi.org/10.1590/s1678-9946202163061 5 downloads

Arquivos Brasileiros de Cardiologia (ABC Cardiol) and the new classification Qualis of Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
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Rochitte, Carlos E.

; Quadros, Alexandre Schaan de

; Sousa, Amanda Guerra de Moraes Rego

; Ladeia, Ana Marice Teixeira

; Brandão, Andréa Araujo

; Lorenzo, Andrea De

; Sposito, Andrei

; Ribeiro, Antonio Luiz Pinho

; Mesquita, Claudio Tinoco

; Colombo, Fernanda Marciano Consolim

; Marin-Neto, José Antônio

; Hajjar, Ludhmila Abrahão

; Bertolami, Marcelo

; Stein, Ricardo

; Fuchs, Sandra

; Kaiser, Sergio Emanuel

; Meneghelo, Romeu Sergio

; Oliveira, Gláucia Maria Moraes de

Arquivos Brasileiros de Cardiologia

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sep 2019, Volume 113 N. 3 Pages 333 - 334

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5935/abc.20190206 933 downloads

Influence of Aerobic Training on The Mechanics of Ventricular Contraction After Acute Myocardial Infarction: A Pilot Study
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Santi, Giovani Luiz De

; Moreira, Henrique Turin

; Carvalho, Eduardo Elias Vieira de

; Crescêncio, Júlio César

; Schmidt, André

; Marin-Neto, José Antônio

; Gallo-Júnior, Lourenço

Arquivos Brasileiros de Cardiologia

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apr 2018, Volume 110 N. 4 Pages 383 - 387

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O estudo da contratilidade miocárdica, baseado nos novos conceitos anatômicos que regem a mecânica cardíaca, representa uma estratégia promissora de análise das adaptações do miocárdio relacionadas ao treinamento físico no contexto do pós-infarto. Nós investigamos a influência do treinamento aeróbico na capacidade física e nos parâmetros de avaliação da mecânica de contração do ventrículo esquerdo em pacientes com infarto do miocárdio. Foram prospectivamente investigados 30 pacientes, 55,1 ± 8,9 anos, acometidos por infarto do miocárdio de parede anterior, aleatorizados em três grupos: grupo treinamento intervalado (GTI) (n = 10), grupo treinamento moderado (GTM) (n=10) e grupo controle (GC) (n = 10). Antes e após as 12 semanas de seguimento clínico, os pacientes realizaram teste cardiopulmonar de exercício e ressonância magnética cardíaca. Os grupos treinados realizaram treinamento aeróbico supervisionado, em esteira ergométrica, aplicando-se duas intensidades distintas. Observou-se aumento estatisticamente significante do consumo de oxigênio (VO2) pico no GTI (19,2 ± 5,1 para 21,9 ± 5,6 ml/kg/min, p < 0,01) e no GTM (18,8 ± 3,7 para 21,6 ± 4,5 ml/kg/min, p < 0,01). O GC não apresentou mudança estatisticamente significante no VO2 pico. Houve aumento estatisticamente significante do strain radial (STRAD) somente no GC: STRAD basal (57,4 ± 16,6 para 84,1 ± 30,9%, p < 0,05), STRAD medial (57,8 ± 27,9 para 74,3 ± 36,1%, p < 0,05) e STRAD apical (38,2 ± 26,0 para 52,4 ± 29,8%, p < 0,01). Os grupos treinados não apresentaram mudança estatisticamente significante do strain radial. Os achados do presente estudo apontam para uma potencial aplicação clínica dos parâmetros de análise da mecânica de contração ventricular, notadamente do strain radial, em discriminar adaptações do miocárdio pós-infarto entre pacientes submetidos ou não a programas de treinamento aeróbico.

Abstract The study of myocardial contractility, based on the new anatomical concepts that govern cardiac mechanics, represents a promising strategy of analysis of myocardial adaptations related to physical training in the context of post-infarction. We investigated the influence of aerobic training on physical capacity and on the evaluation parameters of left ventricular contraction mechanics in patients with myocardial infarction. Thirty-one patients (55.1 ± 8.9 years) who had myocardial infarction in the anterior wall were prospectively investigated in three groups: interval training group (ITG) (n = 10), moderate training group (MTG) n = 10) and control group (CG) (n = 10). Before and after 12 weeks of clinical follow-up, patients underwent cardiopulmonary exercise testing and cardiac magnetic resonance imaging. The trained groups performed supervised aerobic training on treadmill, in two different intensities. A statistically significant increase in peak oxygen uptake (VO2) was observed in the ITG (19.2 ± 5.1 at 21.9 ± 5.6 ml/kg/min, p < 0.01) and in the MTG 18.8 ± 3.7 to 21.6 ± 4.5 ml/kg/min, p < 0.01). The GC did not present a statistically significant change in peak VO2. A statistically significant increase in radial strain (STRAD) was observed in the CG: basal STRAD (57.4 ± 16.6 to 84.1 ± 30.9%, p < 0.05), medial STRAD (57.8 ± 27, 9 to 74.3 ± 36.1%, p < 0.05) and apical STRAD (38.2 ± 26.0 to 52.4 ± 29.8%, p < 0.01). The trained groups did not present a statistically significant change of the radial strain. The present study points to a potential clinical application of the parameters of ventricular contraction mechanics analysis, especially radial strain, to discriminate post-infarction myocardial adaptations between patients submitted or not to aerobic training programs.

https://doi.org/10.5935/abc.20180049 2466 downloads

DIRETRIZ DA SOCIEDADE BRASILEIRA DE CARDIOLOGIA E DA SOCIEDADE BRASILEIRA DE HEMODINÂMICA E CARDIOLOGIA INTERVENCIONISTA SOBRE INTERVENÇÃO CORONÁRIA PERCUTÂNEA
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Feres, Fausto

; Costa, Ricardo A.

; Siqueira, Dimytri

; Costa Jr., J. Ribamar

; Chamié, Daniel

; Staico, Rodolfo

; Chaves, Áurea J.

; Abizaid, Alexandre

; Marin-Neto, José Antônio

; Rassi Jr., Anis

; Botelho, Roberto

; Alves, Cláudia Maria Rodrigues

; Saad, Jamil Abdalla

; Mangione, José A.

; Lemos, Pedro A.

; Quadros, Alexandre S.

; Queiroga, Marcelo A. Cartaxo

; Cantarelli, Marcelo J. C.

; Figueira, Hélio Roque

Arquivos Brasileiros de Cardiologia

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jul 2017, Volume 109 N. 1 Pages 1 - 81

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.5935/abc.20170111 64972 downloads

In-Lab Upfront Use of Tirofiban May Reduce the Occurrence of No-Reflow During Primary Percutaneous Coronary Intervention. A Pilot Randomized Study
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Lago, Igor Matos

; Novaes, Gustavo Caires

; Badran, André Vannucchi

; Pavão, Rafael Brolio

; Barbosa, Ricardo

; Figueiredo, Geraldo Luiz de

; Lima Filho, Moysés de Oliveira

; Haddad, Jorge Luiz

; Schmidt, André

; Marin Neto, José Antônio

Arquivos Brasileiros de Cardiologia

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nov 2016, Volume 107 N. 5 Pages 403 - 410

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: Mesmo com abertura da artéria coronária culpada bem sucedida, a reperfusão miocárdica nem sempre sucede a intervenção coronariana percutânea primária (ICPP). Inibidores da glicoproteína IIb/IIIa são usados no tratamento do fenômeno de não reperfusão (NR), mas seu papel para preveni-lo não está comprovado. Objetivo: Avaliar o efeito da administração, em laboratório, de tirofibana sobre a incidência de NR em infarto agudo do miocárdio com supra do segmento ST (IAMCSST) tratado com ICPP. Métodos: Pacientes com IAMCSST tratados com ICPP foram randomizados (24 tirofibana e 34 placebo) neste estudo duplo-cego para avaliar o impacto de tirofibana intravenosa sobre a incidência de NR após ICPP de acordo com métodos angiográficos e eletrocardiográfico. Os desfechos do estudo foram: fluxo epicárdico TIMI (grau), grau de fluxo miocárdico (MBG), resolução da elevação do segmento ST < 70% (RST < 70%) aos 90 minutos e 24 horas após ICPP. Resultados: Características antropométricas, clínicas e angiográficas basais eram equilibradas entre os grupos. A ocorrência de fluxo TIMI < 3 não foi significativamente diferente entre os grupos tirofibana (25%) e placebo (35,3%). MBG ≤ 2 não ocorreu no grupo tirofibana, e foi detectado em 11,7% dos pacientes do grupo placebo (p=0,13). RST < 70% ocorreu em 41,6% x 55,8% (p=0.42) aos 90 minutos, e em 29% x 55,9% (p=0,06) em 24 horas nos grupos tirofibana e placebo, respectivamente. NR grave (RST ≤ 30%) ocorreu em 0% x 26,5% (p=0,01) aos 90 minutos, e em 4,2% x 23,5% (p=0,06) em 24 horas nos grupos tirofibana e placebo, respectivamente. Conclusão: Este estudo piloto mostrou uma tendência de redução de NR associada ao uso, em laboratório, de tirofibana em pacientes com IAMCSST tratados com ICPP, e abre caminho para um estudo em escala real que teste essa hipótese.

Abstract Background: Despite successful opening of culprit coronary artery, myocardial reperfusion does not always follows primary percutaneous coronary intervention (PPCI). Glycoprotein IIb/IIIa inhibitors are used in the treatment of no-reflow (NR), but their role to prevent it is unproven. Objective: To evaluate the effect of in-lab administration of tirofiban on the incidence of NR in ST-elevation myocardial infarction (STEMI) treated with PPCI. Methods: STEMI patients treated with PPCI were randomized (24 tirofiban and 34 placebo) in this double-blinded study to assess the impact of intravenous tirofiban on the incidence of NR after PPCI according to angiographic and electrocardiographic methods. End-points of the study were: TIMI-epicardial flow grade; myocardial blush grade (MBG); resolution of ST-elevation < 70% (RST < 70%) at 90min and 24h after PPCI. Results: Baseline anthropometric, clinical and angiographic characteristics were balanced between the groups. The occurrence of TIMI flow < 3 was not significantly different between the tirofiban (25%) and placebo (35.3%) groups. MBG ≤ 2 did not occur in the tirofiban group, and was seen in 11.7% of patients in the placebo group (p=0.13). RST < 70% occurred in 41.6% x 55.8% (p=0.42) at 90min and in 29% x 55.9% (p=0.06) at 24h in tirofiban and placebo groups, respectively. Severe NR (RST ≤ 30%) was detected in 0% x 26.5% (p=0.01) at 90 min, and in 4.2% x 23.5% (p=0.06) at 24h in tirofiban and placebo groups, respectively. Conclusion: This pilot study showed a trend toward reduction of NR associated with in-lab upfront use of tirofiban in STEMI patients treated with PPCI and paves the way for a full-scale study testing this hypothesis.

https://doi.org/10.5935/abc.20160149 1413 downloads

SBC Guidelines on Unstable Angina and Non-ST-Elevation Myocardial Infarction: Executive Summary
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Feitosa-Filho, Gilson Soares

; Baracioli, Luciano Moreira

; Barbosa, Carlos José Dornas G.

; Franci, André

; Timerman, Ari

; Soares Piegas, Leopoldo

; Marin-Neto, José Antônio

; Nicolau, José Carlos

Arquivos Brasileiros de Cardiologia

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sep 2015, Volume 105 N. 3 Pages 214 - 227

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5935/abc.20150118 15409 downloads

Trombose coronariana como primeira complicação da aíndrome antifosfolípide
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Miranda, Carlos Henrique

; Gali, Luís Gustavo

; Marin-Neto, José Antônio

; Louzada-Júnior, Paulo

; Pazin-Filho, Antônio

Arquivos Brasileiros de Cardiologia

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apr 2012, Volume 98 N. 4 Pages e66 - e69

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

A síndrome do anticorpo antifosfolípide (SAF) é uma trombofilia autoimune, caracterizada pela presença de anticorpos plasmáticos contra fosfolípides, associada a episódios recorrentes de trombose venosa e/ou arterial e morbidade gestacional (especialmente abortamento de repetição). Reportamos o caso de uma paciente feminina, jovem, com diagnóstico de lúpus eritematoso sistêmico (LES), associado à presença de anticorpos antifosfolípide de longa data, com apresentação de infarto agudo do miocárdio (IAM) por trombose proximal da artéria descendente anterior como primeira complicação clínica da SAF.

The antiphospholipid syndrome (APS) is an autoimmune thrombophilia, characterized by the presence of plasma antibodies against phospholipids, associated with recurrent episodes of venous and/or arterial thrombosis and gestational morbidity (especially recurrent miscarriage). We report the case of a young female patient diagnosed with systemic lupus erythematosus (SLE) associated with the presence of antiphospholipid antibodies for a long time, presenting with acute myocardial infarction (AMI) due to proximal thrombosis of the anterior descending artery as the first clinical complication of APS.

El Síndrome del Anticuerpo Antifosfolípido (SAF), es una trombofilia autoinmune, caracterizada por la presencia de anticuerpos plasmáticos contra fosfolípidos, asociada a episodios recurrentes de trombosis venosa y/o arterial y morbilidad gestacional (especialmente aborto de repetición). Reportamos aquí, el caso de una paciente del sexo femenino, joven, con diagnóstico de lupus eritematoso sistémico (LES), asociado a la presencia de anticuerpos antifosfolípido hacía ya mucho tiempo, presentando infarto agudo del miocardio (IAM), por trombosis proximal de la arteria descendente anterior como primera complicación clínica de la SAF.

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Doenças periodontais em pacientes com doença isquêmica coronariana aterosclerótica, em Hospital Universitário
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Barilli, Ana Lúcia Azevedo

; Passos, Afonso Dinis Costa

; Marin-Neto, José Antônio

; Franco, Laércio Joel

Arquivos Brasileiros de Cardiologia

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dec 2006, Volume 87 N. 6 Pages 695 - 700

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Verificar a freqüência das doenças periodontais (DP) em pacientes com cardiopatia isquêmica. As DP representam grave problema de saúde pública odontológica, com distribuições diferenciadas quanto a gravidade, faixa etária, tipo de infecção, comorbidades e fatores de risco. MÉTODOS: Foram examinados 480 pacientes no Ambulatório de Cardiopatia Isquêmica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, e 154 pacientes sem cardiopatia na mesma instituição. Preencheram os critérios de inclusão para a investigação periodontal, respectivamente, 58 e 62 pacientes, de trinta a 79 anos. Foram utilizados o Índice Periodontal Comunitário (IPC) e o Índice de Perda de Inserção Periodontal (PIP), recomendados pela OMS (1999). RESULTADOS: Houve predomínio de sextantes com DP moderada e grave nos pacientes com cardiopatia (76,3% versus 20,2%; p < 0,00001). Nesses pacientes, 1,1% dos sextantes exibiram saúde periodontal, contra 32,0% nos sem cardiopatia (p < 0,00001). No tocante à história pregressa das DP, 6,0% dos sextantes não exibiram perda de inserção entre os pacientes com cardiopatia, contra 68,0% nos sem cardiopatia (p < 0,00001). Observou-se biofilme dental em 100,0% dos pacientes com cardiopatia e em 82,3% dos sem cardiopatia (p < 0,001). Necessitavam de tratamento de bolsas periodontais > 6 mm, 79,3% dos pacientes com cardiopatia contra 9,7% dos sem cardiopatia (p < 0,0001). CONCLUSÃO: As DP mostraram-se muito prevalentes nos grupos estudados, sendo de maior gravidade naquele com cardiopatia isquêmica. A elevada prevalência de fatores de risco encontrada aponta para a necessidade de adoção de estratégias de intervenção.

OBJECTIVE: To verify the prevalence of periodontal disease (PD) in patients with ischemic heart disease. PD is a serious public dental health care problem with a differentiated distribution in regards to severity, age group, type of infection, co-morbidities and risk factors. METHODS: Four hundred and eighty patients were examined at the Ischemic Cardiopathy Outpatient Clinic of the Hospital das Clínicas of the Ribeirão Preto Medical School, São Paulo University, as well as 154 patients without heart disease from the same institution. Fifty-eight patients with heart disease and 62 patients without heart disease between the ages of 30 and 79 met the criteria to be included in the investigation. In accordance with recommendations of WHO (1999) the Community Periodontal Index (CPI) and the Periodontal Attachment Loss Index (PALI) were used. RESULTS: Patients with heart disease had a prevalence of sextants with moderate to advanced PD (76.3% versus 20.2%; p < 0.00001). In these patients, 1.1% of the sextants were found to be healthy versus 32.0% of those without heart disease (p < 0.00001). In regards to the progression of PD, 6.0% of the sextants of the patients with heart disease did not exhibit attachment loss versus 68.0% of those without heart disease (p < 0.00001). Dental biofilm was observed in 100.0% of the patients with heart disease and in 82.3% of those without heart disease (p < 0.001). Treatment of periodontal pockets > 6 mm was required in 79.3% of the patients with heart disease versus 9.7% of those without heart disease (p < 0.0001). CONCLUSION: PD was very prevalent in the groups studied with a higher degree of severity in those with ischemic heart diseases. The elevated prevalence of risk factors found, indicates that intervention strategies are required.

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10.

Revisão das II Diretrizes da Sociedade Brasileira de Cardiologia para o Diagnóstico e Tratamento da Insuficiência Cardíaca
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Guimarães, Jorge Ilha

; Mesquita, Evandro Tinoco

; Bocchi, Edimar Alcides

; Vilas-Boas, Fábio

; Montera, Marcelo Westerlund

; Moreira, Maria da Consolação Vieira

; Batlouni, Michel

; Barretto, Antonio Carlos Pereira

; Drumond Neto, Cantídio

; Mady, Charles

; Albuquerque, Denílson Campos de

; Brindeiro Filho, Djair Falcão

; Braile, Domingo Marcolino

; Albanesi Filho, Francisco Manes

; Feitosa, Gilson Soares

; Dohmann, Hans Fernando Rocha

; Villacorta Júnior, Humberto

; Atié, Jacob

; Marin Neto, José Antônio

; Mateos, José Carlos Pachon

; Bodanese, Luiz Carlos

; Moreira, Maria da Consolação Vieira

; Clausell, Nadine Oliveira

; Brofman, Paulo Roberto Slud

; Rocha, Ricardo Mourilhe

; Rassi, Salvador

; Mathias Júnior, Wilson

Arquivos Brasileiros de Cardiologia

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2002, Volume 79 Suppl. 4 Pages 1 - 30

Abstract: En | Text: En | PDF: En

135409 downloads Cited 6 times in SciELO

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