AUCTORES
Globalize your Research
Chat with us
Research Article | DOI: https://doi.org/10.31579/2641-0419/397
1Department of cardiac rehabilitation, Ibra Mamadou Wane Medical Center, Dakar, Senegal
2Department of cardiology, Dalal Jam Hospital, Guediawaye, Dakar, Senegal.
3Department of cardiology, Idrissa Pouye General Hospital, Dakar, Senegal.
4School of Medicine, Cheikh Anta Diop University, Dakar, Senegal.
*Corresponding Author: Ngone Diaba Gaye, Department of cardiac rehabilitation, Ibra Mamadou Wane Medical center
Citation: Ngoné D. Gaye, Aliou A. Ngaidé, Joseph Mingou, Fatou Aw, Mame Madjiguène KA, et.al, (2024), Effects of exercise-based cardiac rehabilitation on left ventricular systolic and diastolic function in sub-Saharan African Patients, J Clinical Cardiology and Cardiovascular Interventions, 7(9); DOI: 10.31579/2641-0419/397
Copyright: © 2024, Ngoné Diaba Gaye. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 02 July 2024 | Accepted: 19 July 2024 | Published: 15 August 2024
Keywords: cardiac rehabilitation; sub-saharan Africa; left ventricular systolic function; left ventricular diastolic function; coronary artery disease; chronic heart failure
Background: Cardiac rehabilitation (CR) represents a highly efficacious non-pharmacological intervention for cardiac patients. Yet, its effect on left ventricular systolic function remains controversial and there is a lack of data in sub-Saharan African patients. The aim of this study was to assess effects of exercise based cardiac rehabilitation on left ventricular systolic and diastolic function after cardiac rehabilitation in a black African population.
Results: A total of 103 patients with a male-to-female ratio of 1.64. The mean age was 56,37 yo ± 11,59. Most of the patients (83.5%) presented with dyspnea stage 2 to 3 of classification. Sedentary lifestyle and dyslipidemia were the predominant cardiovascular risk factors, in 90% and 76% of cases respectively. Coronary artery disease was the primary indication, accounting for 74.8% of cases. After cardiac rehabilitation improvement in both left ventricular ejection fraction [+ 17%, P 0.000] and stroke volume [+ 13.5 ml, P 0.00]. This improvement was particularly significant among patients with a left ventricular ejection fraction (LVEF) < 40%. Mean E/e’ ratio decreased significantly upon completion of cardiac rehabilitation [-2.91 pts, P 0.000]. Furthermore, 37.9% of patients had elevated left ventricular filling before CR against 5.9 % after CR (P 0.000).
Conclusion: Cardiac rehabilitation results in significant improvement in both systolic and diastolic left ventricular function in our population subset.
6MWTD 6 minutes walk test distance
ASE American Society of Echocardiography
CAD Coronary Artery Disease
CR Cardiac Rehabilitation
CVDs Cardiovascular diseases
DALY Disability-adjusted life year
HR Heart Rate
IVSd Interventricular Septum Thickness
LAA Left Atrial Area
LV Left Ventricle
LVEDd Left Ventricle End-Diastolic Diameter
LVEF Left Ventricular Ejection Fraction
NCDs non-communicable diseases
NYHA New York Heart Association
PASP Pulmonary Arterial Systolic Pressure
PWT Posterior Wall Thickness
RAA Right Atrial Area
RV Right Ventricule
RVEDd Right Ventricular End-Diastolic Diameter
SAT Systolic Annular Tissue Velocity
TAPSE Tricuspid Annular Plane Systolic Excursion
THR Training Heart Rate
Cardiovascular diseases (CVDs) are one of the leading causes of non-communicable disease (NCDs) deaths globally and in sub-Saharan Africa[1]. The burden of NCDs, including CVDs, has been on the rise in the region over the past two decades due to various risk factors like unhealthy diets, physical inactivity, hypertension, and obesity[1,2]. Ischemic heart disease is the leading cause of cardiovascular disease burden among males in Sub-Saharan Africa, resulting in 4,857,246.3 DALYs in 2017[2]. Cardiovascular disease burden, driven by increasing risk factors such as smoking and unhealthy diets, is likely to increase and pose challenges to health systems in Sub-Saharan Africa[3–6]. Limited access to healthcare services, delayed presentation, and inadequate management contribute to the high morbidity and mortality associated with CVDs in sub-Saharan Africa. Addressing the CVDs burden in this region requires a multifaceted approach, including strengthening primary and secondary prevention strategies, improving access to diagnosis and treatment, and implementing effective rehabilitation programs tailored to the local context. Cardiac rehabilitation is a multidisciplinary intervention that has been shown to improve clinical outcomes and quality of life in patients with various cardiovascular conditions, including heart failure[7–10]. Despite its proven efficacy, cardiac rehabilitation programs have been relatively delayed in our region, particularly in Senegal. Improving access to evidence-based interventions, such as cardiac rehabilitation, is crucial to mitigating the growing burden of CVDs in the region[11,12]. One of the primary objectives of cardiac rehabilitation is to enhance functional abilities, as measured by the amount of energy expended when carrying out different physical tasks. This goal is associated with recognizing that physical capacity is now acknowledged as the most influential independent predictor of longevity[13]. Overall, studies show significant improvement in physical capacity and diastolic function indices after participation in a cardiac rehabilitation program[14–16]. Yet, the effects of exercise-based cardiac rehabilitation on left ventricular systolic function remain truly controversial[17–23]. Furthermore, there is little to no evidence in the black African population. Therefore, we aimed to evaluate the effects of CR on left ventricular systolic and diastolic function in a sub-Saharan African population. A secondary objective was to assess the improvement of right ventricular systolic function after completion of CR program.
Study Design and Period
This study employed a descriptive and analytical cross-sectional design, incorporating both retrospective and prospective data collection methods. Data collection took place between February 1, 2021, and June 30, 2023, at the cardiovascular rehabilitation department of Idrissa POUYE General Hospital.
The study cohort consisted of patients aged 18 years and older, referred to the cardiovascular rehabilitation department of Idrissa Pouye general hospital of Dakar. We included all patients who had undergone at least 10 sessions of exercise training and have had an echocardiogram both before and after cardiac rehabilitation.
Excluded from our study were:
•All patients who expressed a refusal to participate.
•All patients who were irregularly monitored, meaning those who missed at least 3 consecutive training sessions.
•All patients who refused consent after receiving appropriate and thorough information.
•All patients whose initial records were either unavailable or incomplete.
Data Collection
All patients referred for cardiac rehabilitation underwent a comprehensive initial evaluation, which included: a thorough medical history, clinical examination, laboratory tests, assessment of cardiovascular risk factors, electrocardiogram, transthoracic echocardiography, exercise stress testing, and a 6-minute walk test. This initial evaluation allowed for risk stratification of the patient and adaptation of the modalities and monitoring of cardiac rehabilitation.
All echocardiographic examinations were performed using Vivid 8 echocardiography machines from GE Healthcare, equipped with an adult cardiac probe ranging from 2 to 5 MHz. The operator was a cardiologist with at least 4 years of experience in echocardiography.
Exercise stress testing was conducted on a treadmill or a GE Healthcare cycle ergometer, following the modified BRUCE protocol or the protocol for elderly subjects with significant physical deconditioning. The exercise tests determined the level of retraining, initial workload, resting heart rate (HR), maximal exercise heart rate (HR max), and calculated the training heart rate (THR) using the Karvonen formula[24].
THR = Resting HR + K (HR max - Resting HR).
K = 0.6 if the patient is not on beta-blockers, K = 0.8 if the patient is on beta-blockers.
The training protocol involved three sessions per week, each session comprising endurance training lasting 30 to 45 minutes, preceded by a warm-up phase of 3 to 5 minutes and followed by a 3 to 5-minute recovery phase. Additionally, patients engaged in 30 to 45 minutes of gymnastics.
During their stay in the cardiovascular rehabilitation unit, all patients were offered participation in an educational program (group sessions, sometimes individual) regarding their disease and treatment, dietary counseling aimed at lifestyle modifications to control cardiovascular risk factors, physical activity guidance, assistance with smoking cessation, and support for potential return to work.
At the end of the program, post-rehabilitation exercise stress testing, the 6-minute walk test, and echocardiography were performed.
Study Parameters
Statistical Analysis
Data analysis was performed using SPSS (Statistical Package for Social Sciences) version 24.0. In the case of quantitative observations, baseline characteristics were presented as mean standard deviation (SD) for parameters with normal distribution. Median interquartile range was used for parameters showing no normal distribution. Pearson's Chi-square test or Fisher's bilateral exact test were employed to compare frequencies upon applicability. Mean comparisons were executed using the analysis of variance test, with a significance threshold set at p < 0>.
Data analysis was performed using SPSS (Statistical Package for Social Sciences) version 24.0. In the case of quantitative observations, baseline characteristics were presented as mean standard deviation (SD) for parameters with normal distribution. Median interquartile range was used for parameters showing no normal distribution. Pearson's Chi-square test or Fisher's bilateral exact test were employed to compare frequencies upon applicability. Mean comparisons were executed using the analysis of variance test, with a significance threshold set at p < 0>
A total of 103 patients predominantly males (62.2%) were included in the present study. The mean age was 56,37±11,59 years old. 83.5% of the patients presented with dyspnea stage 2 to 3 of NYHA classification. Sedentary lifestyle and dyslipidemia were the predominant cardiovascular risk factors, in 90% and 76% of cases respectively. Coronary artery disease (CAD) was the primary indication, accounting for 74.8% of cases. Demographic characteristics of our population at baseline are summarized in table 1. Overall, CR had a positive impact on weight, waist circumference and LDLc reduction (Table 2). The mean pre-CR LVEDd was 51.9 mm ± 8.1 compared to 50.3 mm ± 4.5 after CR, a significant decrease of -1.57 mm (P 0.043). Greater decrease in LVEDd was found in male subjects (P 0.049), non-sedentary subjects (P 0.043), patients with dilated cardiomyopathy (P 0.00) and those who had more than 15 training sessions (P 0.04).
Table 1: Patient’s demographics at baseline
Table 2: Evolution of clinical and biological parameters
Moreover, cardiac rehabilitation yields a significant increase in stroke ejection volume. Likewise, left ventricular systolic function also improved following cardiovascular rehabilitation, with the mean LVEF increasing from 43.8% ± 10.88 before cardiac rehabilitation to 51.90% ± 11.03, demonstrating a significant gain of 17% (P 0.00). This improvement in LVEF was more significant among patients with dilated cardiomyopathy [+10.6 pts, p=0.003], in age < 50>
Similarly, the assessment of diastolic function before and after cardiac rehabilitation revealed significant improvement in the diastolic function of the left ventricle. Prior to cardiac rehabilitation, 37.9% of patients exhibited elevated filling pressures, compared to 5.9
In this Senegalese cohort of 103 patients with CAD being the most frequent indication, cardiac rehabilitation program improved significantly left ventricular systolic and diastolic function. Furthermore, post-CR peak exercise capacity was improved in our patients. Additionally, LVEDd was significantly decreased after CR in our study, showing that exercise had no adverse effects on cardiac remodeling in our patients.
The improvement of LVEF and stroke volume after CR found in the present study is consistent with recent literature[16,17,29,30]. Sadhegi and al. found a significant increase in LVEF in Iranian patients after CR (45.14 % ± 5.77 versus 50.44% ± 8.70; P <0>
and clotting factors, and development of coronary collateral vessels after regular exercise[31,32]. Also, CR is a comprehensive multidisciplinary program that includes drug optimization, dietary counselling, risk factors control and smoking cessation. These components may also play a part on improvement of left ventricular systolic function after CR.
E/e’ ratio, a left diastolic function indice, was also improved by CR in our patients. This finding has been also reported in previous studies, especially in heart failure patients [33,34]. E/e’ ratio is considered to be more sensitive and accurate than the E/A ratio for the measurement of ventricular relaxation and diastolic dysfunction. However, it is important to note that diastolic function should not be evaluated on one single diastolic index. We did not report changes in diastolic dysfunction grading or left atrial volume index (LAVI), which may limit the extent of our findings.
We found that the right ventricular systolic function was also substantially improved after CR. Prognostic value of the RV function in coronary artery disease, particularly following reduction in exercise tolerance is well established [35]. Indeed, increased risk of death, arrhythmia, and shock has been demonstrated in patients with RV myocardial dysfunction[35]. Baker et al.[36] and Di Salvo [37] found a strong link between RV function and exercise capacity and suggested that exercise capacity could be the primary indicator of mortality. They also noted that exercise capacity seemed to have a stronger connection to RV function than LV function. These results emphasize the complex nature of changes in RV function during exercise regimens, particularly in cardiac rehabilitation programs.
The present study took place in Senegal a sub-Saharan African country, giving valuable insights on an understudied population in CR field. However, our study has some limitations. We are unable to gauge the precise impact of CR on our patients compared to standard medical treatment due to the absence of a control group. Additionally, the lack of follow-up hinders our ability to assess the long-term outcomes of CR in our patients. Thus, it is essential to conduct controlled studies with follow-ups in the Senegalese population to ascertain the specific impact of the CR program on ventricular function in our patients.
The present study demonstrates that exercise-based cardiac rehabilitation leads to significant improvements in both systolic and diastolic left ventricular function in a Sub-Saharan African population. Despite its limitations, these findings underscore the importance of cardiac rehabilitation as a valuable intervention for improving outcomes of CVD’s patients in SSA. Further research with larger sample sizes and longer follow-up periods is necessary to confirm our findings and investigate the long-term impact of cardiac rehabilitation on clinical outcomes in this population.
Ethics approval and consent to participate Written informed consent for participation was obtained from the patients following a thorough explanation of the study
Not applicable
The data that support the findings of this study are available from Pr Aliou Alassane Ngaide but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Pr Aliou Alassane Ngaide.
The authors declare that they have no competing interests
The study had no sponsorship.
NDG and AAN are expected to have made substantial contributions to the conception and design of the work; SIK are expected to have made substantial contributions to the acquisition and analysis, SIK, AAN and NDG are expected to have made substantial contributions to the interpretation of data; NDG have drafted the work and substantively revised it. All authors read and approved the final manuscript.
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!”
