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The Role of Vitamins in Heart Ischemia-Reperfusion

Yıl 2021, Sayı: 14, 323 - 335, 31.08.2021
https://doi.org/10.38079/igusabder.856218

Öz

Today, the increase in the incidence of cardiovascular diseases has increased the studies in this field. It is seen that most deaths among heart diseases occur due to myocardial ischemia. Effective prevention and treatment of myocardial ischemia-reperfusion injury and examination of the underlying mechanisms of ischemia-reperfusion (I/R) injury are the most important points of current research. Vitamins have very important functions, although they are found in trace amounts in the human body. Vitamin deficiencies in living beings cause widespread health problems in the world and in our country. In recent years, there are studies showing a link between the protective effect of vitamins and cardiovascular system diseases. Cardioprotective mechanisms of antioxidant vitamins have been shown. Hemorrhage, myocytolysis and edema develop in the heart I/R tissue. Various studies indicate that necrosis, hemorrhage, myocytolysis, edema and endothelial dysfunction occurring after ischemia-reperfusion in the heart can be prevented with vitamins. Evaluations made with metabolome analysis and electron microscope analysis prove that vitamins have a protective role in the heart today. Vitamins act as antioxidants, reducing or preventing free radical damage. It is observed that people who take enough vitamin supplements do not have heart disease or have a mild illness. In this review, dietary vitamins have been associated with their cardioprotective effects, and the results are summarized according to the changes in biomarkers in tissues according to the recent studies.

Kaynakça

  • Ramasarma T. Dioxygen reduction, reduced oxygen species, oxygen toxicity and antioxidants. Indian Journal of Experimental Biology. 2016;54(11):688-99.
  • Paradies G, Paradies V, Ruggiero FM, Petrosillo G. Mitochondrial bioenergetics and cardiolipin alterations in myocardial ischemia-reperfusion injury: implications for pharmacological cardioprotection. American Journal of Physiology Heart and Circulatory Physiology. 2018;315(5):1341-1352.
  • Andersen HR, Nielsen TT, Rasmussen K, et al. A comparison at coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. The New England Journal of Medicine. 2018;349(8):733-742.
  • Ekmekçi H, Balcı Ö. Konjestif kalp yetmezliği ve B-tipi natriüretik peptid. Sendrom. 2002;(14)4:48-53.
  • Siemionow M, Arslan E. Ischemia/reperfusion injury: a review in relation to free tissue transfers. Microsurgery. 2004;24(6):468-475.
  • Collard CD, Gelman S. Pathophysiology, clinical manifestations, and prevention injury of ischemia-reperfusion. Anesthesiology. 2001;94(6):1133-1138.
  • Li C, Jackson RM. Reactive species mechanisms of cellular hypoxia-reoxygeneration injury. American Journal of Physiology. 2002;282(2):227-241.
  • Silalahi J. Anticancer and health protective properties of citrus fruit components. Asia Pacific Journal of Clinical Nutrition. 2002;11(1):79-84.
  • Huseyin S, Guclu O, Yuksel V, Sezer G, Can N, Canbaz S. Avoiding liver injury with papaverine and ascorbic acid due to infrarenal cross-clamping: an experimental study. Brazilian Journal of Cardiovascular Surgery. 2017;3(3):197-201.
  • Kloner RA, Arimie RB, Kay GL, Cannom D, Matthews R, Bhandari A. Evidence for stunned myocardium in humans; a 2001 update. Coron Artery Disease. 2001;12(5):349-356.
  • Bolli R. Oxygen-derived free radicals and postischemic myocardial dysfunction. Journals of the American College of Cardiology. 1988;12(1):239-249.
  • Hearse DJ. Ischemia reperfusion, and the determinants of tissue injury. Cardiovascular Drugs and Therapy. 1990;12(4):767-776.
  • Manning AS, Hearse DJ. Reperfusion-induced arrhythmias: mechanisms and prevention. Journal of Molecular and Cellular Cardiology. 1984;16(6):497-518.
  • Piper HM, Meuter K, Schafer C. Cellular mechanisms of ischemia-reperfusion injury. The Annals of Thoracic Surgery. 2003;75(2):644-648.
  • Murry CE, Jennings RB, Raimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium circulation. The Annals of Thoracic Surgery. 1986;74(5):1124-1136.
  • Lefer DJ, Granger DN. Oxidative stress and cardiac disease. The American Journal of Medicine. 2000;109(4):315-323.
  • Reiter RJ, Tan DX. Melatonin: a novel protective agent against oxidative injury of the ischemic-reperfused heart. Cardiovascular Research Journal. 2003;58(1):10-19.
  • Kuyumcu A, Düzgün A, Özmen M, Besler HT. Travma ve enfeksiyonda nitrik oksidin rolü. Ulusal Travma ve Acil Cerrahi Dergisi. 2004;10(3):149-159.
  • Kaplan P, Hendrix M, Mubagwa K, Flameng W. Effect of ischemia and reperfusion on sarcoplasmic reticulum uptake. Circulation Research. 1992;71(3):1123-1130.
  • Atakişi O, Atakişi E, Atabay T, Uzun M. L-Arjinin ve N-Nitro -L-Arjinin metil esteri uygulamasının beyin, karaciğer, böbrek dokusu nitrik oksit ve malondialdehit düzeylerine etkisi. Kafkas Üniversitesi Veterinerlik Fakültesi Dergisi. 2009;16(1):71-75.
  • Atalık KE, Doğan N. Nitrik oksit ve fizyolojik etkileri. Genel Tıp Dergisi. 1997;7(3):167-169.
  • Zaer AM, Marefati N, Atkin SL, Butler AE, Sahebkar A. The protective role of curcumin in myocardial ischemia-reperfusion injury. Journal of Cellular Physiology. 2018;231(1):214-222.
  • Yamada Y, Kusakari Y, Watanabe M, et al. Thiamine treatment preserves cardiac function against ischemia injury via maintaining mitochondrial size and ATP levels. Journal of Applied Physiology. 2020;130(1):26-35.
  • Hao J, Li W, Du H, Zhao ZF, Liu F, Yang XC. Role of Vitamin C in cardioprotection of ischemia reperfusion ınjury by activation of mitochondrial KATP Channel. Chemical and Pharmaceutical Bulletin. 2016;64(6):548-557.
  • Oian X, Zhu M, Oian W, Song J. Vitamin D attenuates myocardial ischemia-reperfusion injury by inhibiting inflammation via suppressing the RhoA/ROCK/NF-ĸB pathway. Biotechnology and Applied Biochemistry. 2019;66(5):850-857.
  • Wallert M, Ziegler M, Wang X, et al. α-Tocopherol preserves cardiac function by reducing oxidative stress and inflammation in ischemia/reperfusion injury. Redox Biology. 2019; 26:101292. doi: 10.1016/j.redox.2019.101292.
  • Gvishiani M, Gabunia L, Makharadze T, Gongadze N. Nicorandil efficacy in the treatment of ischemic heart disease. Georgian Medical News. 2018;280(3):152-155.
  • Li J, Xu X, Zhou X, Dai J, Ma L, Chen C. Cardiovascular events associated with nicorandil administration prior to primary percutaneous coronary intervention in patients with acute ST-segment elevated myocardial infarction: a systematic review and meta-analysis. Expert Opinion on Drug Safety. 2019;18(6):537-547.
  • Liang NL, Zhong X, Zhou Y, et al. Cardioprotective effect of nicorandil against myocardial injury following cardiac arrest in swine. American Journal of Emergency Medicine. 2017;35(8):1082-1089.
  • Dhalla NS, Takeda S, Elimban V. Mechanisms of the beneficial effects of vitamin B6 and pyridoxal 5-phosphate on cardiac performance in ischemic heart disease. Clinical Chemistry and Laboratory Medicine. 2013;1(3):535-543.
  • Wang X, Dakshinamurti K, Musat N, Dhalla NS. Pyridoxal 5'-phosphate is an ATP-receptor antagonist in freshly isolated rat cardiomyocytes. Journal of Molecular and Cellular Cardiology. 1999;31(5):1063-1072.
  • Birincioğlu M. İskemi-reperfüzyon aritmilerine ACE inhbitörleri, Glutatyon ve indometazinin etkileri [Yayımlanmamış Yüksek Lisans Tezi]. Malatya, Türkiye: İnönü Üniversitesi Sağlık Bilimleri Enstitüsü;1996.
  • Ertan T, Soran A, Kılıç M, et al. Kan malondialdehid ve total antioksidan seviyesinin önemi. Cerrahi Tıp Bülteni. 2001;2(4):154-167.
  • Pongkan W, Takatori O, Yinhua N, et al. β-Cryptoxanthin exerts greater cardioprotective effects on cardiac ischemia-reperfusion injury than astaxanthin by attenuating mitochondrial dysfunction in mice. Molecular Nutrition and Food Research. 2017;61(10):1060-1077.
  • Liang S, Ping Z, Ge J. Coenzyme Q10 regulates antioxidative stress and autophagy in acute myocardial ischemia-reperfusion injury. Oxidative Medicine and Cellular Longevity. 2017;2017:9863181. doi: 10.1155/2017/9863181.
  • Annapurna A, Mudagal MP, Ansari A, Srinivasa RA. Cardioprotective activity of chalcones in ischemia/reperfusion-induced myocardial infarction in albino rats. Experimental and Clinical Cardiology. 2012;17(3):110-114.
  • Demirhan I, Kurutas EB, Bakaris S, Ozturk U, Oner E. Effects of B17 vitamin on sphingosine-1 phosphate and oxidative/nitrosative stress in the experimental model of heart ischemia/reperfusion. Advance Laboratory Medicine International. 2018;8(1):18-36.
  • Draper H, Hadley M. Malondialdehyde determination as index of lipid peroxidation. Methods in Enzymology. 1990;186(15):421- 31.
  • Liu H, Gua X, Shaoping L. Heart protective effects and mechanism of quercetin preconditioning on anti-myocardial ischemia reperfusion (IR) injuries in rats. The Journal of Gene Medicine. 2014;545(1):149-155.
  • Mahmoudabady M, Lashkari M, Niazmand S, Soukhtanloo M. Cardioprotective effects of Achillea wilhelmsii on the isolated rat heart in ischemia-reperfusion. Journal of Traditional and Complementary Medicine. 2017;7(4):501-507.
  • Ahmad S, Panda BP, Kohli K, Fahim M, Dubey K. Folic acid ameliorates celecoxib cardiotoxicity in a doxorubicin heart failure rat model. Pharmaceutical Biology. 2017;55(1):1295-1303.
  • Altuner D, Cetin N, Suleyman B, et al. Effect of thiamine pyrophosphate on ischemia-reperfusion induced oxidative damage in rat kidney. Indian Journal of Pharmacology. 2013;45(4):339-43.
  • Huang HY, Helzlsouer KJ, Appel LJ. The effects of vitamin C and vitamin E on oxidative DNA damage: results from a randomized controlled trial. Cancer Epidemiology Biomarkers and Prevention. 2000;9(7):647-52.
  • Ravindran S, Murali J, Amirthalingam SK, Kurian GA. Vascular calcification abrogates the nicorandil mediated cardio-protection in ischemia reperfusion injury of rat heart. Vascular Pharmacology. 2017;89(2):31-38.
  • Zhang RQ, Dong YL, Tong X, Shu ZZ, Pan HJ, Wu X. Antioxidative effect of luteolin pretreatment on simulated ischemia/reperfusion injury in cardiomyocyte and perfused rat heart. Chinese Journal of Integrative Medicine. 2016;85(7):518-527.
  • Shu L, Zhang W, Huang C, Huang G, Su G. Troxerutin protects against myocardial ischemia/reperfusion injury via Pi3k/Akt pathway in rats. Cellular Physiology and Biochemistry. 2017;44(5):1939-1948.
  • Vinten J, Zhao J, Jiang R, et al. Preconditioning and postconditioning: innate cardioprotection from ischemia-reperfusion injury. Journal of Applied Physiology. 2007;103(4):1441-1448.

Kalp İskemi-Reperfüzyonunda Vitaminlerin Rolü

Yıl 2021, Sayı: 14, 323 - 335, 31.08.2021
https://doi.org/10.38079/igusabder.856218

Öz

Günümüzde kardiyovasküler hastalıkların görülme insidansının artması bu alanda yapılan çalışmaları da beraberinde artırmıştır. Kalp hastalıkları içerisinde ölümlerin çoğunun miyokardiyal iskemiye bağlı olarak gerçekleştiği görülmektedir. Miyokardiyal iskemi-reperfüzyon hasarının etkili bir şekilde önlenmesi, tedavisinin nasıl sağlanacağı ve iskemi-reperfüzyon (I/R) hasarının altında yatan mekanizmaların incelenmesi, güncel araştırmaların en önemli noktasıdır. Vitaminler, insan vücudunda eser miktarlarda bulunmalarına rağmen çok önemli işlevlere sahiptir. Canlı bünyesinde vitamin eksikliği, dünyada ve ülkemizde yaygın sağlık sorunlarına neden olmaktadır. Son yıllarda vitaminlerin koruyucu etkisi ile kardiyovasküler sistem hastalıkları arasında bağlantı olduğunu gösteren çalışmalar bulunmaktadır. Antioksidan özellikli vitaminlerin kalbi koruyucu kardiyoprotektif mekanizmaları gösterilmiştir. Kalp I/R dokusunda hemoraji, myositolizis, ödem gelişmektedir. Kalpte meydana gelen I/R sonrasında oluşan nekrozun, hemorajinin, myositolizisin, ödem ve endotel disfonksiyonun vitaminler ile önlenebildiği çeşitli çalışmalar ile belirtilmektedir. Metabolom analizi ve elektron mikroskobu ile yapılan değerlendirmeler günümüzde vitaminlerin kalbi koruyucu rolünün olduğunu ispatlamaktadır. Vitaminler, antioksidan işlevi görerek serbest radikal hasarını azaltır ya da önler. Yeterince vitamin takviyesi alan kişilerin kalp hastalıklarına yakalanmadıkları veya hafif atlattıkları görülmektedir. Bu derlemede diyetle alınan vitaminler ile kardiyoprotektif etkileri ilişkilendirilmiş olup yapılan son çalışmalara göre dokularda bulunan biyobelirteçlerin değişimine göre sonuçlar özetlenmiştir.

Kaynakça

  • Ramasarma T. Dioxygen reduction, reduced oxygen species, oxygen toxicity and antioxidants. Indian Journal of Experimental Biology. 2016;54(11):688-99.
  • Paradies G, Paradies V, Ruggiero FM, Petrosillo G. Mitochondrial bioenergetics and cardiolipin alterations in myocardial ischemia-reperfusion injury: implications for pharmacological cardioprotection. American Journal of Physiology Heart and Circulatory Physiology. 2018;315(5):1341-1352.
  • Andersen HR, Nielsen TT, Rasmussen K, et al. A comparison at coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. The New England Journal of Medicine. 2018;349(8):733-742.
  • Ekmekçi H, Balcı Ö. Konjestif kalp yetmezliği ve B-tipi natriüretik peptid. Sendrom. 2002;(14)4:48-53.
  • Siemionow M, Arslan E. Ischemia/reperfusion injury: a review in relation to free tissue transfers. Microsurgery. 2004;24(6):468-475.
  • Collard CD, Gelman S. Pathophysiology, clinical manifestations, and prevention injury of ischemia-reperfusion. Anesthesiology. 2001;94(6):1133-1138.
  • Li C, Jackson RM. Reactive species mechanisms of cellular hypoxia-reoxygeneration injury. American Journal of Physiology. 2002;282(2):227-241.
  • Silalahi J. Anticancer and health protective properties of citrus fruit components. Asia Pacific Journal of Clinical Nutrition. 2002;11(1):79-84.
  • Huseyin S, Guclu O, Yuksel V, Sezer G, Can N, Canbaz S. Avoiding liver injury with papaverine and ascorbic acid due to infrarenal cross-clamping: an experimental study. Brazilian Journal of Cardiovascular Surgery. 2017;3(3):197-201.
  • Kloner RA, Arimie RB, Kay GL, Cannom D, Matthews R, Bhandari A. Evidence for stunned myocardium in humans; a 2001 update. Coron Artery Disease. 2001;12(5):349-356.
  • Bolli R. Oxygen-derived free radicals and postischemic myocardial dysfunction. Journals of the American College of Cardiology. 1988;12(1):239-249.
  • Hearse DJ. Ischemia reperfusion, and the determinants of tissue injury. Cardiovascular Drugs and Therapy. 1990;12(4):767-776.
  • Manning AS, Hearse DJ. Reperfusion-induced arrhythmias: mechanisms and prevention. Journal of Molecular and Cellular Cardiology. 1984;16(6):497-518.
  • Piper HM, Meuter K, Schafer C. Cellular mechanisms of ischemia-reperfusion injury. The Annals of Thoracic Surgery. 2003;75(2):644-648.
  • Murry CE, Jennings RB, Raimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium circulation. The Annals of Thoracic Surgery. 1986;74(5):1124-1136.
  • Lefer DJ, Granger DN. Oxidative stress and cardiac disease. The American Journal of Medicine. 2000;109(4):315-323.
  • Reiter RJ, Tan DX. Melatonin: a novel protective agent against oxidative injury of the ischemic-reperfused heart. Cardiovascular Research Journal. 2003;58(1):10-19.
  • Kuyumcu A, Düzgün A, Özmen M, Besler HT. Travma ve enfeksiyonda nitrik oksidin rolü. Ulusal Travma ve Acil Cerrahi Dergisi. 2004;10(3):149-159.
  • Kaplan P, Hendrix M, Mubagwa K, Flameng W. Effect of ischemia and reperfusion on sarcoplasmic reticulum uptake. Circulation Research. 1992;71(3):1123-1130.
  • Atakişi O, Atakişi E, Atabay T, Uzun M. L-Arjinin ve N-Nitro -L-Arjinin metil esteri uygulamasının beyin, karaciğer, böbrek dokusu nitrik oksit ve malondialdehit düzeylerine etkisi. Kafkas Üniversitesi Veterinerlik Fakültesi Dergisi. 2009;16(1):71-75.
  • Atalık KE, Doğan N. Nitrik oksit ve fizyolojik etkileri. Genel Tıp Dergisi. 1997;7(3):167-169.
  • Zaer AM, Marefati N, Atkin SL, Butler AE, Sahebkar A. The protective role of curcumin in myocardial ischemia-reperfusion injury. Journal of Cellular Physiology. 2018;231(1):214-222.
  • Yamada Y, Kusakari Y, Watanabe M, et al. Thiamine treatment preserves cardiac function against ischemia injury via maintaining mitochondrial size and ATP levels. Journal of Applied Physiology. 2020;130(1):26-35.
  • Hao J, Li W, Du H, Zhao ZF, Liu F, Yang XC. Role of Vitamin C in cardioprotection of ischemia reperfusion ınjury by activation of mitochondrial KATP Channel. Chemical and Pharmaceutical Bulletin. 2016;64(6):548-557.
  • Oian X, Zhu M, Oian W, Song J. Vitamin D attenuates myocardial ischemia-reperfusion injury by inhibiting inflammation via suppressing the RhoA/ROCK/NF-ĸB pathway. Biotechnology and Applied Biochemistry. 2019;66(5):850-857.
  • Wallert M, Ziegler M, Wang X, et al. α-Tocopherol preserves cardiac function by reducing oxidative stress and inflammation in ischemia/reperfusion injury. Redox Biology. 2019; 26:101292. doi: 10.1016/j.redox.2019.101292.
  • Gvishiani M, Gabunia L, Makharadze T, Gongadze N. Nicorandil efficacy in the treatment of ischemic heart disease. Georgian Medical News. 2018;280(3):152-155.
  • Li J, Xu X, Zhou X, Dai J, Ma L, Chen C. Cardiovascular events associated with nicorandil administration prior to primary percutaneous coronary intervention in patients with acute ST-segment elevated myocardial infarction: a systematic review and meta-analysis. Expert Opinion on Drug Safety. 2019;18(6):537-547.
  • Liang NL, Zhong X, Zhou Y, et al. Cardioprotective effect of nicorandil against myocardial injury following cardiac arrest in swine. American Journal of Emergency Medicine. 2017;35(8):1082-1089.
  • Dhalla NS, Takeda S, Elimban V. Mechanisms of the beneficial effects of vitamin B6 and pyridoxal 5-phosphate on cardiac performance in ischemic heart disease. Clinical Chemistry and Laboratory Medicine. 2013;1(3):535-543.
  • Wang X, Dakshinamurti K, Musat N, Dhalla NS. Pyridoxal 5'-phosphate is an ATP-receptor antagonist in freshly isolated rat cardiomyocytes. Journal of Molecular and Cellular Cardiology. 1999;31(5):1063-1072.
  • Birincioğlu M. İskemi-reperfüzyon aritmilerine ACE inhbitörleri, Glutatyon ve indometazinin etkileri [Yayımlanmamış Yüksek Lisans Tezi]. Malatya, Türkiye: İnönü Üniversitesi Sağlık Bilimleri Enstitüsü;1996.
  • Ertan T, Soran A, Kılıç M, et al. Kan malondialdehid ve total antioksidan seviyesinin önemi. Cerrahi Tıp Bülteni. 2001;2(4):154-167.
  • Pongkan W, Takatori O, Yinhua N, et al. β-Cryptoxanthin exerts greater cardioprotective effects on cardiac ischemia-reperfusion injury than astaxanthin by attenuating mitochondrial dysfunction in mice. Molecular Nutrition and Food Research. 2017;61(10):1060-1077.
  • Liang S, Ping Z, Ge J. Coenzyme Q10 regulates antioxidative stress and autophagy in acute myocardial ischemia-reperfusion injury. Oxidative Medicine and Cellular Longevity. 2017;2017:9863181. doi: 10.1155/2017/9863181.
  • Annapurna A, Mudagal MP, Ansari A, Srinivasa RA. Cardioprotective activity of chalcones in ischemia/reperfusion-induced myocardial infarction in albino rats. Experimental and Clinical Cardiology. 2012;17(3):110-114.
  • Demirhan I, Kurutas EB, Bakaris S, Ozturk U, Oner E. Effects of B17 vitamin on sphingosine-1 phosphate and oxidative/nitrosative stress in the experimental model of heart ischemia/reperfusion. Advance Laboratory Medicine International. 2018;8(1):18-36.
  • Draper H, Hadley M. Malondialdehyde determination as index of lipid peroxidation. Methods in Enzymology. 1990;186(15):421- 31.
  • Liu H, Gua X, Shaoping L. Heart protective effects and mechanism of quercetin preconditioning on anti-myocardial ischemia reperfusion (IR) injuries in rats. The Journal of Gene Medicine. 2014;545(1):149-155.
  • Mahmoudabady M, Lashkari M, Niazmand S, Soukhtanloo M. Cardioprotective effects of Achillea wilhelmsii on the isolated rat heart in ischemia-reperfusion. Journal of Traditional and Complementary Medicine. 2017;7(4):501-507.
  • Ahmad S, Panda BP, Kohli K, Fahim M, Dubey K. Folic acid ameliorates celecoxib cardiotoxicity in a doxorubicin heart failure rat model. Pharmaceutical Biology. 2017;55(1):1295-1303.
  • Altuner D, Cetin N, Suleyman B, et al. Effect of thiamine pyrophosphate on ischemia-reperfusion induced oxidative damage in rat kidney. Indian Journal of Pharmacology. 2013;45(4):339-43.
  • Huang HY, Helzlsouer KJ, Appel LJ. The effects of vitamin C and vitamin E on oxidative DNA damage: results from a randomized controlled trial. Cancer Epidemiology Biomarkers and Prevention. 2000;9(7):647-52.
  • Ravindran S, Murali J, Amirthalingam SK, Kurian GA. Vascular calcification abrogates the nicorandil mediated cardio-protection in ischemia reperfusion injury of rat heart. Vascular Pharmacology. 2017;89(2):31-38.
  • Zhang RQ, Dong YL, Tong X, Shu ZZ, Pan HJ, Wu X. Antioxidative effect of luteolin pretreatment on simulated ischemia/reperfusion injury in cardiomyocyte and perfused rat heart. Chinese Journal of Integrative Medicine. 2016;85(7):518-527.
  • Shu L, Zhang W, Huang C, Huang G, Su G. Troxerutin protects against myocardial ischemia/reperfusion injury via Pi3k/Akt pathway in rats. Cellular Physiology and Biochemistry. 2017;44(5):1939-1948.
  • Vinten J, Zhao J, Jiang R, et al. Preconditioning and postconditioning: innate cardioprotection from ischemia-reperfusion injury. Journal of Applied Physiology. 2007;103(4):1441-1448.
Toplam 47 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Makaleler
Yazarlar

İlter Demirhan 0000-0003-0054-7893

Ergül Belge Kurutaş 0000-0002-6653-4801

Yayımlanma Tarihi 31 Ağustos 2021
Kabul Tarihi 9 Mayıs 2021
Yayımlandığı Sayı Yıl 2021 Sayı: 14

Kaynak Göster

JAMA Demirhan İ, Belge Kurutaş E. Kalp İskemi-Reperfüzyonunda Vitaminlerin Rolü. IGUSABDER. 2021;:323–335.

 Alıntı-Gayriticari-Türetilemez 4.0 Uluslararası (CC BY-NC-ND 4.0)