Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Hepatology Reports
Published in: Current Hepatology Reports 3/2018

01-09-2018 | Hepatitis B (JK Lim, Section Editor)

Extrahepatic Manifestations of Chronic Hepatitis B Infection

Authors: Victor Virlogeux, Christian Trépo

Published in: Current Hepatology Reports | Issue 3/2018

Login to get access

Abstract

Purpose of Review

Hepatitis B virus (HBV) is responsible for over 350 million chronic carriers, 50% of whom will die prematurely from cirrhosis and hepatocellular carcinoma associated with T cell-mediated cytopathic immune clearance of the virus occurring over lifetime. Around 20% of acute and chronic HBV carriers are experiencing a great range of extrahepatic manifestations related to complex immunological mechanisms.

Recent Findings

Extrahepatic manifestations are due to circulating immune complexes or possibly local inflammation triggered by viral antigens and activating the complement cascade. Their mechanism and severity are unrelated to progression of liver disease. The exact viral trigger antigens remain elusive and the most likely candidates could be hepatitis B e antigen.
The spectrum of the lesion includes acute infection serum sickness, vasculitis including, polyarteritis nodosa and the most affected organs are skin, large joints, muscles, and kidneys.

Summary

Prompt awareness of these extrahepatic manifestations is now of paramount importance, since well-tolerated nucleoside analogues devoid of resistance are capable of inhibiting HBV replication and have proven not only lifesaving but remarkably also curative, like for PAN, turning as the most prophetic illustration of HBV cure.
Literature
1.
Lavanchy D. Worldwide epidemiology of HBV infection, disease burden, and vaccine prevention. J Clin Virol. 2005;34:S1–3.PubMed
2.
•• Trépo C, HLY C, Lok A. Hepatitis B virus infection. Lancet. 2014;384:2053–63. Overall review on Hepatitis B infection. PubMed
3.
Kappus MR, Sterling RK. Extrahepatic manifestations of acute hepatitis B virus infection. Gastroenterol Hepatol (N Y). 2013;9:123–6.
4.
Mazzaro C, Dal Maso L, Urraro T, Mauro E, Castelnovo L, Casarin P, et al. Hepatitis B virus related cryoglobulinemic vasculitis: a multicentre open label study from the Gruppo Italiano di Studio delle Crioglobulinemie - GISC. Dig Liver Dis. 2016;48:780–4.PubMed
5.
Singh H, Tanwar VS, Sukhija G, Kaur P, Govil N. Vasculitis as a presenting manifestation of chronic hepatitis B virus infection: a case report. J Clin Diagn Res. 2016;10:OD25–6.PubMedPubMedCentral
6.
•• Trepo C, Guillevin L. Polyarteritis nodosa and extrahepatic manifestations of HBV infection: the case against autoimmune intervention in pathogenesis. J Autoimmun. 2001;16:269–74. Review on mechanisms and outcome of hepatitis B polyarteritis nodosa. PubMed
7.
Kussmaul A, Maier R. Ueber eine bisher nicht beschriebene eigenthumliche Arterienerkrankung Periarteritis Nodosa die mit Morbus Brightii und rapid fortschreintender allgemeiner Muskellahmung einhergeht. Deutsches Archiv für Klinische Medizin. Dtsch Arch Klin Med. 1866;1:484.
8.
Trepo C, Thivolet J. Hepatitis associated antigen and periarteritis nodosa (PAN). Vox Sang. 1970;19:410–1.PubMed
9.
Trepo C, Thivolet J. Antigene Australia, virus de l’hépatite et périartérite noueuse. Presse Med. 1970;78:1575.PubMed
10.
Gocke DJ, Hsu K, Morgan C, Bombardieri S, Lockshin M, Christian CL. Vasculitis in association with Australia antigen. J Exp Med. 1971;134:330–6.PubMedPubMedCentral
11.
Prince AM, Trepo C. Role of immune complexes involving SH antigen in pathogenesis of chronic active hepatitis and polyarteritis nodosa. Lancet. 1971;1:1309–12.PubMed
12.
McMahon BJ, Bender TR, Templin DW, Maynard JE, Barrett DH, Berquist KR, et al. Vasculitis in Eskimos living in an area hyperendemic for hepatitis B. JAMA. 1980;244:2180–2.PubMed
13.
•• Guillevin L, Mahr A, Callard P, Godmer P, Pagnoux C, Leray E, et al. Hepatitis B virus-associated polyarteritis nodosa: clinical characteristics, outcome, and impact of treatment in 115 patients. Medicine (Baltimore). 2005;84:313–22. Impact of various treatment on polyarteritis nodosa.
14.
De Virgilio A, Greco A, Magliulo G, Gallo A, Ruoppolo G, Conte M, et al. Polyarteritis nodosa: a contemporary overview. Autoimmun Rev. 2016;15:564–70.PubMed
15.
Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database. Arthritis Rheum. 2010;62:616–26.PubMed
16.
Mason A, Theal J, Bain V, Adams E, Perrillo R. Hepatitis B virus replication in damaged endothelial tissues of patients with extrahepatic disease. Am J Gastroenterol. 2005;100:972–6.PubMed
17.
Guillevin L, Jarrousse B, Lok C, Lhote F, Jais JP, Le Thi Huong Du D, et al. Long-term follow-up after treatment of polyarteritis nodosa and Churg-Strauss angiitis with comparison of steroids, plasma exchange and cyclophosphamide to steroids and plasma exchange. A prospective randomized trial of 71 patients. The Cooperative Study Group for Polyarteritis Nodosa. J Rheumatol. 1991;18:567–74.PubMed
18.
• Guillevin L, Lhote F, Leon A, Fauvelle F, Vivitski L, Trepo C. Treatment of polyarteritis nodosa related to hepatitis B virus with short term steroid therapy associated with antiviral agents and plasma exchanges. A prospective trial in 33 patients. J Rheumatol. 1993;20:289–98. HBV PAN curative physiopathological combination therapy. PubMed
19.
Trepo C, Ouzan D, Delmont J, Tremisi P. Superiorite d’un nouveau traitement curateur des periarterites noueuses induites par le virus de l’hepatite B grace a l’association corticotherapie breve, vidarabine et echanges plasmatiques. Presse Med. 1988;17:1527–31.PubMed
20.
Guillevin L, Merrouche Y, Gayraud M, Jarrousse B, Royer I, Leon A. Périartérite noueuse due au virus de l’hépatite B. Détermination d’une nouvelle stratégie thérapeutique chez 13 patients. Presse Med. 1988;17:1522–6.PubMed
21.
Guillevin L, Lhote F, Sauvaget F, Deblois P, Rossi F, Levallois D, et al. Treatment of polyarteritis nodosa related to hepatitis B virus with interferon-alpha and plasma exchanges. Ann Rheum Dis. 1994;53:334–7.PubMedPubMedCentral
22.
Guillevin L, Mahr A, Cohen P, Larroche C, Queyrel V, Loustaud-Ratti V, et al. Short-term corticosteroids then lamivudine and plasma exchanges to treat hepatitis B virus-related polyarteritis nodosa. Arthritis Rheum. 2004;51:482–7.PubMed
23.
Auguet T, Barragan P, Ramírez R, Quer JC, Sirvent JJ, Richart C. Lamivudine in the treatment of hepatitis B virus-related polyarteritis nodosa. J Clin Rheumatol. 2007;13:298–9.PubMed
24.
• Balwani MR, Kute VB, Shah PR, Shah M, Shinde SG, Shah J, et al. Hepatitis B viremia manifesting as polyarteritis nodosa and secondary membranous nephropathy. J Nephropharmacol. 2016;5:119–21. Recent report of successful NUC HBV therapy for HBV extrahepatic manifestations. PubMedPubMedCentral
25.
Alter H, Block T, Brown N, Brownstein A, Brosgart C, Chang K-M, et al. A research agenda for curing chronic hepatitis B virus infection: Alter et al. Hepatology. 2018;67:1127–31.PubMed
26.
Gupta A, Quigg RJ. Glomerular diseases associated with hepatitis B and C. Adv Chronic Kidney Dis. 2015;22:343–51.PubMed
27.
Bhimma R, Coovadia HM. Hepatitis B virus-associated nephropathy. Am J Nephrol. 2004;24:198–211.PubMed
28.
Ren J, Wang L, Chen Z, Ma ZM, Zhu HG, Yang DL, et al. Gene expression profile of transgenic mouse kidney reveals pathogenesis of hepatitis B virus associated nephropathy. J Med Virol. 2006;78:551–60.PubMed
29.
Deng C-L. Chronic hepatitis serum promotes apoptotic damage in human renal tubular cells. World J Gastroenterol. 2006;12:1752–6.PubMedPubMedCentral
30.
•• Brzosko WJ, Krawczyński K, Nazarewicz T, Morzycka M, Nowoslawski A. Glomerulonephritis associated with hepatitis-B surface antigen immune complexes in children. Lancet. 1974;2:477–82. First study to report the involvement of HBV in the pathogenesis of glomerulonephritis. PubMed
31.
Willson RA. Extrahepatic manifestations of chronic viral hepatitis. Am J Gastroenterol. 1997;92:3–17.PubMed
32.
Dienstag JL. Immunopathogenesis of the extrahepatic manifestations of hepatitis B virus infection. Springer Semin Immunopathol. 1981;3:461–72.PubMed
33.
34.
Nagy J, Bajtai G, Brasch H, Süle T, Ambrus M, Deák G, et al. HBsaG in renal disease. Lancet. 1978;2:315–6.PubMed
35.
Combes B, Shorey J, Barrera A, Stastny P, Eigenbrodt EH, Hull AR, et al. Glomerulonephritis with deposition of Australia antigen-antibody complexes in glomerular basement membrane. Lancet. 1971;2:234–7.PubMed
36.
37.
Chen L, Wu C, Fan X, Gao J, Yin H, Wang T, et al. Replication and infectivity of hepatitis B virus in HBV-related glomerulonephritis. Int J Infect Dis. 2009;13:394–8.PubMed
38.
Kohler PF. Chronic membranous glomerulonephritis caused by hepatitis B antigen-antibody immune complexes. Ann Intern Med. 1974;81:448–51.PubMed
39.
Wada Y, Ogata H, Takeshige Y, Takeshima A, Yoshida N, Yamamoto M, et al. Clinical significance of IgG deposition in the glomerular mesangial area in patients with IgA nephropathy. Clin Exp Nephrol. 2013;17:73–82.PubMed
40.
Wang N-S, Wu Z-L, Zhang Y-E, Liao L-T. Existence and significance of hepatitis B virus DNA in kidneys of IgA nephropathy. World J Gastroenterol. 2005;11:712–6.PubMedPubMedCentral
41.
Liang TJ. Hepatitis B: the virus and disease. Hepatology. 2009;49:S13–21.PubMed
42.
Ozdamar SO, Gucer S, Tinaztepe K. Hepatitis-B virus associated nephropathies: a clinicopathological study in 14 children. Pediatr Nephrol. 2003;18:23–8.PubMed
43.
Gilbert RD, Wiggelinkhuizen J. The clinical course of hepatitis B virus-associated nephropathy. Pediatr Nephrol. 1994;8:11–4.PubMed
44.
Lai KN, Li PK, Lui SF, Au TC, Tam JS, Tong KL, et al. Membranous nephropathy related to hepatitis B virus in adults. N Engl J Med. 1991;324:1457–63.PubMed
45.
Lai KN, Tang SCW, Schena FP, Novak J, Tomino Y, Fogo AB, et al. IgA nephropathy. Nat Rev Dis Primers. 2016;2:16001.PubMed
46.
Khaira A, Upadhyay BK, Sharma A, Das P, Mahajan S, Makhariya G, et al. Hepatitis B virus associated focal and segmental glomerular sclerosis: report of two cases and review of literature. Clin Exp Nephrol. 2009;13:373–7.PubMed
47.
Lai KN, Tam JS, Lin HJ, Lai FM. The therapeutic dilemma of the usage of corticosteroid in patients with membranous nephropathy and persistent hepatitis B virus surface antigenaemia. Nephron. 1990;54:12–7.PubMed
48.
Cadrobbi P, Bortolotti F, Zacchello G, Rinaldi R, Armigliato M, Realdi G. Hepatitis B virus replication in acute glomerulonephritis with chronic active hepatitis. Arch Dis Child. 1985;60:583–5.PubMedPubMedCentral
49.
Lai FM, Tam JS, Li PK, Lai KN. Replication of hepatitis B virus with corticosteroid therapy in hepatitis B virus related membranous nephropathy. Virchows Arch A Pathol Anat Histopathol. 1989;414:279–84.PubMed
50.
Chung DR, Yang WS, Kim SB, Yu E, Chung YH, Lee Y, et al. Treatment of hepatitis B virus associated glomerulonephritis with recombinant human alpha interferon. Am J Nephrol. 1997;17:112–7.PubMed
51.
Okuse C, Yotsuyanagi H, Yamada N, Ikeda H, Takahashi H, Suzuki M, et al. Successful treatment of hepatitis B virus-associated membranous nephropathy with lamivudine. Clin Nephrol. 2006;65:53–6.PubMed
52.
Tang S, Lai FM-M, Lui YH, CSO T, NNS K, Ho YW, et al. Lamivudine in hepatitis B-associated membranous nephropathy. Kidney Int. 2005;68:1750–8.PubMed
53.
Lin CY. Treatment of hepatitis B virus-associated membranous nephropathy with recombinant alpha-interferon. Kidney Int. 1995;47:225–30.PubMed
54.
Conjeevaram HS, Hoofnagle JH, Austin HA, Park Y, Fried MW, Di Bisceglie AM. Long-term outcome of hepatitis B virus-related glomerulonephritis after therapy with interferon alfa. Gastroenterology. 1995;109:540–6.PubMed
55.
• Wang W, Wu M, Ma F, Sun T, Xu Z. Meta-analysis of the efficacy and safety of nucleotide/nucleoside analog monotherapy for hepatitis B virus-associated glomerulonephritis. Clin Nephrol. 2016;85:21–9. A recent meta-analysis based on ten clinical trials evaluating the efficacy and safety of nucleos(t)ide analogue monotherapy for HBV-related glomerulonephritis. PubMed
56.
Yi Z, Jie YW, Nan Z. The efficacy of anti-viral therapy on hepatitis B virus-associated glomerulonephritis: a systematic review and meta-analysis. Ann Hepatol. 2011;10:165–73.PubMed
57.
• Sun L-J, Shan J-P, Cui R-L, Yuan W-J, Jiang G-R. Combination therapy with lamivudine and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker for hepatitis B virus-associated glomerulonephritis with mild to moderate proteinuria: a clinical review of 38 cases. Int Urol Nephrol 2017 Jun; 49(6):1049–1056. A recent retrospective study exploring the effect of a combination of lamivudine plus angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) or a ACEI/ARB monotherapyon liver function and proteinuria. PubMed
58.
Hollinger FB, DT-Y L. Hepatitis B: the pathway to recovery through treatment. Gastroenterol Clin N Am. 2006;35:895–931.
59.
Wands JR, Mann E, Alpert E, Isselbacher KJ. The pathogenesis of arthritis associated with acute hepatitis-B surface antigen-positive hepatitis. Complement activation and characterization of circulating immune complexes. J Clin Invest. 1975;55:930–6.PubMedPubMedCentral
60.
Michitaka K, Horiike N, Chen Y, Duong TN, Konishi I, Mashiba T, et al. Gianotti-Crosti syndrome caused by acute hepatitis B virus genotype D infection. Intern Med. 2004;43:696–9.PubMed
61.
Ishimaru Y, Ishimaru H, Toda G, Baba K, Mayumi M. An epidemic of infantile papular acrodermatitis (Gianotti’s disease) in Japan associated with hepatitis-B surface antigen subtype ayw. Lancet. 1976;1:707–9.PubMed
62.
63.
Baleviciené G, Maciuleviciené R, Schwartz RA. Papular acrodermatitis of childhood: the Gianotti-Crosti syndrome. Cutis. 2001;67:291–4.PubMed
64.
Lewis JH, Brandon JM, Gorenc TJ, Maxwell NG. Hepatitis B. A study of 200 cases positive for the hepatitis B antigen. Am J Dig Dis. 1973;18:921–9.PubMed
65.
Steigman AJ. Rashes and arthropathy in viral hepatitis. Mt Sinai J Med. 1973;40:752–7.PubMed
66.
McElgunn PS. Dermatologic manifestations of hepatitis B virus infection. J Am Acad Dermatol. 1983;8:539–48.PubMed
67.
Shumaker JB, Goldfinger SE, Alpert E, Isselbacher KJ. Arthritis and rash. Clues to anicteric viral hepatitis. Arch Intern Med. 1974;133:483–5.PubMed
68.
Niermeijer P, Gips CH. Natural history of acute hepatitis B in previously healthy patients: a prospective study. Acta Hepatogastroenterol (Stuttg). 1977;24:317–25.
69.
Dienstag JL, Rhodes AR, Bhan AK, Dvorak AM, Mihm MC, Wands JR. Urticaria associated with acute viral hepatitis type B: studies of pathogenesis. Ann Intern Med. 1978;89:34–40.PubMed
70.
Dogan B. Dermatological manifestations in hepatitis B surface antigen carriers in east region of Turkey. J Eur Acad Dermatol Venereol. 2005;19:323–5.PubMed
71.
Bokor-Bratic M. Lack of evidence of hepatic disease in patients with oral lichen planus in Serbia. Oral Dis. 2004;10:283–6.PubMed
72.
Löhr H, Goergen B, Weber W, Gödderz W, Meyer zum Büschenfelde KH, Gerken G. Mixed cryoglobulinemia type II in chronic hepatitis B associated with HBe-minus HBV mutant: cellular immune reactions and response to interferon treatment. J Med Virol. 1994;44:330–5.PubMed
73.
Levo Y, Gorevic PD, Kassab HJ, Zucker-Franklin D, Franklin EC. Association between hepatitis B virus and essential mixed cryoglobulinemia. N Engl J Med. 1977;296:1501–4.PubMed
74.
McMahon BJ, Alberts SR, Wainwright RB, Bulkow L, Lanier AP. Hepatitis B-related sequelae. Prospective study in 1400 hepatitis B surface antigen-positive Alaska native carriers. Arch Intern Med. 1990;150:1051–4.PubMed
75.
Yamazaki T, Akimoto T, Okuda K, Sugase T, Takeshima E, Numata A, et al. Purpura with ulcerative skin lesions and mixed cryoglobulinemia in a quiescent hepatitis B virus carrier. Intern Med. 2014;53:115–9.PubMed
76.
Nath A, Agarwal R, Malhotra P, Varma S. Prevalence of hepatitis B virus infection in non-Hodgkin lymphoma: a systematic review and meta-analysis. Intern Med J. 2010;40:633–41.PubMed
77.
•• Engels EA, Cho ER, Jee SH, Hepatitis B. virus infection and risk of non-Hodgkin lymphoma in South Korea: a cohort study. Lancet Oncol. 2010;11:827–34. Large Korean prospective cohort study evaluating the risk of non-Hodgkin lymphoma over 14 years of follow-up among patients with chronic HBV infection. PubMedPubMedCentral
78.
Becker N, Schnitzler P, Boffetta P, Brennan P, Foretova L, Maynadié M, et al. Hepatitis B virus infection and risk of lymphoma: results of a serological analysis within the European case-control study Epilymph. J Cancer Res Clin Oncol. 2012;138:1993–2001.PubMed
79.
Dalia S, Chavez J, Castillo JJ, Sokol L. Hepatitis B infection increases the risk of non-Hodgkin lymphoma: a meta-analysis of observational studies. Leuk Res. 2013;37:1107–15.PubMed
80.
Tsukada N, Koh CS, Inoue A, Yanagisawa N. Demyelinating neuropathy associated with hepatitis B virus infection. Detection of immune complexes composed of hepatitis B virus surface antigen. J Neurol Sci. 1987;77:203–16.PubMed
81.
Ray G, Ghosh B, Bhattacharyya R. Acute Hepatitis B presenting as Guillain-Barré syndrome. Indian J Gastroenterol. 2003;22:228.PubMed
82.
Yimam KK, Merriman RB, Todd Frederick R. A rare case of acute hepatitis B virus infection causing Guillain-Barré syndrome. Gastroenterol Hepatol (N Y). 2013;9:121–3.
83.
McMahon BJ, Helminiak C, Wainwright RB, Bulkow L, Trimble BA, Wainwright K. Frequency of adverse reactions to hepatitis B vaccine in 43,618 persons. Am J Med. 1992;92:254–6.PubMed
84.
Baxter R, Bakshi N, Fireman B, Lewis E, Ray P, Vellozzi C, et al. Lack of association of Guillain-Barre syndrome with vaccinations. Clin Infect Dis. 2013;57:197–204.PubMed
85.
• Pakpoor J, Noyce A, Goldacre R, Selkihova M, Mullin S, Schrag A, et al. Viral hepatitis and Parkinson disease: a national record-linkage study. Neurology. 2017 Apr 25;88(17):1630–1633. A recent retrospective cohort study reporting a significant association between HBV infection and Parkinson disease. PubMed
86.
Grob PJ, Martenet AC, Witmer R. Nonspecific immune parameters and hepatitis B antigens in patients with uveitis. Mod Probl Ophthalmol. 1976;16:254–8.PubMed
87.
Murray PI, Prasad J, Rahi AH. Status of hepatitis B virus in the aetiology of uveitis in Great Britain. Br J Ophthalmol. 1983;67:685–7.PubMedPubMedCentral
88.
Murray PI, Waite J, Rahi AH, Tedder RS. Acute anterior uveitis and hepatitis B virus infection. Br J Ophthalmol. 1984;68:595–7.PubMedPubMedCentral
89.
Cacoub P, Saadoun D, Bourlière M, Khiri H, Martineau A, Benhamou Y, et al. Hepatitis B virus genotypes and extrahepatic manifestations. J Hepatol. 2005;43:764–70.PubMed
Metadata
Title
Extrahepatic Manifestations of Chronic Hepatitis B Infection
Authors
Victor Virlogeux
Christian Trépo
Publication date
01-09-2018
Publisher
Springer US
Published in
Current Hepatology Reports / Issue 3/2018
Electronic ISSN: 2195-9595
DOI
https://doi.org/10.1007/s11901-018-0403-0

Other articles of this Issue 3/2018

Current Hepatology Reports 3/2018 Go to the issue

Portal Hypertension (J Gonzalez-Abraldes and E Tsochatzis, Section Editors)

Treatment of Gastro-Fundal Varices (Including a Discussion of BRTO)

Drug-Induced Liver Injury (NP Chalasani and MS Ghabril, Section Editors)

Drug-Induced Fatty Liver Disease

Drug-Induced Liver Injury (NP Chalasani and MS Ghabril, Section Editors)

Novel Approaches to Causality Adjudication in Drug-Induced Liver Disease

Drug-Induced Liver Injury (NP Chalasani and MS Ghabril, Section Editors)

Uncommon Presentations of Idiosyncratic Drug-Induced Liver Injury

Autoimmune, Cholestatic, and Biliary Diseases (S Gordon and C Bowlus, Section Editors)

Management of Autoimmune Hepatitis Patients Refractory to or Intolerant of Standard Therapies

Invited Commentary

Knowns and Unknowns: the Safety and Efficacy of Cancer Immunotherapy in Chronic Liver Disease

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits