Won-Jang Kim - Academia.edu (original) (raw)
Papers by Won-Jang Kim
Molecular Medicine Reports, 2016
Small non-coding microRNAs (miRNAs) are not only important for heart and vascular development but... more Small non-coding microRNAs (miRNAs) are not only important for heart and vascular development but are also important in cardiovascular pathophysiology and diseases, such as ischemia and atherosclerosis-related diseases. However, the effect of miR-146a, miR-149, miR-196a2 and miR-499 polymorphisms on coronary artery disease (CAD) susceptibility remain unknown. The aim of the present study was to examine the genotype frequencies of miR-146a, miR-149, miR-196a2 and miR-499 polymorphisms in patients with CAD, and assess their clinical applications for diagnosing and monitoring CAD. Using polymerase chain reaction-amplified DNA, microRNA polymorphisms were analyzed in 522 patients with CAD and 535 control subjects. The miR-149 rs2292832 C>T and miR-196a2 rs11614913 T>C polymorphisms were shown to be significantly associated with CAD prevalence. In subgroup analyses according to disease severity, the miR-146a rs2910164GG genotype was significantly associated with CAD risk in the stent ≥2 group. In addition, miR-146aG/-149T/-196a2C/-499 G allele combination was significantly associated with CAD prevalence (G-T-C-G and G-CC -G of miR-146a/-149/-196a2/-499). The combination genotypes of miR-146aGG/149TC+CC and miR-149CC/196a2TC were significantly associated with CAD incidence. In subgroup analyses, miR-146a rs2910164 C>G increased the risk of developing CAD in non-smoking, hypertensive and nondiabetic subgroups. Furthermore, miR-149 rs2292832 C>T and miR-196a2 rs11614913 T>C was shown to increase CAD risk in females and patients aged >63 years old. The miR-149T allele, miR-196a2C allele and miR-146aG/-149T/-196a2C/-499 G allele combination were associated with CAD pathogenesis. The combined effects of environmental factor and genotype combination of miRNA polymorphisms may contribute to CAD prevalence. miRNA polymorphisms (miR-146a, miR-149, miR-196a2 and miR-499) are associated with the risk of coronary artery disease
JACC: Cardiovascular Interventions, 2012
The American Journal of Cardiology, 2013
The histology evaluation was demonstrated the similar results. At 14 days and 28 days, combo sten... more The histology evaluation was demonstrated the similar results. At 14 days and 28 days, combo stent showed decreased fibrin and inflammation, compared with SES and PFSES. In addition, the combo SES is associated with increased endothelium-dependent relaxation, protected vascular Endothelial Function. Conclusion: The polymer-free sirolimus-eluting stent modified with anti-CD34 antibody demonstrates equivalent early and superior late reduction of intimal proliferation compared with SES in a porcine model. After implantation of combo stent, delayed arterial healing was minimal, and there was no increased inflammation at 28 days compared with SES implantation. The use of combo stents may have a potential short-term benefit over traditional polymeric-coated drugeluting stents.
The American Journal of Cardiology, 2013
The American Journal of Cardiology, 2013
morphological properties of the stenosis and the vasoreactivity of the microvasculature in the su... more morphological properties of the stenosis and the vasoreactivity of the microvasculature in the supplied myocardial territory. The aim of the this study was the analysis of the relation between the measured FFR values and pressure gradients calculated by fluid dynamic equations, based on morphological and contrast flow data obtained from 3D reconstruction of the stenosis. Methods: FFR measurements were performed on 26 coronary artery segments of 22 patients. After 3D reconstruction of the same segments carried out with the IC3D software on the Axiom Artis (Siemens) X-ray machine, the following parameters of the stenosis were determined: the cross-sectional area stenosis (AS), the length of the stenosis (L), the minimum lumen area (MLA), the plaque volume (PV) and the distalis reference area (dRef A). The coronary artery volumetric flow was calculated under vasodilatation, based on the flow velocity, determined using the distance traveled by the contrast material (reconstructed in 3D) per unit time, and the various parameters listed above; then the pressure gradient was determined by the fluid dynamic equations: dPϭ Q(RpϩQRt), where Rpϭ 0.75*L / MLA2 and Rtϭ 3.76* (1/MLA Ϫ 1/dRef A)2, Q(volumetric flow)(ml/s) ϭ flow velocity * dRefA. Results: Regression analysis demonstrated strongly significant relationship between the measured and the calculated FFR (rϭ0.85; pϭ 0.0004. The AS (rϭϪ0.63; pϭ0.005), the PV (rϭϪ0.60; pϭ0,001) and the MLA (rϭ0.50; pϭ0.009) showed weaker relationship with the measured FFR. Conclusions: Although statistical correlation can be demonstrated between the morphological parameters calculated by 3D coronary angiography and the measured FFR values, taking into account the flow data is necessary to facilitate a more precise prediction of FFR.
The American Journal of Cardiology, 2013
This dissertation examines occasional events at the Jacobean court through the literature written... more This dissertation examines occasional events at the Jacobean court through the literature written about them-the largely understudied and yet voluminous occasional works published in inexpensive formats during the first Stuart reign. Through a series of contextualized readings of key occasional events and texts, I argue that these poems and pamphlets not only move beyond the epideictic to engage in key political debates, but also that they present competing visions of the Stuart realm and illustrate the international frame of its court. By examining the relationship between occasional works and the "real" events which they discuss, I show how writers sought to persuade the public to accept their political viewpoints through fictional representations of the Stuarts. More importantly, I demonstrate the need to look beyond representations of the Stuarts sponsored by the Stuarts such as masques to fully understand their iconography. Attending to the contexts which shaped occasional literature and the meaningful ways in which authors yoked descriptions of state events to commentaries on political issues, demands a new history of occasional events at court and a new understanding of the Stuart court as polycentric in nature and international in scope. Scholars have long acknowledged the importance of occasional events at court, but dismissed the printed works published about them as ephemeral propaganda. To understand the court, they turned instead to manuscript correspondence and entertainments such as masques, from which they created an image of the Stuarts as a patriarchal family centered on James. By studying representations of the Stuarts in printed works intended for an audience comprised of more than the royal family, nobles, and courtiers, I seek to show a different vision of the Stuarts, one that is international, multi-centric, popular, and poly-vocal. Each chapter focuses on a major court event and the literary response to it: the 1606 state visit to London of the Danish king Christian IV; the death of Henry, Prince of Wales, in London in 1612; the wedding of Elizabeth, daughter of James VI & I and his consort Anna of Denmark, to Frederick, Count Palatine, in London in 1613; and the funeral of Anna in London in 1618. Offering densely contextualized readings of representative occasional works, I argue that authors used these events to envision idealized relationships between, respectively, Britain and Denmark; Britain and France; Britain and Germany; and, England and Scotland. In each case, they picture one member of the royal family establishing and maintaining these relationships. In other words, they imagined different members of the royal family in critical positions of power, and as mediating, through these events, a wide range of religious and political controversies. By examining representational wars over the images of various members of the Stuarts, I hope to offer a complex portrait of a royal family at the center of international debates. These representations which insist on the multiplicity and internationality of the Stuart courts reveal a complex set of cultural and political exchanges across Europe.
The American Journal of Cardiology, 2013
This thesis is submitted to the Research Board at Blekinge Institute of Technology, in partial fu... more This thesis is submitted to the Research Board at Blekinge Institute of Technology, in partial fulfillment of the requirements for the degree of Licentiate of Engineering.
The American Journal of Cardiology, 2012
The American Journal of Cardiology, 2012
titatively associated with larger reductions over time in polymeric strut echogenicity (yϭϪ0.159x... more titatively associated with larger reductions over time in polymeric strut echogenicity (yϭϪ0.159x-6.85; rϭϪ0.781, pϽ0.001). Scaffolded segments with vasoconstriction to Ach had larger vessel areas (14.37Ϯ2.50mm 2 vs. 11.85Ϯ2.54mm 2 , pϭ0.030), larger plaque burden (57.31Ϯ5.96% vs. 49.09Ϯ9.10%, pϭ0.018) and larger necrotic core areas (1.39 mm 2 [ϩ1.14; ϩ1.74] vs. 0.78 mm 2 [ϩ0.20; ϩ0.98], pϭ0.006) compared to those with vasodilation. Conclusion: Vasodilatory response to Ach, in coronary segments scaffolded by the ABSORB BVS device, is associated with a reduction in echogenicity of the scaffold over time, and a low amount of necrotic core. In particular, the latter finding resembles the behavior of a native coronary artery not caged by an intracoronary device.
The American Journal of Cardiology, 2012
The American Journal of Cardiology, 2012
The American Journal of Cardiology, 2012
The American Journal of Cardiology, 2013
Journal of Cardiovascular Ultrasound, 2008
The American Journal of Cardiology, 2012
High-dose rosuvastatin induces regression of coronary atherosclerosis, but it remains uncertain w... more High-dose rosuvastatin induces regression of coronary atherosclerosis, but it remains uncertain whether usual-dose statin has similar effects. We compared the effects of atorvastatin 20 mg/day versus rosuvastatin 10 mg/day on mild coronary atherosclerotic plaques (20% to 50% luminal narrowing and lesion length >10 mm) using intravascular ultrasound (IVUS). Three hundred fifty statin-naive patients with mild coronary atherosclerotic plaques were randomized to receive atorvastatin 20 mg/day or rosuvastatin 10 mg/day. IVUS examinations were performed at baseline and 6-month follow-up. Primary end point was percent change in total atheroma volume (TAV) defined as (TAV at 6 months ؊ TAV at baseline)/(TAV at baseline) ؋ 100. Evaluable IVUS was obtained for 271 patients (atorvastatin in 143, rosuvastatin in 128). Clinical characteristics, lipid levels, and IVUS measurements at baseline were similar between the 2 groups. At 6-month follow-up, percent change in TAV was significantly less in the atorvastatin group than in the rosuvastatin group (؊3.9 ؎ 11.9% vs ؊7.4 ؎ 10.6%, respectively, p ؍ 0.018). In contrast, change in percent atheroma volume was not different between the 2 groups (؊0.3 ؎ 4.2 vs ؊1.1 ؎ 3.5, respectively, p ؍ 0.157). Compared to baseline, TAV and TAV at the most diseased 10-mm subsegment were significantly decreased in the 2 groups (p <0.001). Changes in lipid profiles at 6-month follow-up were similar between the 2 groups. In conclusion, usual doses of atorvastatin and rosuvastatin induced significant regression of coronary atherosclerosis in statin-naive patients, with a greater decrease in favor of rosuvastatin.
The American Journal of Cardiology, 2013
Circulation: …, 2009
Background-Left ventricular (LV) apical rotation and twist can be estimated noninvasively by spec... more Background-Left ventricular (LV) apical rotation and twist can be estimated noninvasively by speckle-tracking echocardiography (STE). In this study, we tested whether apical rotation is an accurate index of LV contractility. Methods and Results-We measured LV basal and apical rotation by STE in 11 open-chest anesthetized mongrel dogs under 8 different inotropic stages before and after ligation of either left anterior descending (nϭ6) or circumflex coronary artery (nϭ5). We measured LV pressure simultaneously with a high-fidelity pressure catheter and calculated LV ejection fraction (EF) with the biplane Simpson method and 2D echocardiography. Maximal positive dP/dt (dP/dt max) was used as the gold standard measurement of LV contractility. We compared LV twist and apical rotation and EF against dP/dt max by linear mixed model. LV apical rotation and twist showed dose-dependent increases and decreases after dobutamine and esmolol infusion, respectively. However, basal rotation did not change significantly during different inotropic conditions. There was a stronger association between dP/dt max and LV twist (R 2 ϭ0.747, PϽ0.001) and apical rotation (R 2 ϭ0.726, PϽ0.001) than between dP/dt max and EF (R 2 ϭ0.408, PϽ0.001), and this trend was more apparent with coronary ligation irrespective of the ligation site. There was also a high association between dP/dt max and apical rotation alone, both with (R 2 ϭ0.805, PϽ0.001) and without (R 2 ϭ0.748, PϽ0.001) coronary ligation. Apical rotation alone showed comparable accuracy to LV twist. Apical rotational velocity also showed a high association with dP/dt max (R 2 ϭ0.669, PϽ0.001) and LV twist (R 2 ϭ0.892, PϽ0.001). Conclusions-Apical rotation assessed by STE is an effective noninvasive index of global LV contractility and is more closely related to dP/dt max than LV EF.
The American Journal of Cardiology
Background: Differential angiographic outcomes among the current drug-eluting stents (DES) remain... more Background: Differential angiographic outcomes among the current drug-eluting stents (DES) remain uncertain.
The American Journal of Cardiology
The American Journal of Cardiology
Molecular Medicine Reports, 2016
Small non-coding microRNAs (miRNAs) are not only important for heart and vascular development but... more Small non-coding microRNAs (miRNAs) are not only important for heart and vascular development but are also important in cardiovascular pathophysiology and diseases, such as ischemia and atherosclerosis-related diseases. However, the effect of miR-146a, miR-149, miR-196a2 and miR-499 polymorphisms on coronary artery disease (CAD) susceptibility remain unknown. The aim of the present study was to examine the genotype frequencies of miR-146a, miR-149, miR-196a2 and miR-499 polymorphisms in patients with CAD, and assess their clinical applications for diagnosing and monitoring CAD. Using polymerase chain reaction-amplified DNA, microRNA polymorphisms were analyzed in 522 patients with CAD and 535 control subjects. The miR-149 rs2292832 C>T and miR-196a2 rs11614913 T>C polymorphisms were shown to be significantly associated with CAD prevalence. In subgroup analyses according to disease severity, the miR-146a rs2910164GG genotype was significantly associated with CAD risk in the stent ≥2 group. In addition, miR-146aG/-149T/-196a2C/-499 G allele combination was significantly associated with CAD prevalence (G-T-C-G and G-CC -G of miR-146a/-149/-196a2/-499). The combination genotypes of miR-146aGG/149TC+CC and miR-149CC/196a2TC were significantly associated with CAD incidence. In subgroup analyses, miR-146a rs2910164 C>G increased the risk of developing CAD in non-smoking, hypertensive and nondiabetic subgroups. Furthermore, miR-149 rs2292832 C>T and miR-196a2 rs11614913 T>C was shown to increase CAD risk in females and patients aged >63 years old. The miR-149T allele, miR-196a2C allele and miR-146aG/-149T/-196a2C/-499 G allele combination were associated with CAD pathogenesis. The combined effects of environmental factor and genotype combination of miRNA polymorphisms may contribute to CAD prevalence. miRNA polymorphisms (miR-146a, miR-149, miR-196a2 and miR-499) are associated with the risk of coronary artery disease
JACC: Cardiovascular Interventions, 2012
The American Journal of Cardiology, 2013
The histology evaluation was demonstrated the similar results. At 14 days and 28 days, combo sten... more The histology evaluation was demonstrated the similar results. At 14 days and 28 days, combo stent showed decreased fibrin and inflammation, compared with SES and PFSES. In addition, the combo SES is associated with increased endothelium-dependent relaxation, protected vascular Endothelial Function. Conclusion: The polymer-free sirolimus-eluting stent modified with anti-CD34 antibody demonstrates equivalent early and superior late reduction of intimal proliferation compared with SES in a porcine model. After implantation of combo stent, delayed arterial healing was minimal, and there was no increased inflammation at 28 days compared with SES implantation. The use of combo stents may have a potential short-term benefit over traditional polymeric-coated drugeluting stents.
The American Journal of Cardiology, 2013
The American Journal of Cardiology, 2013
morphological properties of the stenosis and the vasoreactivity of the microvasculature in the su... more morphological properties of the stenosis and the vasoreactivity of the microvasculature in the supplied myocardial territory. The aim of the this study was the analysis of the relation between the measured FFR values and pressure gradients calculated by fluid dynamic equations, based on morphological and contrast flow data obtained from 3D reconstruction of the stenosis. Methods: FFR measurements were performed on 26 coronary artery segments of 22 patients. After 3D reconstruction of the same segments carried out with the IC3D software on the Axiom Artis (Siemens) X-ray machine, the following parameters of the stenosis were determined: the cross-sectional area stenosis (AS), the length of the stenosis (L), the minimum lumen area (MLA), the plaque volume (PV) and the distalis reference area (dRef A). The coronary artery volumetric flow was calculated under vasodilatation, based on the flow velocity, determined using the distance traveled by the contrast material (reconstructed in 3D) per unit time, and the various parameters listed above; then the pressure gradient was determined by the fluid dynamic equations: dPϭ Q(RpϩQRt), where Rpϭ 0.75*L / MLA2 and Rtϭ 3.76* (1/MLA Ϫ 1/dRef A)2, Q(volumetric flow)(ml/s) ϭ flow velocity * dRefA. Results: Regression analysis demonstrated strongly significant relationship between the measured and the calculated FFR (rϭ0.85; pϭ 0.0004. The AS (rϭϪ0.63; pϭ0.005), the PV (rϭϪ0.60; pϭ0,001) and the MLA (rϭ0.50; pϭ0.009) showed weaker relationship with the measured FFR. Conclusions: Although statistical correlation can be demonstrated between the morphological parameters calculated by 3D coronary angiography and the measured FFR values, taking into account the flow data is necessary to facilitate a more precise prediction of FFR.
The American Journal of Cardiology, 2013
This dissertation examines occasional events at the Jacobean court through the literature written... more This dissertation examines occasional events at the Jacobean court through the literature written about them-the largely understudied and yet voluminous occasional works published in inexpensive formats during the first Stuart reign. Through a series of contextualized readings of key occasional events and texts, I argue that these poems and pamphlets not only move beyond the epideictic to engage in key political debates, but also that they present competing visions of the Stuart realm and illustrate the international frame of its court. By examining the relationship between occasional works and the "real" events which they discuss, I show how writers sought to persuade the public to accept their political viewpoints through fictional representations of the Stuarts. More importantly, I demonstrate the need to look beyond representations of the Stuarts sponsored by the Stuarts such as masques to fully understand their iconography. Attending to the contexts which shaped occasional literature and the meaningful ways in which authors yoked descriptions of state events to commentaries on political issues, demands a new history of occasional events at court and a new understanding of the Stuart court as polycentric in nature and international in scope. Scholars have long acknowledged the importance of occasional events at court, but dismissed the printed works published about them as ephemeral propaganda. To understand the court, they turned instead to manuscript correspondence and entertainments such as masques, from which they created an image of the Stuarts as a patriarchal family centered on James. By studying representations of the Stuarts in printed works intended for an audience comprised of more than the royal family, nobles, and courtiers, I seek to show a different vision of the Stuarts, one that is international, multi-centric, popular, and poly-vocal. Each chapter focuses on a major court event and the literary response to it: the 1606 state visit to London of the Danish king Christian IV; the death of Henry, Prince of Wales, in London in 1612; the wedding of Elizabeth, daughter of James VI & I and his consort Anna of Denmark, to Frederick, Count Palatine, in London in 1613; and the funeral of Anna in London in 1618. Offering densely contextualized readings of representative occasional works, I argue that authors used these events to envision idealized relationships between, respectively, Britain and Denmark; Britain and France; Britain and Germany; and, England and Scotland. In each case, they picture one member of the royal family establishing and maintaining these relationships. In other words, they imagined different members of the royal family in critical positions of power, and as mediating, through these events, a wide range of religious and political controversies. By examining representational wars over the images of various members of the Stuarts, I hope to offer a complex portrait of a royal family at the center of international debates. These representations which insist on the multiplicity and internationality of the Stuart courts reveal a complex set of cultural and political exchanges across Europe.
The American Journal of Cardiology, 2013
This thesis is submitted to the Research Board at Blekinge Institute of Technology, in partial fu... more This thesis is submitted to the Research Board at Blekinge Institute of Technology, in partial fulfillment of the requirements for the degree of Licentiate of Engineering.
The American Journal of Cardiology, 2012
The American Journal of Cardiology, 2012
titatively associated with larger reductions over time in polymeric strut echogenicity (yϭϪ0.159x... more titatively associated with larger reductions over time in polymeric strut echogenicity (yϭϪ0.159x-6.85; rϭϪ0.781, pϽ0.001). Scaffolded segments with vasoconstriction to Ach had larger vessel areas (14.37Ϯ2.50mm 2 vs. 11.85Ϯ2.54mm 2 , pϭ0.030), larger plaque burden (57.31Ϯ5.96% vs. 49.09Ϯ9.10%, pϭ0.018) and larger necrotic core areas (1.39 mm 2 [ϩ1.14; ϩ1.74] vs. 0.78 mm 2 [ϩ0.20; ϩ0.98], pϭ0.006) compared to those with vasodilation. Conclusion: Vasodilatory response to Ach, in coronary segments scaffolded by the ABSORB BVS device, is associated with a reduction in echogenicity of the scaffold over time, and a low amount of necrotic core. In particular, the latter finding resembles the behavior of a native coronary artery not caged by an intracoronary device.
The American Journal of Cardiology, 2012
The American Journal of Cardiology, 2012
The American Journal of Cardiology, 2012
The American Journal of Cardiology, 2013
Journal of Cardiovascular Ultrasound, 2008
The American Journal of Cardiology, 2012
High-dose rosuvastatin induces regression of coronary atherosclerosis, but it remains uncertain w... more High-dose rosuvastatin induces regression of coronary atherosclerosis, but it remains uncertain whether usual-dose statin has similar effects. We compared the effects of atorvastatin 20 mg/day versus rosuvastatin 10 mg/day on mild coronary atherosclerotic plaques (20% to 50% luminal narrowing and lesion length >10 mm) using intravascular ultrasound (IVUS). Three hundred fifty statin-naive patients with mild coronary atherosclerotic plaques were randomized to receive atorvastatin 20 mg/day or rosuvastatin 10 mg/day. IVUS examinations were performed at baseline and 6-month follow-up. Primary end point was percent change in total atheroma volume (TAV) defined as (TAV at 6 months ؊ TAV at baseline)/(TAV at baseline) ؋ 100. Evaluable IVUS was obtained for 271 patients (atorvastatin in 143, rosuvastatin in 128). Clinical characteristics, lipid levels, and IVUS measurements at baseline were similar between the 2 groups. At 6-month follow-up, percent change in TAV was significantly less in the atorvastatin group than in the rosuvastatin group (؊3.9 ؎ 11.9% vs ؊7.4 ؎ 10.6%, respectively, p ؍ 0.018). In contrast, change in percent atheroma volume was not different between the 2 groups (؊0.3 ؎ 4.2 vs ؊1.1 ؎ 3.5, respectively, p ؍ 0.157). Compared to baseline, TAV and TAV at the most diseased 10-mm subsegment were significantly decreased in the 2 groups (p <0.001). Changes in lipid profiles at 6-month follow-up were similar between the 2 groups. In conclusion, usual doses of atorvastatin and rosuvastatin induced significant regression of coronary atherosclerosis in statin-naive patients, with a greater decrease in favor of rosuvastatin.
The American Journal of Cardiology, 2013
Circulation: …, 2009
Background-Left ventricular (LV) apical rotation and twist can be estimated noninvasively by spec... more Background-Left ventricular (LV) apical rotation and twist can be estimated noninvasively by speckle-tracking echocardiography (STE). In this study, we tested whether apical rotation is an accurate index of LV contractility. Methods and Results-We measured LV basal and apical rotation by STE in 11 open-chest anesthetized mongrel dogs under 8 different inotropic stages before and after ligation of either left anterior descending (nϭ6) or circumflex coronary artery (nϭ5). We measured LV pressure simultaneously with a high-fidelity pressure catheter and calculated LV ejection fraction (EF) with the biplane Simpson method and 2D echocardiography. Maximal positive dP/dt (dP/dt max) was used as the gold standard measurement of LV contractility. We compared LV twist and apical rotation and EF against dP/dt max by linear mixed model. LV apical rotation and twist showed dose-dependent increases and decreases after dobutamine and esmolol infusion, respectively. However, basal rotation did not change significantly during different inotropic conditions. There was a stronger association between dP/dt max and LV twist (R 2 ϭ0.747, PϽ0.001) and apical rotation (R 2 ϭ0.726, PϽ0.001) than between dP/dt max and EF (R 2 ϭ0.408, PϽ0.001), and this trend was more apparent with coronary ligation irrespective of the ligation site. There was also a high association between dP/dt max and apical rotation alone, both with (R 2 ϭ0.805, PϽ0.001) and without (R 2 ϭ0.748, PϽ0.001) coronary ligation. Apical rotation alone showed comparable accuracy to LV twist. Apical rotational velocity also showed a high association with dP/dt max (R 2 ϭ0.669, PϽ0.001) and LV twist (R 2 ϭ0.892, PϽ0.001). Conclusions-Apical rotation assessed by STE is an effective noninvasive index of global LV contractility and is more closely related to dP/dt max than LV EF.
The American Journal of Cardiology
Background: Differential angiographic outcomes among the current drug-eluting stents (DES) remain... more Background: Differential angiographic outcomes among the current drug-eluting stents (DES) remain uncertain.
The American Journal of Cardiology
The American Journal of Cardiology