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Ретроспективное исследование результатов внутривенного использования железа карбоксимальтозата в короткие сроки перед кардиохирургическими вмешательствами
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
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Stepin AV. A retrospective study of the results of intravenous use of iron carboxymaltosate in a short period of time before cardiac surgery. Consilium Medicum. 2025;27(1):26–31. DOI: 10.26442/20751753.2025.1.203186
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Материалы и методы. B ретроспективное исследование включены данные историй болезни 113 пациентов с дефицитом железа, которым проведено кардиохирургическое вмешательство. Всех пациентов разделили на две группы в зависимости от наличия (n=60) или отсутствия (n=53) анемии в предоперационном периоде. Рассмотрено влияние инфузии ЖКМ на уровень гемоглобина (Hb), ферритина, потребность в переливании эритроцитсодержащих компонентов крови, продолжительность послеоперационного периода, летальность и осложнения.
Результаты. После инфузии ЖКМ в группе 1 отмечено увеличение уровня ферритина в среднем до 536,3±150,4 нг/мл, в группе 2 – до 640,6±231,5 нг/мл (р=0,7). Увеличение уровня Hb после инфузии ЖКМ в группе 1 составило в среднем 5,1±3,2 г/л, в группе 2 – 3,5±5,0 г/л (р=0,0428). В послеоперационном периоде пациентам группы 1 перелито в среднем 0,08±0,3 дозы эритроцитсодержащих компонентов против 0,1±0,5 дозы в группе 2 (р=0,97). Летальных исходов не зафиксировано. Продолжительность лечения в отделении реанимации и общая продолжительность послеоперационного периода в обеих группах достоверно не отличались. Хирургические кровотечения зафиксированы у 3 (5%) пациентов в группе 1 и у 2 (3,7%) человек в группе 2 (р=0,372). Инфекционные осложнения выявлены у 1 пациента в каждой группе (p=0,93).
Заключение. Использование однократной инфузии ЖКМ в короткие сроки перед кардиохирургическими вмешательствами позволяет эффективно восстанавливать концентрацию ферритина и увеличивать уровень Hb у кардиохирургических пациентов с анемией и без нее, не влияя на риск развития инфекционных осложнений и летального исхода.
Ключевые слова: дефицит железа, кардиохирургия, железа карбоксимальтозат, железодефицитная анемия, гемотрансфузии
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Aim. To evaluate the results of intravenous use of iron carboxymaltosate in the short term before cardiac surgery in patients with iron deficiency.
Materials and methods. The retrospective study included data from the medical records of 113 patients with iron deficiency who underwent cardiac surgery. All patients were divided into two groups depending on the presence (60 people) or absence (53 people) of anemia in the preoperative period. The effect of iron carboxymaltosate infusion on the level of hemoglobin (Hb), ferritin, the need for transfusion of erythrocyte-containing blood components, the duration of the postoperative period, mortality and complications was analyzed.
Results. After iron carboxymaltosate infusion, an increase in ferritin levels was noted in group 1 to an average of 536.3±150.4 ng/ml, in group 2 – 640.6±231.5 ng/ml (p=0.7). The increase in Hb levels after iron carboxymaltosate infusion in group 1 averaged 5.1±3.2 g/l, in group 2 – 3.5±5.0g/l (p=0.0428). In the postoperative period group 1 patients received an average of 0.08±0.3 doses of erythrocyte-containing blood components versus 0.1±0.5 doses in group 2 (p=0.97). No deaths were recorded. The duration of treatment in the intensive care unit and the total duration of the postoperative period in both groups did not significantly differ. Surgical bleeding was recorded in 3 patients (5%) of group 1 and 2 patients (3.7%) of group 2 (p=0.372). Infectious complications were detected in 1 patient in each group (p=0.93).
Conclusion. The use of a single infusion of iron carboxymaltosate in a short time before cardiac surgery makes it possible to effectively restore ferritin concentration and increase Hb levels in cardiac surgery patients with and without anemia, without affecting the risk of infectious complications and death.
Keywords: iron deficiency, cardiac surgery, iron carboxymaltosate, iron deficiency anemia, blood transfusion
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6. Richards T, Breymann C, Brookes MJ, et al. Questions and answers on iron deficiency treatment selection and the use of intravenous iron in routine clinical practice. Ann Med. 2021;53(1):274-85. DOI:10.1080/07853890.2020.1867323
7. Gupta S, Panchal P, Gilotra K, et al. Intravenous iron therapy for patients with preoperative iron deficiency or anaemia undergoing cardiac surgery reduces blood transfusions: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2020;31(2):141-51. DOI:10.1093/icvts/ivaa094
8. Muñoz M, Acheson AG, Auerbach M, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 2017;72(2):233-47. DOI:10.1111/anae.13773
9. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. DOI:10.1093/eurheartj/ehab368
10. Nugara C, Vitale G, Caccamo G, et al. Effect of intravenous iron replacement therapy on exercise capacity in iron deficient anemic patients after cardiac surgery. Monaldi Arch Chest Dis. 2020;90(1). DOI:10.4081/monaldi.2020.1196
11. Gurusamy KS, Nagendran M, Broadhurst JF, et al. Iron therapy in anaemic adults without chronic kidney disease. Cochrane Database Syst Rev. 2014;2014(12):CD010640. DOI:10.1002/14651858.CD010640.pub2
12. Xu H, Duan Y, Yuan X, et al. Intravenous Iron Versus Placebo in the Management of Postoperative Functional Iron Deficiency Anemia in Patients Undergoing Cardiac Valvular Surgery: A Prospective, Single-Blinded, Randomized Controlled Trial. J Cardiothorac Vasc Anesth. 2019;33(11):2941-98. DOI:10.1053/j.jvca.2019.01.063
13. Steinbicker AU. Role of anesthesiologists in managing perioperative anemia. Curr Opin Anaesthesiol. 2019;32(1):64-71. DOI:10.1097/ACO.0000000000000671
14. Spahn DR, Schoenrath F, Spahn GH, et al. Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery: a prospective randomised trial. Lancet. 2019;393(10187):2201-22. DOI:10.1016/S0140-6736(18)32555-8
15. Ponikowski P, Kirwan BA, Anker SD, et al. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet. 2020;396(10266):1895-904. DOI:10.1016/S0140-6736(20)32339-4
16. Venturini E, Iannuzzo G, DI Lorenzo A, et al. Short-term treatment of iron deficiency anemia after cardiac surgery. Int J Cardiol Heart Vasc. 2022;40:101038. DOI:10.1016/j.ijcha.2022.101038
17. Lyseng-Williamson KA, Keating GM. Ferric carboxymaltose: a review of its use in iron-deficiency anaemia. Drugs. 2009;69(6):739-56. DOI:10.2165/00003495-200969060-00007
18. Brautaset Englund KV, Østby CM, Rolid K, et al. Intravenous iron supplement for iron deficiency in cardiac transplant recipients (IronIC): A randomized clinical trial. J Heart Lung Transplant. 2021;40(5):359-67. DOI:10.1016/j.healun.2021.01.1390
19. Dhir A, Tempe DK. Anemia and Patient Blood Management in Cardiac Surgery-Literature Review and Current Evidence. J Cardiothorac Vasc Anesth. 2018;32(6):2726-72. DOI:10.1053/j.jvca.2017.11.043
20. Patel NN, Avlonitis VS, Jones HE, et al. Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis. Lancet Haematol. 2015;2(12):e543-53. DOI:10.1016/S2352-3026(15)00198-2
21. Carson JL, Stanworth SJ, Dennis JA, et al. Transfusion thresholds for guiding red blood cell transfusion. Cochrane Database Syst Rev. 2021;12(12):CD002042. DOI:10.1002/14651858.CD002042.pub5
22. Litton E, Xiao J, Ho KM. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ. 2013;347:f4822. DOI:10.1136/bmj.f4822
23. Ionescu A, Sharma A, Kundnani NR, et al. Intravenous iron infusion as an alternative to minimize blood transfusion in peri-operative patients. Sci Rep. 2020;10(1):18403. DOI:10.1038/s41598-020-75535-2
24. Elhenawy AM, Meyer SR, Bagshaw SM, et al. Role of preoperative intravenous iron therapy to correct anemia before major surgery: a systematic review and meta-analysis. Syst Rev. 2021;10(1):36. DOI:10.1186/s13643-021-01579-8
25. Tankard KA, Park B, Brovman EY, et al. The Impact of Preoperative Intravenous Iron Therapy on Perioperative Outcomes in Cardiac Surgery: A Systematic Review. J Hematol. 2020;9(4):97-108. DOI:10.14740/jh696
26. Quarterman C, Shaw M, Hughes S, et al. Anaemia in cardiac surgery – a retrospective review of a centre's experience with a pre-operative intravenous iron clinic. Anaesthesia. 2021;76(5):629-38. DOI:10.1111/anae.15271
27. Myles PS, Richards T, Klein A. Preoperative intravenous iron for cardiac surgery. Lancet. 2020;396(10266):1883-4. DOI:10.1016/S0140-6736(20)32406-5
28. Muñoz M, Gómez-Ramírez S, Rondinelli MB, Weltert L. Preoperative intravenous iron for cardiac surgery. Lancet. 2020;396(10266):1884. DOI:10.1016/S0140-6736(20)32407-7
29. Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA), Boer C, Meesters MI, et al. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2018;32(1):88-120. DOI:10.1053/j.jvca.2017.06.026
30. Cladellas M, Farré N, Comín-Colet J, et al. Effects of preoperative intravenous erythropoietin plus iron on outcome in anemic patients after cardiac valve replacement. Am J Cardiol. 2012;110(7):1021-6. DOI:10.1016/j.amjcard.2012.05.036
31. Garrido-Martín P, Nassar-Mansur MI, de la Llana-Ducrós R, et al. The effect of intravenous and oral iron administration on perioperative anaemia and transfusion requirements in patients undergoing elective cardiac surgery: a randomized clinical trial. Interact Cardiovasc Thorac Surg. 2012;15(6):1013-8. DOI:10.1093/icvts/ivs344
32. Evans CR, Jones R, Phillips G, et al. Observational study of pre-operative intravenous iron given to anaemic patients before elective cardiac surgery. Anaesthesia. 2021;76(5):639-46. DOI:10.1111/anae.15396
33. Johansson PI, Rasmussen AS, Thomsen LL. Intravenous iron isomaltoside 1000 (Monofer®) reduces postoperative anaemia in preoperatively non-anaemic patients undergoing elective or subacute coronary artery bypass graft, valve replacement or a combination thereof: a randomized double-blind placebo-controlled clinical trial (the PROTECT trial). Vox Sang. 2015;109(3):257-66. DOI:10.1111/vox.12278
34. Klein AA, Chau M, Yeates JA, et al. Preoperative intravenous iron before cardiac surgery: a prospective multicentre feasibility study. Br J Anaesth. 2020;124(3):243-50. DOI:10.1016/j.bja.2019.11.023
35. Padmanabhan H, Siau K, Nevill AM, et al. Intravenous iron does not effectively correct preoperative anaemia in cardiac surgery: a pilot randomized controlled trial. Interactive CardioVascular and Thoracic Surgery. 2018;28(3):447-54. DOI:10.1093/icvts/ivy226
36. Ranucci M, Pavesi M, Pistuddi V, Baryshnikova E. Preoperative Anemia Correction in Cardiac Surgery: A Propensity-Matched Study. J Cardiothorac Vasc Anesth. 2021;35(3):874-81. DOI:10.1053/j.jvca.2020.07.015
37. Peters F, Eveslage M, Gallitz I, et al. Post-Operative Iron Carboxymaltose May Have an Effect on Haemoglobin Levels in Cardiothoracic Surgical Patients on the ICU – an Observational Pilot Study about Anaemia Treatment with Intravenous Iron. Transfus Med Hemother. 2018;45(1):42-6. DOI:10.1159/000481143
38. Muñoz M, Gómez-Ramírez S, Besser M, et al. Current misconceptions in diagnosis and management of iron deficiency. Blood Transfus. 2017;15(5):422-37. DOI:10.2450/2017.0113-17
39. Banerjee S, McCormack S. Intravenous Iron Preparations for Patients Undergoing Elective Surgery: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health, 2019.
40. Auerbach M, Macdougall I. The available intravenous iron formulations: History, efficacy, and toxicology. Hemodial Int. 2017;21(Suppl. 1):S83-92. DOI:10.1111/hdi.12560
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1. Garganeeva AA, Tukish OV, Kuzheleva EA, et al. Iron deficiency in cardiac surgery patients and the possibility of its correction at the preoperative stage. Kardiologiia. 2023;63(7):68-76 (in Russian). DOI:10.18087/cardio.2023.7.n2471
2. Clevenger B, Richards T. Pre-operative anaemia. Anaesthesia. 2015;70(Suppl. 1):20-8, e6-8. DOI:10.1111/anae.12918
3. Kupryashov АА, Samuilova ОV, Samuilova DSh. Optimal blood management as priority route in cardiac surgery. Russian Journal of Hematology and Transfusiology. 2021;66(3):395-416 (in Russian). DOI:10.35754/0234-5730-2021-66-3-395-416
4. Yudin GV, Rybka MM, Khinchagov DY, et al. Anemia as a Risk Factor for Organ Dysfunctions in Patients Operated on Heart Valves. Kardiologiia. 2021;61(4):39-45 (in Russian). DOI:10.18087/cardio.2021.4.n1596
5. Kalyuta TY, Kazhekin OA, Ilyasova TA, Kochenkova OV. Prognostic value of anemic syndrome in surgical patients with elective surgery (review of literature). Challenges in Modern Medicine. 2020;43(1):165-75 (in Russian).
6. Richards T, Breymann C, Brookes MJ, et al. Questions and answers on iron deficiency treatment selection and the use of intravenous iron in routine clinical practice. Ann Med. 2021;53(1):274-85. DOI:10.1080/07853890.2020.1867323
7. Gupta S, Panchal P, Gilotra K, et al. Intravenous iron therapy for patients with preoperative iron deficiency or anaemia undergoing cardiac surgery reduces blood transfusions: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2020;31(2):141-51. DOI:10.1093/icvts/ivaa094
8. Muñoz M, Acheson AG, Auerbach M, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 2017;72(2):233-47. DOI:10.1111/anae.13773
9. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. DOI:10.1093/eurheartj/ehab368
10. Nugara C, Vitale G, Caccamo G, et al. Effect of intravenous iron replacement therapy on exercise capacity in iron deficient anemic patients after cardiac surgery. Monaldi Arch Chest Dis. 2020;90(1). DOI:10.4081/monaldi.2020.1196
11. Gurusamy KS, Nagendran M, Broadhurst JF, et al. Iron therapy in anaemic adults without chronic kidney disease. Cochrane Database Syst Rev. 2014;2014(12):CD010640. DOI:10.1002/14651858.CD010640.pub2
12. Xu H, Duan Y, Yuan X, et al. Intravenous Iron Versus Placebo in the Management of Postoperative Functional Iron Deficiency Anemia in Patients Undergoing Cardiac Valvular Surgery: A Prospective, Single-Blinded, Randomized Controlled Trial. J Cardiothorac Vasc Anesth. 2019;33(11):2941-98. DOI:10.1053/j.jvca.2019.01.063
13. Steinbicker AU. Role of anesthesiologists in managing perioperative anemia. Curr Opin Anaesthesiol. 2019;32(1):64-71. DOI:10.1097/ACO.0000000000000671
14. Spahn DR, Schoenrath F, Spahn GH, et al. Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery: a prospective randomised trial. Lancet. 2019;393(10187):2201-22. DOI:10.1016/S0140-6736(18)32555-8
15. Ponikowski P, Kirwan BA, Anker SD, et al. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet. 2020;396(10266):1895-904. DOI:10.1016/S0140-6736(20)32339-4
16. Venturini E, Iannuzzo G, DI Lorenzo A, et al. Short-term treatment of iron deficiency anemia after cardiac surgery. Int J Cardiol Heart Vasc. 2022;40:101038. DOI:10.1016/j.ijcha.2022.101038
17. Lyseng-Williamson KA, Keating GM. Ferric carboxymaltose: a review of its use in iron-deficiency anaemia. Drugs. 2009;69(6):739-56. DOI:10.2165/00003495-200969060-00007
18. Brautaset Englund KV, Østby CM, Rolid K, et al. Intravenous iron supplement for iron deficiency in cardiac transplant recipients (IronIC): A randomized clinical trial. J Heart Lung Transplant. 2021;40(5):359-67. DOI:10.1016/j.healun.2021.01.1390
19. Dhir A, Tempe DK. Anemia and Patient Blood Management in Cardiac Surgery-Literature Review and Current Evidence. J Cardiothorac Vasc Anesth. 2018;32(6):2726-72. DOI:10.1053/j.jvca.2017.11.043
20. Patel NN, Avlonitis VS, Jones HE, et al. Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis. Lancet Haematol. 2015;2(12):e543-53. DOI:10.1016/S2352-3026(15)00198-2
21. Carson JL, Stanworth SJ, Dennis JA, et al. Transfusion thresholds for guiding red blood cell transfusion. Cochrane Database Syst Rev. 2021;12(12):CD002042. DOI:10.1002/14651858.CD002042.pub5
22. Litton E, Xiao J, Ho KM. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ. 2013;347:f4822. DOI:10.1136/bmj.f4822
23. Ionescu A, Sharma A, Kundnani NR, et al. Intravenous iron infusion as an alternative to minimize blood transfusion in peri-operative patients. Sci Rep. 2020;10(1):18403. DOI:10.1038/s41598-020-75535-2
24. Elhenawy AM, Meyer SR, Bagshaw SM, et al. Role of preoperative intravenous iron therapy to correct anemia before major surgery: a systematic review and meta-analysis. Syst Rev. 2021;10(1):36. DOI:10.1186/s13643-021-01579-8
25. Tankard KA, Park B, Brovman EY, et al. The Impact of Preoperative Intravenous Iron Therapy on Perioperative Outcomes in Cardiac Surgery: A Systematic Review. J Hematol. 2020;9(4):97-108. DOI:10.14740/jh696
26. Quarterman C, Shaw M, Hughes S, et al. Anaemia in cardiac surgery – a retrospective review of a centre's experience with a pre-operative intravenous iron clinic. Anaesthesia. 2021;76(5):629-38. DOI:10.1111/anae.15271
27. Myles PS, Richards T, Klein A. Preoperative intravenous iron for cardiac surgery. Lancet. 2020;396(10266):1883-4. DOI:10.1016/S0140-6736(20)32406-5
28. Muñoz M, Gómez-Ramírez S, Rondinelli MB, Weltert L. Preoperative intravenous iron for cardiac surgery. Lancet. 2020;396(10266):1884. DOI:10.1016/S0140-6736(20)32407-7
29. Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA), Boer C, Meesters MI, et al. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. J Cardiothorac Vasc Anesth. 2018;32(1):88-120. DOI:10.1053/j.jvca.2017.06.026
30. Cladellas M, Farré N, Comín-Colet J, et al. Effects of preoperative intravenous erythropoietin plus iron on outcome in anemic patients after cardiac valve replacement. Am J Cardiol. 2012;110(7):1021-6. DOI:10.1016/j.amjcard.2012.05.036
31. Garrido-Martín P, Nassar-Mansur MI, de la Llana-Ducrós R, et al. The effect of intravenous and oral iron administration on perioperative anaemia and transfusion requirements in patients undergoing elective cardiac surgery: a randomized clinical trial. Interact Cardiovasc Thorac Surg. 2012;15(6):1013-8. DOI:10.1093/icvts/ivs344
32. Evans CR, Jones R, Phillips G, et al. Observational study of pre-operative intravenous iron given to anaemic patients before elective cardiac surgery. Anaesthesia. 2021;76(5):639-46. DOI:10.1111/anae.15396
33. Johansson PI, Rasmussen AS, Thomsen LL. Intravenous iron isomaltoside 1000 (Monofer®) reduces postoperative anaemia in preoperatively non-anaemic patients undergoing elective or subacute coronary artery bypass graft, valve replacement or a combination thereof: a randomized double-blind placebo-controlled clinical trial (the PROTECT trial). Vox Sang. 2015;109(3):257-66. DOI:10.1111/vox.12278
34. Klein AA, Chau M, Yeates JA, et al. Preoperative intravenous iron before cardiac surgery: a prospective multicentre feasibility study. Br J Anaesth. 2020;124(3):243-50. DOI:10.1016/j.bja.2019.11.023
35. Padmanabhan H, Siau K, Nevill AM, et al. Intravenous iron does not effectively correct preoperative anaemia in cardiac surgery: a pilot randomized controlled trial. Interactive CardioVascular and Thoracic Surgery. 2018;28(3):447-54. DOI:10.1093/icvts/ivy226
36. Ranucci M, Pavesi M, Pistuddi V, Baryshnikova E. Preoperative Anemia Correction in Cardiac Surgery: A Propensity-Matched Study. J Cardiothorac Vasc Anesth. 2021;35(3):874-81. DOI:10.1053/j.jvca.2020.07.015
37. Peters F, Eveslage M, Gallitz I, et al. Post-Operative Iron Carboxymaltose May Have an Effect on Haemoglobin Levels in Cardiothoracic Surgical Patients on the ICU – an Observational Pilot Study about Anaemia Treatment with Intravenous Iron. Transfus Med Hemother. 2018;45(1):42-6. DOI:10.1159/000481143
38. Muñoz M, Gómez-Ramírez S, Besser M, et al. Current misconceptions in diagnosis and management of iron deficiency. Blood Transfus. 2017;15(5):422-37. DOI:10.2450/2017.0113-17
39. Banerjee S, McCormack S. Intravenous Iron Preparations for Patients Undergoing Elective Surgery: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health, 2019.
40. Auerbach M, Macdougall I. The available intravenous iron formulations: History, efficacy, and toxicology. Hemodial Int. 2017;21(Suppl. 1):S83-92. DOI:10.1111/hdi.12560
ГБУЗ СО «Научно-практический центр специализированных видов медицинской помощи "Уральский институт кардиологии"», Екатеринбург, Россия
*arstepin@me.com
________________________________________________
Artem V. Stepin*
Ural Institute of Cardiology, Ekaterinburg, Russia
*arstepin@me.com