array:24 [
  "pii" => "S2254887421000369"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2020.03.003"
  "estado" => "S300"
  "fechaPublicacion" => "2021-05-01"
  "aid" => "1824"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
  "copyrightAnyo" => "2020"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "edi"
  "cita" => "Rev Clin Esp. 2021;221:279-80"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0014256520301016"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2020.03.002"
      "estado" => "S300"
      "fechaPublicacion" => "2021-05-01"
      "aid" => "1824"
      "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "edi"
      "cita" => "Rev Clin Esp. 2021;221:279-80"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">EDITORIAL</span>"
        "titulo" => "Estenosis a&#243;rtica como fase final de la enfermedad valvular a&#243;rtica calcificada&#58; la punta del iceberg"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "279"
            "paginaFinal" => "280"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Aortic stenosis as the final phase of calcified aortic valve disease&#58; The tip of the iceberg"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "O&#46; de Diego, R&#46; Andrea"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "O&#46;"
                "apellidos" => "de Diego"
              ]
              1 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Andrea"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887421000369"
          "doi" => "10.1016/j.rceng.2020.03.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000369?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520301016?idApp=WRCEE"
      "url" => "/00142565/0000022100000005/v1_202105061437/S0014256520301016/v1_202105061437/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "S2254887421000370"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2020.03.004"
    "estado" => "S300"
    "fechaPublicacion" => "2021-05-01"
    "aid" => "1828"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "edi"
    "cita" => "Rev Clin Esp. 2021;221:281-2"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "The lung&#44; paradigm of point-of-care ultrasound"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "281"
          "paginaFinal" => "282"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Ecograf&#237;a pulmonar&#44; paradigma de la ecograf&#237;a cl&#237;nica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Torres Macho, G&#46; Garc&#237;a de Casasola S&#225;nchez"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Torres Macho"
            ]
            1 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Garc&#237;a de Casasola S&#225;nchez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000370?idApp=WRCEE"
    "url" => "/22548874/0000022100000005/v3_202105110748/S2254887421000370/v3_202105110748/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2254887421000345"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2020.01.007"
    "estado" => "S300"
    "fechaPublicacion" => "2021-05-01"
    "aid" => "1818"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Rev Clin Esp. 2021;221:274-8"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Brief Original</span>"
      "titulo" => "Do internists know what limitation of therapeutic effort means&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "274"
          "paginaFinal" => "278"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "&#191;Saben los internistas qu&#233; es la limitaci&#243;n del esfuerzo terap&#233;utico&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Garc&#237;a-Caballero, D&#46; Real de As&#250;a, L&#46; Garc&#237;a Olmos, B&#46; Herreros"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Garc&#237;a-Caballero"
            ]
            1 => array:2 [
              "nombre" => "D&#46;"
              "apellidos" => "Real de As&#250;a"
            ]
            2 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Garc&#237;a Olmos"
            ]
            3 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Herreros"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256520300953"
        "doi" => "10.1016/j.rce.2020.01.005"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520300953?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000345?idApp=WRCEE"
    "url" => "/22548874/0000022100000005/v3_202105110748/S2254887421000345/v3_202105110748/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Aortic stenosis as the final phase of calcified aortic valve disease&#58; The tip of the iceberg"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "279"
        "paginaFinal" => "280"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "O&#46; de Diego, R&#46; Andrea"
        "autores" => array:2 [
          0 => array:2 [
            "nombre" => "O&#46;"
            "apellidos" => "de Diego"
          ]
          1 => array:4 [
            "nombre" => "R&#46;"
            "apellidos" => "Andrea"
            "email" => array:1 [
              0 => "randrea@clinic.cat"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Instituto Cl&#237;nico Cardiovascular&#44; Hospital Cl&#237;nic Barcelona&#44; IDIBAPS&#44; Barcelona&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Estenosis a&#243;rtica como fase final de la enfermedad valvular a&#243;rtica calcificada&#58; la punta del iceberg"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Calcific aortic valve disease &#40;CAVD&#41; encompasses a wide range of aortic valve involvement&#46; This includes initial phases with cellular involvement&#44; without macroscopic changes&#44; and evolves to progressive calcification of the leaflets without affecting valve functionality &#40;aortic sclerosis&#41;&#44; and up through the onset of aortic transvalvular flow obstruction &#40;aortic stenosis&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Aortic stenosis &#40;AS&#41; is the primary valvular heart disease that most often determines the need for surgery or catheter intervention&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In addition&#44; according to current prevalence rates and demographic forecasts&#44; the number of patients with AS &#62;70 or &#62;75 years of age could double or triple over the next 50 years in developed countries&#44; as it is a disease with massive epidemiological relevance&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It is understandable that severe AS attracts the majority of medical interest within the big picture of this disease&#46; This illness directly produces multiple clinical manifestations &#40;typically dyspnoea&#44; angina and syncope&#44; but also sudden death in some cases&#41;&#44; as well as extracardiac manifestations &#40;such as gastrointestinal bleeding due to angiodysplasia or Heyde&#8217;s syndrome&#44; whose pathogenesis involves impaired platelet function and acquired von Willebrand factor depletion due to the shear stress on the blood as it passes though the stenotic valve&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Nevertheless&#44; patients with AS represent only 0&#46;4&#37; of the general population and 1&#46;7&#37; of the population &#62;65 years&#46; On the contrary&#44; the prevalence of aortic sclerosis is estimated to be 25&#37; of the population &#62;65 years and almost 50&#37; of the population &#62;85 in developed countries&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The current issue of <span class="elsevierStyleItalic">Revista Cl&#237;nica Espa&#241;ola</span> features a study by Gracia-Baena et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#44; which aims to determine the association between different cardiovascular risk factors and comorbidities with severe symptomatic aortic stenosis&#46; In the study&#44; they select as case subjects patients &#62;65 years of age referred to a tertiary referral centre for valve intervention assessment &#40;n&#8239;&#61;&#8239;102&#41; and&#44; as controls&#44; age-matched subjects&#8239;&#177;&#8239;five years and sex&#44; without known AS and from the same health care area as the case subjects &#40;n&#8239;&#61;&#8239;221&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The applied logistic regression model determines the variables of age&#44; high blood pressure&#44; smoking&#44; hypercholesterolemia&#44; and low HDL levels to be factors associated with severe symptomatic AS&#46; Regarding comorbidities&#44; those associated with the disease are&#58; history of cerebrovascular accident &#40;CVA&#41;&#44; carotid artery disease &#40;CAD&#41;&#44; history of chronic kidney disease &#40;CKD&#41; and low haemoglobin levels&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">These results coincide significantly with those obtained in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5-9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Factors that have been mentioned in the literature as associated with the risk of presenting with CAVD significantly overlap with those associated with atherosclerosis and include&#58; age&#44; male sex&#44; high blood pressure&#44; smoking&#44; hypercholesterolemia&#44; obesity&#44; metabolic syndrome&#44; diabetes&#44; and high levels of lipoprotein &#40;a&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The current observational study describes an association between the history of CVA&#44; CAD&#44; and CKD and severe symptomatic AS&#46; As the researchers point out&#44; such associations are likely more justified because all these diseases share common risk factors and represent different manifestations of cardiovascular disease&#44; rather than because there is a real causal association between them&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">On the other hand&#44; the association found between severe symptomatic AS and anaemia deserves special attention&#46; There are various mechanisms through which AS could cause anaemia&#44; such as bleeding due to gastrointestinal angiodysplasias or impaired iron absorption due to heart failure and chronic disease&#59; however&#44; beyond being able to explain its presence in patients with severe AS&#44; anaemia is a severity marker in these patients and determines a worse prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">This study confirms the results of others in the reference population and once again underscores the importance of cardiovascular risk factor control and the study of comorbidities for the development of cardiovascular disease&#46; Nevertheless&#44; as explained&#44; severe symptomatic AS is just the tip of the iceberg of CAVD&#44; a multifactorial disease that involves inflammation&#44; lipoprotein infiltration&#44; oxidation&#44; local angiotensin II overexpression&#44; and complex mineralisation and osteogenesis mechanisms with osteoblastic differentiation of valvular interstitial cells<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;10</span></a>&#59; and while this disease is often considered a dichotomy &#40;severe AS&#47;non-severe AS&#41; from the clinical perspective due to the significant repercussion of end-stage CAVD&#44; understanding it as a continuum broadens the possibilities for preventing and detecting it and slowing down its progression&#46; Therefore&#44; the fact that the Gracia-Baena<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> study establishes a comparison between patients with severe AS and patients for whom&#44; while they did not have known AS&#44; it was unknown whether they could have some degree of valvular sclerosis&#44; this limits the comparison or extrapolation of the results to patients with a lower degree of CAVD&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Currently&#44; the investigative challenge that this disease presents has shifted to the genetic field&#44; where various alterations related to CAVD have been determined and which would also contribute to explaining its heterogeneous geographic distribution&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> In terms of preventing disease development&#44; after various studies have failed in their attempts to demonstrate the efficacy of statin therapy<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> to reduce the progression of CAVD&#44; current lines of research include as treatment targets lipoprotein &#40;a&#41; and the renin-angiotensin system&#44; among others&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;15&#44;16</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">However&#44; to date there is no effective treatment to prevent or reduce CAVD progression&#46; Its diagnosis should be founded on clinical suspicion based on a detailed medical history&#44; careful auscultation and subsequent confirmation via echocardiogram&#46; Knowledge of CAVD risk factors could help clinicians by facilitating early detection and anticipating the diagnosis prior to the onset of symptoms resulting from severe AS to support intervention at the indicated time and thereby modify the prognosis&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; de Diego O&#44; Andrea R&#46; Estenosis a&#243;rtica como fase final de la enfermedad valvular a&#243;rtica calcificada&#58; la punta del iceberg&#46; Rev Clin Esp&#46; 2021&#59;221&#58;279&#8211;280&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:16 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2017 ESC&#47;EACTS Guidelines for the management of valvular heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Baumgartner"
                            1 => "V&#46; Falk"
                            2 => "J&#46;J&#46; Bax"
                            3 => "M&#46; De Bonis"
                            4 => "C&#46; Hamm"
                            5 => "P&#46;J&#46; Holm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehx391"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2017"
                        "volumen" => "38"
                        "paginaInicial" => "2739"
                        "paginaFinal" => "2786"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28886619"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calcific aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;R&#46; Lindman"
                            1 => "M&#46; Clavel"
                            2 => "P&#46; Mathieu"
                            3 => "B&#46; Iung"
                            4 => "C&#46;M&#46; Otto"
                            5 => "P&#46; Pibarot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrdp.2016.6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Dis Prim"
                        "fecha" => "2016"
                        "volumen" => "2"
                        "numero" => "116006"
                        "paginaInicial" => "1"
                        "paginaFinal" => "28"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "From clinical observation to mechanism &#8212; Heyde&#8217;s syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Loscalzo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMcibr1205363"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2012"
                        "volumen" => "367"
                        "paginaInicial" => "1954"
                        "paginaFinal" => "1956"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23150964"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factores de riesgo y comorbilidades asociadas a la estenosis a&#243;rtica grave&#58; estudio de casos y controles"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Gracia Baena"
                            1 => "I&#46; Calaf Vall"
                            2 => "M&#46; Zielonka"
                            3 => "J&#46;R&#46; Marsal Mora"
                            4 => "P&#46; Godoy"
                            5 => "F&#46; Worner Diz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2020.01.010"
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2021"
                        "volumen" => "221"
                        "paginaInicial" => "249"
                        "paginaFinal" => "257"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical factors associated with calcific aortic valve disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;F&#46; Stewart"
                            1 => "D&#46; Siscovick"
                            2 => "B&#46;K&#46; Lind"
                            3 => "J&#46;M&#46; Gardin"
                            4 => "J&#46;S&#46; Gottdiener"
                            5 => "V&#46;E&#46; Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0735-1097(96)00563-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1997"
                        "volumen" => "29"
                        "paginaInicial" => "630"
                        "paginaFinal" => "634"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9060903"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of calcific aortic valve disease in the elderly and associated risk factors&#58; a population-based study in a Mediterranean area"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Ferreira-Gonz&#225;lez"
                            1 => "J&#46; Pinar-Sopena"
                            2 => "A&#46; Ribera"
                            3 => "J&#46;R&#46; Marsal"
                            4 => "P&#46; Cascant"
                            5 => "T&#46; Gonz&#225;lez-Alujas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/2047487312451238"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Prev Cardiol"
                        "fecha" => "2012"
                        "volumen" => "20"
                        "paginaInicial" => "1022"
                        "paginaFinal" => "1030"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22679252"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors associated with calcific aortic valve degeneration in the elderly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Lindroos"
                            1 => "M&#46; Kupari"
                            2 => "J&#46; Valanne"
                            3 => "T&#46; Strandberg"
                            4 => "J&#46; Heikkil&#228;"
                            5 => "R&#46; Tilvis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/oxfordjournals.eurheartj.a060602"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "1994"
                        "volumen" => "15"
                        "paginaInicial" => "865"
                        "paginaFinal" => "870"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7925504"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correlation of serum lipids&#44; calcium&#44; and phosphorus&#44; diabetes mellitus and history of systemic hypertension with presence or absence of calcified or thickened aortic cusps or root in elderly patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46;S&#46; Aronow"
                            1 => "K&#46;S&#46; Schwartz"
                            2 => "M&#46; Koenigsberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0002-9149(87)91144-1"
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "1987"
                        "volumen" => "59"
                        "paginaInicial" => "998"
                        "paginaFinal" => "999"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence and progression of aortic valve calcium in the multi-ethnic study of atherosclerosis &#40;MESA&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;S&#46; Owens"
                            1 => "R&#46; Katz"
                            2 => "J&#46; Takasu"
                            3 => "R&#46; Kronmal"
                            4 => "M&#46;J&#46; Budoff"
                            5 => "K&#46;D&#46; O&#8217;Brien"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2009.10.071"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "701"
                        "paginaFinal" => "708"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20185020"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calcific aortic valve disease&#58; not simply a degenerative process a review and agenda for research from the National Heart and Lung and Blood Institute Aortic Stenosis Working Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;M&#46; Rajamannan"
                            1 => "F&#46;J&#46; Evans"
                            2 => "E&#46; Aikawa"
                            3 => "K&#46;J&#46; Grande-Allen"
                            4 => "L&#46;L&#46; Demer"
                            5 => "D&#46;D&#46; Heistad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.110.006767"
                      "Revista" => array:5 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2011"
                        "volumen" => "124"
                        "paginaInicial" => "1783"
                        "paginaFinal" => "1791"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anaemia in patients with aortic stenosis&#58; influence on long-term prognosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;C&#46;T&#46; Ng"
                            1 => "W&#46;K&#46;F&#46; Kong"
                            2 => "V&#46; Kamperidis"
                            3 => "M&#46; Bertini"
                            4 => "M&#46;L&#46; Antoni"
                            5 => "D&#46;Y&#46; Leung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ejhf.297"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2015"
                        "volumen" => "17"
                        "paginaInicial" => "1042"
                        "paginaFinal" => "1049"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26044286"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1386505618308542"
                          "estado" => "S300"
                          "issn" => "13865056"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Familial aggregation of calcific aortic valve stenosis in the western part of France"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Probst"
                            1 => "S&#46; Le Scouarnec"
                            2 => "A&#46; Legendre"
                            3 => "V&#46; Jousseaume"
                            4 => "P&#46; Jaafar"
                            5 => "J&#46;M&#46; Nguyen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.105.569467"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2006"
                        "volumen" => "113"
                        "paginaInicial" => "856"
                        "paginaFinal" => "860"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16461814"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Genetic associations with valvular calcification and aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Thanassoulis"
                            1 => "C&#46;Y&#46; Campbell"
                            2 => "D&#46;S&#46; Owens"
                            3 => "J&#46;G&#46; Smith"
                            4 => "A&#46;V&#46; Smith"
                            5 => "G&#46;M&#46; Peloso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1109034"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "368"
                        "paginaInicial" => "503"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23388002"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of lipid lowering with rosuvastatin on progression of aortic stenosis results of the aortic stenosis progression observation&#58; measuring effects of rosuvastatin &#40;ASTRONOMER&#41; trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;L&#46; Chan"
                            1 => "K&#46; Teo"
                            2 => "J&#46;G&#46; Dumesnil"
                            3 => "A&#46; Ni"
                            4 => "J&#46; Tam"
                            5 => "for the ASTRONOMER Investigators"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.109.900027"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2010"
                        "volumen" => "121"
                        "paginaInicial" => "306"
                        "paginaFinal" => "314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20048204"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of hypertension and renin-angiotensin system inhibitors in aortic stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Capoulade"
                            1 => "M&#46;A&#46; Clavel"
                            2 => "P&#46; Mathieu"
                            3 => "N&#46; C&#244;t&#233;"
                            4 => "J&#46;G&#46; Dumesnil"
                            5 => "M&#46; Arsenault"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/eci.12169"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Invest"
                        "fecha" => "2013"
                        "volumen" => "43"
                        "paginaInicial" => "1262"
                        "paginaFinal" => "1272"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24117162"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Angiotensin receptor blockers are associated with a lower remodelling score of stenotic aortic valves"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46; C&#244;t&#233;"
                            1 => "C&#46; Couture"
                            2 => "P&#46; Pibarot"
                            3 => "J&#46;P&#46; Despr&#233;s"
                            4 => "P&#46; Mathieu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2362.2011.02522.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Clin Invest"
                        "fecha" => "2011"
                        "volumen" => "41"
                        "paginaInicial" => "1172"
                        "paginaFinal" => "1179"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21988540"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000022100000005/v3_202105110748/S2254887421000369/v3_202105110748/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "72714"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorials"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022100000005/v3_202105110748/S2254887421000369/v3_202105110748/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000369?idApp=WRCEE"
]
Share
Journal Information
Share
Share
Download PDF
More article options
Editorial
Aortic stenosis as the final phase of calcified aortic valve disease: The tip of the iceberg
Estenosis aórtica como fase final de la enfermedad valvular aórtica calcificada: la punta del iceberg
O. de Diego, R. Andrea
Corresponding author
randrea@clinic.cat

Corresponding author.
Instituto Clínico Cardiovascular, Hospital Clínic Barcelona, IDIBAPS, Barcelona, Spain

Purchase article

For the purchase of this article it is necessary to fill in the following form:

Afganistan
Albania
Alemania
Andorra
Angola
Anguilla
Antartica
Antigua and barbuda
Antillas holandesas
Arabia saudita
Argelia
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgica
Belice
Benin
Bermudas/antillas britanicas
Bhutan
Bolivia
Bosnia y herzegowina
Botswana
Brasil
Brunei darussalam
Bulgaria
Burkina faso
Burundi
Cabo verde
Camboya
Camerun
Canada
Chad
Chile
China
Chipre
Colombia
Comoros
Corea
Costa rica
Cote d´ivoire
Croacia
Cuba
Dinamarca
Djibouti
Dominica
East timor
Ecuador
Egipto
El salvador
Emiratos arabes unidos
Eritrea
Escocia
Eslovaquia
Eslovenia
España
Estados federados de micronesia
Estados unidos
Estonia
Etiopia
Fiji
Filipinas
Finlandia
Francia
Gabon
Gambia
Georgia
Ghana
Gibraltar
Grecia
Grenada
Groenlandia
Guadalupe
Guam
Guatemala
Guayana britanica
Guinea
Guinea ecuatorial
Guinea francesa
Guinea-bissau
Haiti
Holanda
Honduras
Hong kong
Hungria
India
Indonesia
Irak
Iran
Irlanda
Isla bouvet
Isla cocos (keeling)
Isla cook
Isla mauricio
Isla navidad
Isla norfolk
Islandia
Islas caiman
Islas falkland (malvinas)
Islas faroe
Islas georgia del sur y sandwich
Islas heard and mc donald
Islas marshall
Islas northern mariana
Islas salomon
Islas svalbard and jan mayen
Islas turks and caicos
Islas united states minor outlyi
Islas virgenes (britanicas)
Islas virgenes (u.s.a.)
Islas wallis and futuna
Israel
Italia
Jamaica
Japon
Jordania
Kazakhstan
Kenia
Kiribati
Kuwait
Kyrgyzstan
Lesoto
Letonia
Libano
Liberia
Libia arab jamahiriya
Liechtenstein
Lituania
Luxemburgo
Macao
Macedonia
Madagascar
Malasia
Malawi
Maldives
Mali
Malta
Marruecos
Martinica
Mauritania
Mayotte
Mexico
Monaco
Mongolia
Monserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Nicaragua
Niger
Nigeria
Niue
Noruega
Nueva caledonia
Nueva zelanda
Oman
Pakistan
Palau
Panama
Papua new guinea
Paraguay
Peru
Pitcairn
Polinesia francesa
Polonia
Portugal
Posesiones gran bretaña
Posesiones u.s.a.
Puerto rico
Qatar
Reino unido
Republica checa
Republica de africa central
Republica de cabo verde
Republica de congo
Republica de corea
Republica de moldova
Republica democratica de laos
Republica democratica del congo
Republica dominicana
Reunion
Ruanda
Rumania
Rusia
Sahara occidental
Saint kitts and nevis
Samoa
Samoa americana
San marino
San tomas y principe
San vincent and the grenadines
Santa lucia
Senegal
Serbia
Seychelles
Sierra leona
Singapur
Siria
Somalia
Sri lanka
St. helena
St. pierre and miquelon
Sudafrica
Sudan
Suecia
Suiza
Surinam
Swaziland
Tailandia
Taiwan republica de china
Tajikistan
Tanzania
Territorio de indias britanicas
Togo
Tokelau
Tonga
Trinidad and tobago
Tunisia
Turkmenistan
Turquia
Tuvalu
Ucrania
Uganda
Uruguay
Uzbekistan
Vanuatu
Vaticano
Venezuela
Vietnam
Yemen
Yugoslavia
Zambia
Zimbawe
Lebanon
Paises bajos
A coruña
Alava
Albacete
Alicante
Almeria
Asturias
Avila
Badajoz
Balears
Barcelona
Bizkaia
Burgos
Caceres
Cadiz
Cantabria
Castellon
Ceuta
Ciudad real
Cordoba
Cuenca
Girona
Granada
Guadalajara
Guipuzcoa
Huelva
Huesca
Jaen
La rioja
Las palmas
Leon
Lleida
Lugo
Madrid
Malaga
Melilla
Murcia
Navarra
Ourense
Palencia
Pontevedra
Salamanca
Segovia
Sevilla
Soria
Tarragona
Tenerife
Teruel
Toledo
Valencia
Valladolid
Zamora
Zaragoza
-- Not applicable --
I accept to receive information about Elsevier's special products and promotions by email
I accept to receive information about products and special promotions from Elsevier partners by email
I have read and understand the Privacy Policy and Terms and conditions and agree to be bound by all of its terms.
* Required fields
In addition to temporary access to the article, it will be sent by email.
Customer Support
Phone
Calls from Spain
932 415 960
Calls from abroad
+34 932 415 960
Hours from 9 a.m. to 6 p.m. except the months of July and August, which will be from 9 am to 3 pm.
Idiomas
Revista Clínica Española (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?