A Rare Optical Coherence Tomography Finding of a Striped, Low-Attenuation Plaque Protruding into the Lumen in In-Stent Restenosis

A Rare Optical Coherence Tomography Finding of a Striped, Low-Attenuation Plaque Protruding into the Lumen in In-Stent Restenosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A Rare Optical Coherence Tomography Finding of a Striped, Low-Attenuation Plaque Protruding into the Lumen in In-Stent Restenosis Naoya Otaka¹, Hidenori Matsusaka¹, Kunio Morishige¹ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7555324/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Jan, 2026 Read the published version in The Egyptian Heart Journal → Version 1 posted 12 You are reading this latest preprint version Abstract Background : In-stent restenosis (ISR) remains a clinical challenge in the drug-eluting stent (DES) era. Neoatherosclerosis is a recognized mechanism, but tissue responses after drug-coated balloon (DCB) therapy may present with atypical morphologies. Case presentation : We report a 55-year-old man with recurrent angina and ISR nine years after DES implantation and one year after DCB angioplasty. Optical coherence tomography (OCT) revealed a rare striped, low-attenuation plaque protruding into the lumen from outside the stent struts. This lesion lacked lipid, calcification, or macrophages, making it difficult to classify as typical neoatherosclerosis. The morphology suggested layered neointimal remodeling with possible thrombus organization after DCB treatment. The lesion was successfully treated with excimer laser coronary angioplasty, scoring balloon dilatation, and DCB angioplasty. Conclusion : This is, to our knowledge, the first report of a striped, low-attenuation plaque protruding into the stent lumen. Recognition of such atypical ISR morphologies may enhance understanding of neointimal healing after DCB treatment and guide interventional strategies. In-stent restenosis Optical coherence tomography Drug-coated balloon Neoatherosclerosis Thrombus organization Case report Figures Figure 1 Introduction In-stent restenosis (ISR) after drug-eluting stent (DES) implantation remains a therapeutic challenge. Neoatherosclerosis, defined as the development of atherosclerotic changes within the neointima of DES, is recognized as one of the major mechanisms of late stent failure [ 1 ]. Optical coherence tomography (OCT) allows detailed tissue characterization and has revealed diverse ISR morphologies. Here, we describe a rare OCT finding of a striped, low-attenuation plaque protruding into the lumen from outside the stent struts in a patient with recurrent ISR one year after drug-coated balloon (DCB) therapy. Case presentation A 55-year-old man with multiple cardiovascular risk factors presented with recurrent angina. Nine years earlier, XIENCE Alpine stents (Abbott Vascular, USA) had been implanted in the proximal to mid-left anterior descending artery (LAD). One year before the current admission, a DES was implanted in the right coronary artery, and DCB angioplasty was performed for LAD ISR. Follow-up angiography revealed a hazy lesion in the mid-LAD, with a fractional flow reserve of 0.72, confirming significant ischemia (Fig. 1 A). PCI was therefore scheduled. OCT (Dragonfly Opstar; Abbott Vascular) demonstrated a striped, low-attenuation plaque protruding into the lumen from outside the stent struts (Fig. 1A1–3). This unique morphology suggested a layered neointimal change following prior DCB therapy, including possible thrombus organization and healing processes, rather than classical neoatherosclerosis. The lesion was treated with excimer laser coronary angioplasty (ELCA; Philips, USA; 1.4 mm C-type catheter, 60 mJ/mm², 40 Hz), followed by lesion preparation using a 3.5×13 mm scoring balloon (Aperta NSE, Nipro, Japan). Post-ablation OCT showed partial reduction of the protruding tissue (Fig. 1 B). Flow compromise occurred in the diagonal branch, which was managed with balloon dilatation using a Ryurei 1.5×10 mm semi-compliant balloon (Terumo, Japan). Finally, a SeQuent Please Neo 3.5×30 mm paclitaxel-coated balloon (Nipro) was applied to the LAD, followed by snuggled kissing balloon inflation involving the diagonal branch (Fig. 1 C). Final OCT demonstrated adequate lesion expansion and compression of the protruding tissue (Fig. 1 D, D1–3). Discussion This case highlights an unusual OCT morphology of a striped, low-attenuation plaque protruding into the stent lumen. Unlike typical neoatherosclerosis, which is characterized by lipid deposition, calcification, or macrophage accumulation, this lesion lacked such features. Instead, its layered appearance suggested neointimal remodeling after prior DCB angioplasty, possibly reflecting thrombus healing or dissection repair. Neointimal remodeling after DCB therapy has been increasingly recognized. A recent study reported layered tissue patterns on OCT after DCB treatment, likely representing complex healing processes [ 2 ]. Moreover, previous OCT investigations have demonstrated a variety of neointimal changes following DCB therapy, such as progression or regression of neoatherosclerosis, calcifications, uncovered struts, evaginations, and even mushroom-like protrusions [ 3 ]. These findings underscore the spectrum of ISR morphologies after DCB treatment. This case illustrates the diverse morphological patterns of ISR and emphasizes the diagnostic value of OCT. Recognition of such atypical features may refine our understanding of vascular healing after DCB therapy and guide individualized interventional strategies. Limitations This report is limited by the absence of OCT or angiographic images from the prior DCB procedure, which would have provided additional insights into lesion evolution. Furthermore, the image quality in Fig. 1 D was suboptimal, although interpretation remained feasible. Conclusion We report a rare OCT finding of a striped, low-attenuation plaque protruding into the stent lumen during recurrent ISR after DCB angioplasty. This morphology likely represents layered neointimal remodeling with thrombus healing, rather than typical neoatherosclerosis. Further case accumulation is warranted to clarify its clinical significance. Abbreviations DCB: Drug-coated balloon DES: Drug-eluting stent ELCA: Excimer laser coronary angioplasty ISR: In-stent restenosis LAD: Left anterior descending artery OCT: Optical coherence tomography PCI: Percutaneous coronary intervention Declarations Funding None. Author Contribution N.O. performed the intervention and drafted the manuscript. H.M. and K.M. contributed to patient care and critically revised the manuscript. All authors approved the final version. Acknowledgement The authors thank the catheterization laboratory staff for their assistance during the procedure. Data Availability The authors confirm that the data supporting the finding of this study are available within the article. References Otsuka F, Byrne RA, Yahagi K, Mori H, Ladich E, Fowler DR, et al. Neoatherosclerosis: overview of histopathologic findings and implications for clinical outcomes. Eur Heart J. 2015;36(32):2147-59. doi:10.1093/eurheartj/ehv205. Hoshino M, Yonetsu T, Hada M, Sugiyama T, Yamaguchi T, Kakuta T. Neointimal remodeling following drug-coated balloon angioplasty: insights from optical coherence tomography. Ther Adv Cardiovasc Dis. 2023;17:17539447231199660. doi:10.1177/17539447231199660. Jinnouchi H, Kuramitsu S, Shinozaki T, Tomoi Y, Hiromasa T, Kobayashi Y, et al. Difference of tissue characteristics between early and late restenosis after second-generation drug-eluting stent implantation: an optical coherence tomography study. Circ J. 2017;81(4):450-7. doi:10.1253/circj.CJ-16-1069. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 12 Jan, 2026 Read the published version in The Egyptian Heart Journal → Version 1 posted Editorial decision: Revision requested 13 Dec, 2025 Reviews received at journal 07 Dec, 2025 Reviews received at journal 07 Dec, 2025 Reviewers agreed at journal 01 Dec, 2025 Reviewers agreed at journal 18 Nov, 2025 Reviews received at journal 15 Nov, 2025 Reviewers agreed at journal 01 Nov, 2025 Reviewers agreed at journal 20 Sep, 2025 Reviewers invited by journal 15 Sep, 2025 Editor assigned by journal 11 Sep, 2025 Submission checks completed at journal 11 Sep, 2025 First submitted to journal 07 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":1525624,"visible":true,"origin":"","legend":"\u003cp\u003eA: Coronary angiography showing a hazy lesion in the mid-LAD.\u003c/p\u003e\n\u003cp\u003eA1–3: OCT images demonstrating a striped, low-attenuation plaque protruding into the stent lumen.\u003c/p\u003e\n\u003cp\u003eB: Post-excimer laser OCT showing partial reduction of the protruding plaque.\u003c/p\u003e\n\u003cp\u003eC: Final angiographic result after DCB and kissing balloon inflation.\u003c/p\u003e\n\u003cp\u003eD, D1–3: Final OCT images showing adequate lesion expansion and plaque compression.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"Fig.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7555324/v1/401500faee3f7dfb43a00e28.jpg"},{"id":100616207,"identity":"3274e9c2-b5e8-4bf3-9131-b40f03fcfa22","added_by":"auto","created_at":"2026-01-19 17:41:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1831930,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7555324/v1/26195b57-2058-4e53-ba19-fa65606796f6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Rare Optical Coherence Tomography Finding of a Striped, Low-Attenuation Plaque Protruding into the Lumen in In-Stent Restenosis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn-stent restenosis (ISR) after drug-eluting stent (DES) implantation remains a therapeutic challenge. Neoatherosclerosis, defined as the development of atherosclerotic changes within the neointima of DES, is recognized as one of the major mechanisms of late stent failure [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Optical coherence tomography (OCT) allows detailed tissue characterization and has revealed diverse ISR morphologies. Here, we describe a rare OCT finding of a striped, low-attenuation plaque protruding into the lumen from outside the stent struts in a patient with recurrent ISR one year after drug-coated balloon (DCB) therapy.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 55-year-old man with multiple cardiovascular risk factors presented with recurrent angina. Nine years earlier, XIENCE Alpine stents (Abbott Vascular, USA) had been implanted in the proximal to mid-left anterior descending artery (LAD). One year before the current admission, a DES was implanted in the right coronary artery, and DCB angioplasty was performed for LAD ISR.\u003c/p\u003e\u003cp\u003eFollow-up angiography revealed a hazy lesion in the mid-LAD, with a fractional flow reserve of 0.72, confirming significant ischemia (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). PCI was therefore scheduled.\u003c/p\u003e\u003cp\u003eOCT (Dragonfly Opstar; Abbott Vascular) demonstrated a striped, low-attenuation plaque protruding into the lumen from outside the stent struts (Fig.\u0026nbsp;1A1\u0026ndash;3). This unique morphology suggested a layered neointimal change following prior DCB therapy, including possible thrombus organization and healing processes, rather than classical neoatherosclerosis.\u003c/p\u003e\u003cp\u003eThe lesion was treated with excimer laser coronary angioplasty (ELCA; Philips, USA; 1.4 mm C-type catheter, 60 mJ/mm\u0026sup2;, 40 Hz), followed by lesion preparation using a 3.5\u0026times;13 mm scoring balloon (Aperta NSE, Nipro, Japan). Post-ablation OCT showed partial reduction of the protruding tissue (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). Flow compromise occurred in the diagonal branch, which was managed with balloon dilatation using a Ryurei 1.5\u0026times;10 mm semi-compliant balloon (Terumo, Japan).\u003c/p\u003e\u003cp\u003eFinally, a SeQuent Please Neo 3.5\u0026times;30 mm paclitaxel-coated balloon (Nipro) was applied to the LAD, followed by snuggled kissing balloon inflation involving the diagonal branch (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e1\u003c/span\u003eC). Final OCT demonstrated adequate lesion expansion and compression of the protruding tissue (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e1\u003c/span\u003eD, D1\u0026ndash;3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis case highlights an unusual OCT morphology of a striped, low-attenuation plaque protruding into the stent lumen. Unlike typical neoatherosclerosis, which is characterized by lipid deposition, calcification, or macrophage accumulation, this lesion lacked such features. Instead, its layered appearance suggested neointimal remodeling after prior DCB angioplasty, possibly reflecting thrombus healing or dissection repair.\u003c/p\u003e\u003cp\u003eNeointimal remodeling after DCB therapy has been increasingly recognized. A recent study reported layered tissue patterns on OCT after DCB treatment, likely representing complex healing processes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Moreover, previous OCT investigations have demonstrated a variety of neointimal changes following DCB therapy, such as progression or regression of neoatherosclerosis, calcifications, uncovered struts, evaginations, and even mushroom-like protrusions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These findings underscore the spectrum of ISR morphologies after DCB treatment.\u003c/p\u003e\u003cp\u003eThis case illustrates the diverse morphological patterns of ISR and emphasizes the diagnostic value of OCT. Recognition of such atypical features may refine our understanding of vascular healing after DCB therapy and guide individualized interventional strategies.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis report is limited by the absence of OCT or angiographic images from the prior DCB procedure, which would have provided additional insights into lesion evolution. Furthermore, the image quality in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e1\u003c/span\u003eD was suboptimal, although interpretation remained feasible.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe report a rare OCT finding of a striped, low-attenuation plaque protruding into the stent lumen during recurrent ISR after DCB angioplasty. This morphology likely represents layered neointimal remodeling with thrombus healing, rather than typical neoatherosclerosis. Further case accumulation is warranted to clarify its clinical significance.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eDCB: Drug-coated balloon\u003c/p\u003e\n\u003cp\u003eDES: Drug-eluting stent\u003c/p\u003e\n\u003cp\u003eELCA: Excimer laser coronary angioplasty\u003c/p\u003e\n\u003cp\u003eISR: In-stent restenosis\u003c/p\u003e\n\u003cp\u003eLAD: Left anterior descending artery\u003c/p\u003e\n\u003cp\u003eOCT: Optical coherence tomography\u003c/p\u003e\n\u003cp\u003ePCI: Percutaneous coronary intervention\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNone.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eN.O. performed the intervention and drafted the manuscript. H.M. and K.M. contributed to patient care and critically revised the manuscript. All authors approved the final version.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors thank the catheterization laboratory staff for their assistance during the procedure.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe authors confirm that the data supporting the finding of this study are available within the article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eOtsuka F, Byrne RA, Yahagi K, Mori H, Ladich E, Fowler DR, et al. Neoatherosclerosis: overview of histopathologic findings and implications for clinical outcomes. Eur Heart J. 2015;36(32):2147-59. doi:10.1093/eurheartj/ehv205.\u003c/li\u003e\n \u003cli\u003eHoshino M, Yonetsu T, Hada M, Sugiyama T, Yamaguchi T, Kakuta T. Neointimal remodeling following drug-coated balloon angioplasty: insights from optical coherence tomography. Ther Adv Cardiovasc Dis. 2023;17:17539447231199660. doi:10.1177/17539447231199660.\u003c/li\u003e\n \u003cli\u003eJinnouchi H, Kuramitsu S, Shinozaki T, Tomoi Y, Hiromasa T, Kobayashi Y, et al. Difference of tissue characteristics between early and late restenosis after second-generation drug-eluting stent implantation: an optical coherence tomography study. Circ J. 2017;81(4):450-7. doi:10.1253/circj.CJ-16-1069.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-heart-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tehj","sideBox":"Learn more about [The Egyptian Heart Journal](https://tehj.springeropen.com)","snPcode":"43044","submissionUrl":"https://submission.springernature.com/new-submission/43044/3","title":"The Egyptian Heart Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"In-stent restenosis, Optical coherence tomography, Drug-coated balloon, Neoatherosclerosis, Thrombus organization, Case report","lastPublishedDoi":"10.21203/rs.3.rs-7555324/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7555324/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: In-stent restenosis (ISR) remains a clinical challenge in the drug-eluting stent (DES) era. Neoatherosclerosis is a recognized mechanism, but tissue responses after drug-coated balloon (DCB) therapy may present with atypical morphologies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e: We report a 55-year-old man with recurrent angina and ISR nine years after DES implantation and one year after DCB angioplasty. Optical coherence tomography (OCT) revealed a rare striped, low-attenuation plaque protruding into the lumen from outside the stent struts. This lesion lacked lipid, calcification, or macrophages, making it difficult to classify as typical neoatherosclerosis. The morphology suggested layered neointimal remodeling with possible thrombus organization after DCB treatment. The lesion was successfully treated with excimer laser coronary angioplasty, scoring balloon dilatation, and DCB angioplasty.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: This is, to our knowledge, the first report of a striped, low-attenuation plaque protruding into the stent lumen. Recognition of such atypical ISR morphologies may enhance understanding of neointimal healing after DCB treatment and guide interventional strategies.\u003c/p\u003e","manuscriptTitle":"A Rare Optical Coherence Tomography Finding of a Striped, Low-Attenuation Plaque Protruding into the Lumen in In-Stent Restenosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-24 12:59:39","doi":"10.21203/rs.3.rs-7555324/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-13T11:35:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-07T19:47:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-07T13:45:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296868952524709232550243113460307955886","date":"2025-12-01T19:13:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230591388440358131288867494122040573323","date":"2025-11-18T18:07:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-15T18:29:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153828134007750025454612662503952351677","date":"2025-11-01T12:09:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"248387701827446360850670804507984832088","date":"2025-09-20T21:03:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-15T19:11:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-12T00:52:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-12T00:51:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"The Egyptian Heart Journal","date":"2025-09-07T09:22:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-heart-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tehj","sideBox":"Learn more about [The Egyptian Heart Journal](https://tehj.springeropen.com)","snPcode":"43044","submissionUrl":"https://submission.springernature.com/new-submission/43044/3","title":"The Egyptian Heart Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"292a6031-83ed-47e9-95c5-65627a24d555","owner":[],"postedDate":"September 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T17:05:47+00:00","versionOfRecord":{"articleIdentity":"rs-7555324","link":"https://doi.org/10.1186/s43044-025-00711-6","journal":{"identity":"the-egyptian-heart-journal","isVorOnly":false,"title":"The Egyptian Heart Journal"},"publishedOn":"2026-01-12 16:29:32","publishedOnDateReadable":"January 12th, 2026"},"versionCreatedAt":"2025-09-24 12:59:39","video":"","vorDoi":"10.1186/s43044-025-00711-6","vorDoiUrl":"https://doi.org/10.1186/s43044-025-00711-6","workflowStages":[]},"version":"v1","identity":"rs-7555324","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7555324","identity":"rs-7555324","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}