PROS AND CONS
Is heart failure with midrange ejection fraction similar to preserved ejection fraction? In favor
La insuficiencia cardiaca con fracción de eyección en rango intermedio ¿es similar a la de fracción de eyección preservada? A favor
M. Camafort Babkowski
Servicio de Medicina Interna General, ICMiD Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
Read
10
Timeswas read the article
6
Total PDF
4
Total HTML
Share statistics
array:24 [ "pii" => "S2254887417300346" "issn" => "22548874" "doi" => "10.1016/j.rceng.2017.01.003" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1368" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2017;217:296-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "PDF" => 2 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0014256517300553" "issn" => "00142565" "doi" => "10.1016/j.rce.2017.01.013" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1368" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2017;217:296-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 66 "formatos" => array:2 [ "HTML" => 36 "PDF" => 30 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Pros y Contras</span>" "titulo" => "La insuficiencia cardiaca con fracción de eyección en rango intermedio ¿es similar a la de fracción de eyección preservada? A favor" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "296" "paginaFinal" => "298" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Is heart failure with midrange ejection fraction similar to preserved ejection fraction? For" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Camafort Babkowski" "autores" => array:1 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Camafort Babkowski" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887417300346" "doi" => "10.1016/j.rceng.2017.01.003" "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/S2254887417300346?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256517300553?idApp=WRCEE" "url" => "/00142565/0000021700000005/v1_201705300032/S0014256517300553/v1_201705300032/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2254887417300450" "issn" => "22548874" "doi" => "10.1016/j.rceng.2017.01.005" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1367" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2017;217:299-301" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "PDF" => 2 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">PROS AND CONS</span>" "titulo" => "Is heart failure with midrange ejection fraction similar to preserved ejection fraction? Against" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "299" "paginaFinal" => "301" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La insuficiencia cardiaca con fracción de eyección en rango intermedio ¿es similar a la de fracción de eyección preservada? En contra" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Formiga" "autores" => array:1 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Formiga" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256517300541" "doi" => "10.1016/j.rce.2017.01.012" "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/S0014256517300541?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887417300450?idApp=WRCEE" "url" => "/22548874/0000021700000005/v1_201705300028/S2254887417300450/v1_201705300028/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2254887417300115" "issn" => "22548874" "doi" => "10.1016/j.rceng.2016.12.008" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1353" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Rev Clin Esp. 2017;217:289-95" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "PDF" => 3 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Symposium. Polypathology</span>" "titulo" => "Polypathology, polypharmacy, medication regimen complexity and drug therapy appropriateness" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "289" "paginaFinal" => "295" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pluripatología, polifarmacia, complejidad terapéutica y uso adecuado de la medicación" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 698 "Ancho" => 1658 "Tamanyo" => 49235 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Example of prescription cascade.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Gómez Aguirre, A. Caudevilla Martínez, L. Bellostas Muñoz, M. Crespo Avellana, J. Velilla Marco, J. Díez-Manglano" "autores" => array:6 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Gómez Aguirre" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Caudevilla Martínez" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Bellostas Muñoz" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Crespo Avellana" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Velilla Marco" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Díez-Manglano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256517300267" "doi" => "10.1016/j.rce.2016.12.013" "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/S0014256517300267?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887417300115?idApp=WRCEE" "url" => "/22548874/0000021700000005/v1_201705300028/S2254887417300115/v1_201705300028/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">PROS AND CONS</span>" "titulo" => "Is heart failure with midrange ejection fraction similar to preserved ejection fraction? In favor" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "296" "paginaFinal" => "298" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M. Camafort Babkowski" "autores" => array:1 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Camafort Babkowski" "email" => array:1 [ 0 => "camafort@ub.edu" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna General, ICMiD Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La insuficiencia cardiaca con fracción de eyección en rango intermedio ¿es similar a la de fracción de eyección preservada? A favor" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The differentiation of patients with HF based on LVEF echocardiographic values is important due mainly to the fact that it helps establish 2 subtypes: HF with reduced LVEF (<40%) (HFrEF) and HF with preserved LVEF (≥50%) (HFpEF).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> The 2 conditions are differentiated in terms of demographic characteristics, etiological factors, associated comorbidities and treatment.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Patients with HFrEF are younger and have fewer comorbidities, and their fundamental etiology is ischemic heart disease. Historically, most studies designed to treat HF have focused on patients with HFrEF, with most clinical trials excluding those patients with HFpEF. Therefore, most of the therapeutic evidence (both pharmaceutical and nonpharmaceutical) has been generated from patients with a LVEF typically <35–40%.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Recently, the European Society of Cardiology has established a new category in the classification of HF based on LVEF.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> This new category is known as HF with mid-range EF (HFmEF) and encompasses all patients with LVEF between 40% and 49%, which until now constituted an undefined “gray area”.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> As with HFpEF, the evidence on its treatment is highly limited. Although this new category currently represents no more than 10%,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> the improvements in treating ischemic heart disease will increasingly lead to more patients with ischemia presenting less myocardial damage, increasing the percentage of those with HFmEF.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The patterns of the various types of HF have varying characteristics. Thus, patients with HFrEF have primary and symptomatic heart disease as the leading cause of their HF, while those with HFpEF have multiorgan disease in which various phases occur, symptomatic or not.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Therefore, when establishing whether there are similarities between HFmEF and HFpEF, we need other data (in addition to LVEF) such as natriuretic peptide levels, renal function and comorbidity data that help us make comparisons.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A study performed on 1663 patients with HF (of hypertensive, ischemic or idiopathic origin) assessed the presence of left ventricular dysfunction in each of the 3 HF categories (based on their LVEF).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Sixty-seven percent of the patients had HFrEF, 23% had HFpEF, and the remaining 10% had HFmEF. In terms of the differential characteristics between the various types of HF, the study observed that the patients with HFmEF had a systolic and diastolic blood pressure and a prevalence of atrial fibrillation similar to those with preserved LVEF. Compared with the HFrEF group, the patients with HFpEF and HFmEF had a lower percentage of cases in functional classes III and IV, lower serum BNP concentrations, lower right ventricular dysfunction (defined as tricuspid annular plane systolic excursion [TAPSE] <14%) and a lower percentage of patients with systolic pulmonary artery pressure >40<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Unlike the HFpEF group, the patients with HFmEF had more ischemic heart disease; were more frequently treated with angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, beta-blockers and spironolactone and had a greater rate of device implantation.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In another recent study, Kapoor et al. analyzed a total of 99,825 patients with HF who were hospitalized in 305 centers in the United States from 2005 to 2013.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Forty-nine percent of the patients were classified as HFrEF, 13% as HFmEF and 38% as HFpEF. The patients with HFmEF had a similar age, sex and comorbidities to those of patients with HFpEF (older, percentage of women and number of comorbidities). However, the HFmEF group had ischemic heart disease as the fundamental cause, similar to the HFrEF group.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Another aspect to consider is that patients with HFmEF do not constitute a homogeneous group because, depending on the pathophysiological mechanism, the LVEF can be the result of the recovery of previously reduced systolic function or the result of a systolic function impairment that achieves mid-range LVEF readings.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> A recent study observed that patients with recovered HFmEF had fewer cardiovascular events, as did those who had HFpEF. Nevertheless, this patient group with recovered HFmEF showed biological, epidemiological and echocardiographic characteristics different from those of the other HFpEF and HFrEF groups and could therefore constitute a type with its own identity.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> Nevertheless, one of the main criticisms of this article would be that the authors define HFpEF starting from an LVEF ≥55%. This aspect impedes the differentiation between HFmEF and HFpEF, because a consensus has still not been reached on what constitutes the normal value for LVEF.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In summary, given that normal LVEF values have not been defined and considering the pathophysiological mechanisms and clinical progression, we can conclude that HFmEF is probably similar to HFpEF. Nevertheless, the evidence is still limited for reaching a definitive conclusion on this fascinating dilemma.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:3 [ "identificador" => "xres844949" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec839875" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres844948" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec839874" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-12-19" "fechaAceptado" => "2017-01-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec839875" "palabras" => array:3 [ 0 => "Heart failure" 1 => "Diastolic dysfunction" 2 => "Left ventricular ejection fraction" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec839874" "palabras" => array:3 [ 0 => "Insuficiencia cardiaca" 1 => "Disfunción diastólica" 2 => "Fracción de eyección de ventrículo izquierdo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Basing heart failure (HF) classification on the echocardiographic values of left ventricular ejection fraction (LVEF) has been useful in defining two sub-types of HF:HF with reduced LVEF and HF with preserved LVEF. A new category has recently been defined: HF with midrange LVEF (40–49%). When current information is taken into account, this new category is more similar to HF with preserved LVEF than reduced LVEF.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La clasificación de la insuficiencia cardiaca (IC) basada en los valores ecocardiográficos de la fracción de eyección del ventrículo izquierdo (FEVI) ha sido útil para definir 2 subtipos de IC: con FEVI reducida y con FEVI preservada. Recientemente se ha definido una nueva categoría, denominada IC con FEVI en rango medio (40-49%), que teniendo en cuenta la información disponible hasta el momento, posee más similitudes con la IC y FEVI preservada que reducida. No obstante, la evidencia aún es limitada para que la conclusión sea definitiva.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Camafort Babkowski M. La insuficiencia cardiaca con fracción de eyección en rango intermedio ¿es similar a la de fracción de eyección preservada? A favor. Rev Clin Esp. 2017;217:296–298.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What have we learned about patients with heart failure and preserved ejection fraction from DIG-PEF, CHARM-preserved, and I-PRESERVE" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.T. Campbell" 1 => "P.S. Jhund" 2 => "D. Castagno" 3 => "N.M. Hawkins" 4 => "M.C. Petrie" 5 => "J.J. McMurray" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2012.04.064" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2012" "volumen" => "60" "paginaInicial" => "2349" "paginaFinal" => "2356" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23141494" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.W. Yancy" 1 => "M. Jessup" 2 => "B. Bozkurt" 3 => "J. Butler" 4 => "D.E. Casey" 5 => "M.H. Drazner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIR.0b013e31829e8776" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2013" "volumen" => "128" "paginaInicial" => "e240" "paginaFinal" => "e327" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23741058" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Ponikowski" 1 => "A.A. Voors" 2 => "S.D. Anker" 3 => "H. Bueno" 4 => "J.G.F. Cleland" 5 => "A.J.S. Coats" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehw128" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2016" "volumen" => "37" "paginaInicial" => "2129" "paginaFinal" => "2200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27206819" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart failure with mid-range ejection fraction-new opportunities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L.H. Lund" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cardfail.2016.07.439" "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2016" "volumen" => "22" "paginaInicial" => "769" "paginaFinal" => "771" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27469481" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The middle child in heart failure: heart failure with mid-range ejection fraction (40–50%)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.S.P. Lam" 1 => "S.D. Solomon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ejhf.159" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2014" "volumen" => "16" "paginaInicial" => "1049" "paginaFinal" => "1055" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25210008" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Different correlates but similar prognostic implications for right ventricular dysfunction in heart failure patients with reduced or preserved ejection fraction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Ghio" 1 => "M. Guazzi" 2 => "A.B. Scardovi" 3 => "C. Klersy" 4 => "F. Clemenza" 5 => "E. Carluccio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ejhf.664" "Revista" => array:2 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2016" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Precipitating clinical factors, heart failure characterization, and outcomes in patients hospitalized with heart failure with reduced, borderline, and preserved ejection fraction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.R. Kapoor" 1 => "R. Kapoor" 2 => "C. Ju" 3 => "P.A. Heidenreich" 4 => "Z.J. Eapen" 5 => "A.F. Hernandez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jchf.2016.02.017" "Revista" => array:6 [ "tituloSerie" => "JACC Heart Fail" "fecha" => "2016" "volumen" => "4" "paginaInicial" => "464" "paginaFinal" => "472" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27256749" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart failure and midrange ejection fraction: implications of recovered ejection fraction for exercise tolerance and outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W. Nadruz" 1 => "E. West" 2 => "M. Santos" 3 => "H. Skali" 4 => "J.D. Groarke" 5 => "D.E. Forman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCHEARTFAILURE.115.002826" "Revista" => array:5 [ "tituloSerie" => "Circ Heart Fail" "fecha" => "2016" "volumen" => "9" "paginaInicial" => "e002826" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27009553" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021700000005/v1_201705300028/S2254887417300346/v1_201705300028/en/main.assets" "Apartado" => array:4 [ "identificador" => "66381" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Pros and cons" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021700000005/v1_201705300028/S2254887417300346/v1_201705300028/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887417300346?idApp=WRCEE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 4 | 4 | 8 |
| 2017 June | 0 | 1 | 1 |
| 2017 May | 0 | 1 | 1 |
