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PREDICTIVE VALUE OF FIBROSIS-4 INDEX FOR HIGHER TROPONIN LEVELS IN ACUTE CORONARY SYNDROME

Yıl 2024, Cilt: 26 Sayı: 1, 34 - 41, 24.04.2024

Hüseyin Durak Elif Ergül

https://doi.org/10.24938/kutfd.1400280

Öz

Objective: Non-alcoholic fatty liver disease, a condition that affects nearly one-third of the population, is associated with cardiovascular disease and is the leading cause of death. Studies have found that peak troponin level is a strong predictor of all- cause death and infarct area width in the left ventricle after acute coronary syndrome. The fibrosis-4 (FIB-4) index is a noninvasive clinical tool that combines four laboratory parameters to measure liver fibrosis. The relationship between the FIB-4 index and peak troponin level is unclear. We speculated that a higher FIB-4 index might be associated with higher peak troponin levels, as it is linked to cardiovascular disease. We aimed to explore the relationship between peak troponin levels and the FIB-4 index in patients with acute coronary syndrome.
Material and Methods: This was an observational, cross- sectional cohort study. A total of 302 inpatients with acute coronary syndrome admitted to our clinic between June and September 2023 were enrolled. The FIB-4 index and peak troponin levels were evaluated. The maximum mean troponin level was determined, and two patient groups were formed and compared according to whether it was below or above this level.
Results: We demonstrated for the first time that the FIB-4 index is a strong indicator of peak troponin levels in patients with acute coronary syndrome (odds ratio: 2.301, 95% CI 1.667-3.172, p<0.001).
Conclusion: A higher FIB-4 index in patients with acute coronary syndrome was associated with higher troponin levels. It may be beneficial for clinicians to take more preventive measures in patients with acute coronary syndrome with a higher FIB-4 index.

Anahtar Kelimeler

FIB-4 index acute coronary syndrome troponin

Etik Beyan

Prior to conducting the study, we obtained ethical approval from the ethics committee at our institution (Health Directorate Scientific Research Application Review Commission / 26.05.2023 / E-64960800-799-216481811/).

Destekleyen Kurum

This research received no grants from any funding agency in the public, commercial, or not-for-profit sectors.

Kaynakça

  • Cao M, Li T, Li Z, et al. A retrospective study on the relationship between fibrosis-4 index and all-cause mortality in patients with acute myocardial infarction. Exp Ther Med. 2022;24(4):643.
  • Tokushige K, Ikejima K, Ono M, et al. Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis 2020. J Gastroenterol. 2021;56(11):951-963.
  • Cordero A, Escribano D, Quintanilla MA, et al. Prognostic value of liver fibrosis assessed by the FIB-4 index in patients with acute coronary syndrome. Rev Esp Cardiol. 2023;76(8):618-625.
  • Gaggini M, Minichilli F, Gorini F, et al. FIB-4 Index and neutrophil-to-lymphocyte-ratio as death predictor in coronary artery disease patients. Biomedicines. 2023;11(1):76.
  • Liu HH, Cao YX, Jin JL, et al. Liver fibrosis scoring systems as novel tools for predicting cardiovascular outcomes in patients following elective percutaneous coronary intervention. J Am Heart Assoc. 2021;10(3):e018869.
  • Mallet V, Parlati L, Vallet-Pichard A, et al. FIB-4 index to rule-out advanced liver fibrosis in NAFLD patients. Presse Med (Paris, France : 1983). 2019;48(12):1484-1488.
  • Smith JN, Negrelli JM, Manek MB, et al. Diagnosis and management of acute coronary syndrome: An evidence- based update. J Am Board Fam Med. 2015;28(2):283-293.
  • Mingels AM, Gorgels TP, van Dieijen-Visser MP. Cardiac troponin. Ned Tijdschr Geneeskd. 2012;156(42):A5044.
  • Janorkar S, Koning R, Eltchaninoff H, et al. Relation between serum cardiac troponin I values and severity of clinical, electrocardiographic and quantitative angiographic features in unstable angina. Indian Heart J. 1999;51(1):31-34.
  • Yan Z, Liu Y, Li W, et al. Liver fibrosis scores and prognosis in patients with cardiovascular diseases: A systematic review and meta-analysis. Eur J Clin Invest. 2022;52(11):e13855.
  • Higashiura Y, Tanaka M, Mori K, et al. High fibrosis-4 index predicts the new onset of ischaemic heart disease during a 10-year period in a general population. Eur Heart J Open. 2022;2(3):oeac030.
  • Vieira Barbosa J, Milligan S, Frick A, et al. Fibrosis-4 index can independently predict major adverse cardiovascular events in nonalcoholic fatty liver disease. Am J Gastroenterol. 2022;117(3):453-461.
  • Kontos MC, Shah R, Fritz LM, et al. Implication of different cardiac troponin I levels for clinical outcomes and prognosis of acute chest pain patients. J Am Coll Cardiol. 2004;43(6):958-965.
  • Ladue JS, Wroblewski F, Karmen A. Serum glutamic oxaloacetic transaminase activity in human acute transmural myocardial infarction. Science (New York, NY). 1954;120(3117):497-499.
  • Danese E, Montagnana M. An historical approach to the diagnostic biomarkers of acute coronary syndrome. Ann Transl Med. 2016;4(10):194.
  • Jasiewicz M, Siedlaczek M, Kasprzak M, et al. Elevated serum transaminases in patients with acute coronary syndromes: Do we need a revision of exclusion criteria for clinical trials? Cardiol J. 2023;30(5):747-752.
  • Moon J, Kang W, Oh PC, et al. Serum transaminase determined in the emergency room predicts outcomes in patients with acute ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention. Int J Cardiol. 2014;177(2):442-447.
  • Mantovani A, Csermely A, Petracca G, et al. Non- alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: An updated systematic review and meta-analysis. Lancet Gastroenterol & Hepatol. 2021;6(11):903-913.
  • Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatol. 2006;43(6):1317-1325.
  • Shah AG, Lydecker A, Murray K, et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7(10):1104-1112.
  • Mózes FE, Lee JA, Selvaraj EA, et al. Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: An individual patient data meta-analysis. Gut. 2022;71(5):1006-1019.
  • Ismaiel A, Leucuta DC, Popa SL, et al. Noninvasive biomarkers in predicting nonalcoholic steatohepatitis and assessing liver fibrosis: Systematic review and meta- analysis. Panminerva Med. 2021;63(4):508-518.
  • Giannitsis E, Blankenberg S, Christenson RH, et al. Critical appraisal of the 2020 ESC guideline recommendations on diagnosis and risk assessment in patients with suspected non-ST-segment elevation acute coronary syndrome. Clin Res Cardiol. 2021;110(9):1353- 1368.
  • Sze J, Mooney J, Barzi F, et al. Cardiac troponin and its relationship to cardiovascular outcomes in community populations-A systematic review and meta-analysis. Heart Lung Circ. 2016;25(3):217-228.
  • Ottani F, Galvani M, Nicolini FA, et al. Elevated cardiac troponin levels predict the risk of adverse outcome in patients with acute coronary syndromes. Am Heart J. 2000;140(6):917-927.
  • Byrne RA, Ndrepepa G, Braun S, et al. Peak cardiac troponin-T level, scintigraphic myocardial infarct size and one-year prognosis in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2010;106(9):1212-1217.
  • Ebell MH, White LL, Weismantel D. A systematic review of troponin T and I values as a prognostic tool for patients with chest pain. J Fam Pract. 2000;49(8):746-753.
  • Wijarnpreecha K, Lou S, Panjawatanan P, et al. Association between diastolic cardiac dysfunction and nonalcoholic fatty liver disease: A systematic review and meta-analysis. Dig Liver Dis. 2018;50(11):1166-1175.
  • Schonmann Y, Yeshua H, Bentov I, et al. Liver fibrosis marker is an independent predictor of cardiovascular morbidity and mortality in the general population. Dig Liver Dis. 2021;53(1):79-85.
  • Xiong S, Yin S, Deng W, et al. Predictive value of liver fibrosis scores in cardiovascular diseases among hypertensive population. J Hypertens. 2023;41(5):741- 750.
  • Yki-Järvinen H. Non-alcoholic fatty liver disease as a cause and a consequence of metabolic syndrome. Lancet Diabetes Endocrinol. 2014;2(11):901-910.
  • Lee J, Kim HS, Cho YK, et al. Association between noninvasive assessment of liver fibrosis and coronary artery calcification progression in patients with nonalcoholic fatty liver disease. Sci Rep. 2020;10(1):18323.
  • Ismaiel A, Dumitraşcu DL. Cardiovascular risk in fatty liver disease: The liver-heart axis-literature review. Front Med. 2019;6:202.
  • Targher G, Corey KE, Byrne CD. NAFLD, and cardiovascular and cardiac diseases: Factors influencing risk, prediction and treatment. Diabetes Metab. 2021;47(2):101215.
  • Ye Q, Zou B, Yeo YH, et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: A systematic review and meta-analysis. Lancet Gastroentero Hepatol. 2020;5(8):739-752.
  • Bhatt HA, Sanghani DR, Lee D, et al. Predictors of peak troponin level in acute coronary syndromes: Prior aspirin use and SYNTAX score. Int J Angiol. 2016;25(1):54-63.
  • Guasti L, Dentali F, Castiglioni L, et al. Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularisation. A systematic review on more than 34,000 subjects. Thromb Haemost. 2011;106(4):591-599.
  • Lorenzatti A, Servato ML. Role of anti-inflammatory interventions in coronary artery disease: Understanding the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS). Eur Cardiol. 2018;13(1):38- 41.
  • Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2019;140(11):e596-e646.

Akut Koroner Sendromda Fibrozis-4 İndeksinin Yüksek Troponin Düzeyleri için Öngördürücü Değeri

Yıl 2024, Cilt: 26 Sayı: 1, 34 - 41, 24.04.2024

Hüseyin Durak Elif Ergül

https://doi.org/10.24938/kutfd.1400280

Öz

Amaç: Non-alkolik yağlı karaciğer hastalığı nüfusun yaklaşık üçte birini etkiler. Kardiyovasküler hastalıklar, non-alkolik yağlı karaciğer hastalığı olan hastalarda ölümün başlıca nedenidir. Çalışmalar, zirve troponin seviyesinin akut koroner sendrom sonrası tüm nedenlere bağlı ölümün ve sol ventrikül infarkt alanı genişliğinin güçlü bir öngörücüsü olduğunu göstermiştir. Fibrozis-4 (FIB-4) indeksi, karaciğer fibrozunu ölçmek için dört laboratuvar parametresini birleştiren invaziv olmayan bir klinik araçtır. FIB-4 indeksi ile zirve troponin seviyesi arasındaki ilişki bilinmemektedir. Yüksek FIB-4 indeks seviyesinin kardiyovasküler hastalıklar ile bağlantılı olduğu bilindiği için zirve troponin seviyelerinin de FIB-4 indeks ile ilişkili olabileceğini varsaydık. Bu çalışmada akut koroner sendrom hastalarında zirve troponin seviyesi ile FIB-4 indeksi arasındaki ilişkiyi incelemeyi amaçladık.
Gereç ve Yöntemler: Bu çalışma gözlemsel, kesitsel bir kohort çalışmasıydı. Haziran ve Eylül 2023 arasında kliniğimize kabul edilen akut koroner sendrom hastalarından toplam 302 hasta çalışmaya dahil edildi. FIB-4 indeksi ve zirve troponin seviyeleri değerlendirildi. Ortalama zirve troponin seviyesi belirlendi ve hastalar bu seviyenin altında veya üstünde olup olmamasına göre iki gruba ayrıldı ve birbirleriyle karşılaştırıldı.
Bulgular: FIB-4 indeksinin akut koroner sendrom hastalarında zirve troponin seviyelerinin güçlü bir öngörücüsü olduğunu gösterdik (Odds oranı: 2.301, %95 CI 1.667-3.172, p<0.001).
Sonuç: Akut koroner sendrom hastalarında daha yüksek bir FIB-4 indeksi, daha yüksek troponin seviyeleri ile ilişkilidir. Daha yüksek bir FIB-4 indeksi olan akut koroner sendrom hastalarında daha fazla önleyici tedbir almanın klinisyenler için faydalı olabileceği düşünülebilir.

Anahtar Kelimeler

FIB-4 indeks akut koroner sendrom troponin

Etik Beyan

Araştırmayı yapmadan önce kurumumuz etik kurulundan etik onay aldık (26.05.2023 / E-64960800-799-216481811/).

Destekleyen Kurum

Çalışma için herhangi bir kurumdan finansal destek alınmamıştır.

Kaynakça

  • Cao M, Li T, Li Z, et al. A retrospective study on the relationship between fibrosis-4 index and all-cause mortality in patients with acute myocardial infarction. Exp Ther Med. 2022;24(4):643.
  • Tokushige K, Ikejima K, Ono M, et al. Evidence-based clinical practice guidelines for nonalcoholic fatty liver disease/nonalcoholic steatohepatitis 2020. J Gastroenterol. 2021;56(11):951-963.
  • Cordero A, Escribano D, Quintanilla MA, et al. Prognostic value of liver fibrosis assessed by the FIB-4 index in patients with acute coronary syndrome. Rev Esp Cardiol. 2023;76(8):618-625.
  • Gaggini M, Minichilli F, Gorini F, et al. FIB-4 Index and neutrophil-to-lymphocyte-ratio as death predictor in coronary artery disease patients. Biomedicines. 2023;11(1):76.
  • Liu HH, Cao YX, Jin JL, et al. Liver fibrosis scoring systems as novel tools for predicting cardiovascular outcomes in patients following elective percutaneous coronary intervention. J Am Heart Assoc. 2021;10(3):e018869.
  • Mallet V, Parlati L, Vallet-Pichard A, et al. FIB-4 index to rule-out advanced liver fibrosis in NAFLD patients. Presse Med (Paris, France : 1983). 2019;48(12):1484-1488.
  • Smith JN, Negrelli JM, Manek MB, et al. Diagnosis and management of acute coronary syndrome: An evidence- based update. J Am Board Fam Med. 2015;28(2):283-293.
  • Mingels AM, Gorgels TP, van Dieijen-Visser MP. Cardiac troponin. Ned Tijdschr Geneeskd. 2012;156(42):A5044.
  • Janorkar S, Koning R, Eltchaninoff H, et al. Relation between serum cardiac troponin I values and severity of clinical, electrocardiographic and quantitative angiographic features in unstable angina. Indian Heart J. 1999;51(1):31-34.
  • Yan Z, Liu Y, Li W, et al. Liver fibrosis scores and prognosis in patients with cardiovascular diseases: A systematic review and meta-analysis. Eur J Clin Invest. 2022;52(11):e13855.
  • Higashiura Y, Tanaka M, Mori K, et al. High fibrosis-4 index predicts the new onset of ischaemic heart disease during a 10-year period in a general population. Eur Heart J Open. 2022;2(3):oeac030.
  • Vieira Barbosa J, Milligan S, Frick A, et al. Fibrosis-4 index can independently predict major adverse cardiovascular events in nonalcoholic fatty liver disease. Am J Gastroenterol. 2022;117(3):453-461.
  • Kontos MC, Shah R, Fritz LM, et al. Implication of different cardiac troponin I levels for clinical outcomes and prognosis of acute chest pain patients. J Am Coll Cardiol. 2004;43(6):958-965.
  • Ladue JS, Wroblewski F, Karmen A. Serum glutamic oxaloacetic transaminase activity in human acute transmural myocardial infarction. Science (New York, NY). 1954;120(3117):497-499.
  • Danese E, Montagnana M. An historical approach to the diagnostic biomarkers of acute coronary syndrome. Ann Transl Med. 2016;4(10):194.
  • Jasiewicz M, Siedlaczek M, Kasprzak M, et al. Elevated serum transaminases in patients with acute coronary syndromes: Do we need a revision of exclusion criteria for clinical trials? Cardiol J. 2023;30(5):747-752.
  • Moon J, Kang W, Oh PC, et al. Serum transaminase determined in the emergency room predicts outcomes in patients with acute ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention. Int J Cardiol. 2014;177(2):442-447.
  • Mantovani A, Csermely A, Petracca G, et al. Non- alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: An updated systematic review and meta-analysis. Lancet Gastroenterol & Hepatol. 2021;6(11):903-913.
  • Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatol. 2006;43(6):1317-1325.
  • Shah AG, Lydecker A, Murray K, et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7(10):1104-1112.
  • Mózes FE, Lee JA, Selvaraj EA, et al. Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: An individual patient data meta-analysis. Gut. 2022;71(5):1006-1019.
  • Ismaiel A, Leucuta DC, Popa SL, et al. Noninvasive biomarkers in predicting nonalcoholic steatohepatitis and assessing liver fibrosis: Systematic review and meta- analysis. Panminerva Med. 2021;63(4):508-518.
  • Giannitsis E, Blankenberg S, Christenson RH, et al. Critical appraisal of the 2020 ESC guideline recommendations on diagnosis and risk assessment in patients with suspected non-ST-segment elevation acute coronary syndrome. Clin Res Cardiol. 2021;110(9):1353- 1368.
  • Sze J, Mooney J, Barzi F, et al. Cardiac troponin and its relationship to cardiovascular outcomes in community populations-A systematic review and meta-analysis. Heart Lung Circ. 2016;25(3):217-228.
  • Ottani F, Galvani M, Nicolini FA, et al. Elevated cardiac troponin levels predict the risk of adverse outcome in patients with acute coronary syndromes. Am Heart J. 2000;140(6):917-927.
  • Byrne RA, Ndrepepa G, Braun S, et al. Peak cardiac troponin-T level, scintigraphic myocardial infarct size and one-year prognosis in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2010;106(9):1212-1217.
  • Ebell MH, White LL, Weismantel D. A systematic review of troponin T and I values as a prognostic tool for patients with chest pain. J Fam Pract. 2000;49(8):746-753.
  • Wijarnpreecha K, Lou S, Panjawatanan P, et al. Association between diastolic cardiac dysfunction and nonalcoholic fatty liver disease: A systematic review and meta-analysis. Dig Liver Dis. 2018;50(11):1166-1175.
  • Schonmann Y, Yeshua H, Bentov I, et al. Liver fibrosis marker is an independent predictor of cardiovascular morbidity and mortality in the general population. Dig Liver Dis. 2021;53(1):79-85.
  • Xiong S, Yin S, Deng W, et al. Predictive value of liver fibrosis scores in cardiovascular diseases among hypertensive population. J Hypertens. 2023;41(5):741- 750.
  • Yki-Järvinen H. Non-alcoholic fatty liver disease as a cause and a consequence of metabolic syndrome. Lancet Diabetes Endocrinol. 2014;2(11):901-910.
  • Lee J, Kim HS, Cho YK, et al. Association between noninvasive assessment of liver fibrosis and coronary artery calcification progression in patients with nonalcoholic fatty liver disease. Sci Rep. 2020;10(1):18323.
  • Ismaiel A, Dumitraşcu DL. Cardiovascular risk in fatty liver disease: The liver-heart axis-literature review. Front Med. 2019;6:202.
  • Targher G, Corey KE, Byrne CD. NAFLD, and cardiovascular and cardiac diseases: Factors influencing risk, prediction and treatment. Diabetes Metab. 2021;47(2):101215.
  • Ye Q, Zou B, Yeo YH, et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: A systematic review and meta-analysis. Lancet Gastroentero Hepatol. 2020;5(8):739-752.
  • Bhatt HA, Sanghani DR, Lee D, et al. Predictors of peak troponin level in acute coronary syndromes: Prior aspirin use and SYNTAX score. Int J Angiol. 2016;25(1):54-63.
  • Guasti L, Dentali F, Castiglioni L, et al. Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularisation. A systematic review on more than 34,000 subjects. Thromb Haemost. 2011;106(4):591-599.
  • Lorenzatti A, Servato ML. Role of anti-inflammatory interventions in coronary artery disease: Understanding the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS). Eur Cardiol. 2018;13(1):38- 41.
  • Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2019;140(11):e596-e646.
Toplam 39 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Hizmetleri ve Sistemleri (Diğer)
Bölüm Özgün Araştırma
Yazarlar

Hüseyin Durak 0000-0002-8248-5966

Elif Ergül 0000-0003-3192-4719

Yayımlanma Tarihi 24 Nisan 2024
Gönderilme Tarihi 4 Aralık 2023
Kabul Tarihi 28 Şubat 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 26 Sayı: 1

Kaynak Göster

APA Durak, H., & Ergül, E. (2024). PREDICTIVE VALUE OF FIBROSIS-4 INDEX FOR HIGHER TROPONIN LEVELS IN ACUTE CORONARY SYNDROME. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 26(1), 34-41. https://doi.org/10.24938/kutfd.1400280
AMA Durak H, Ergül E. PREDICTIVE VALUE OF FIBROSIS-4 INDEX FOR HIGHER TROPONIN LEVELS IN ACUTE CORONARY SYNDROME. Kırıkkale Üni Tıp Derg. Nisan 2024;26(1):34-41. doi:10.24938/kutfd.1400280
Chicago Durak, Hüseyin, ve Elif Ergül. “PREDICTIVE VALUE OF FIBROSIS-4 INDEX FOR HIGHER TROPONIN LEVELS IN ACUTE CORONARY SYNDROME”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 26, sy. 1 (Nisan 2024): 34-41. https://doi.org/10.24938/kutfd.1400280.
EndNote Durak H, Ergül E (01 Nisan 2024) PREDICTIVE VALUE OF FIBROSIS-4 INDEX FOR HIGHER TROPONIN LEVELS IN ACUTE CORONARY SYNDROME. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 26 1 34–41.
IEEE H. Durak ve E. Ergül, “PREDICTIVE VALUE OF FIBROSIS-4 INDEX FOR HIGHER TROPONIN LEVELS IN ACUTE CORONARY SYNDROME”, Kırıkkale Üni Tıp Derg, c. 26, sy. 1, ss. 34–41, 2024, doi: 10.24938/kutfd.1400280.
ISNAD Durak, Hüseyin - Ergül, Elif. “PREDICTIVE VALUE OF FIBROSIS-4 INDEX FOR HIGHER TROPONIN LEVELS IN ACUTE CORONARY SYNDROME”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 26/1 (Nisan 2024), 34-41. https://doi.org/10.24938/kutfd.1400280.
JAMA Durak H, Ergül E. PREDICTIVE VALUE OF FIBROSIS-4 INDEX FOR HIGHER TROPONIN LEVELS IN ACUTE CORONARY SYNDROME. Kırıkkale Üni Tıp Derg. 2024;26:34–41.
MLA Durak, Hüseyin ve Elif Ergül. “PREDICTIVE VALUE OF FIBROSIS-4 INDEX FOR HIGHER TROPONIN LEVELS IN ACUTE CORONARY SYNDROME”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, c. 26, sy. 1, 2024, ss. 34-41, doi:10.24938/kutfd.1400280.
Vancouver Durak H, Ergül E. PREDICTIVE VALUE OF FIBROSIS-4 INDEX FOR HIGHER TROPONIN LEVELS IN ACUTE CORONARY SYNDROME. Kırıkkale Üni Tıp Derg. 2024;26(1):34-41.
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