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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introducci&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">La inhibici&#243;n de la aldosterona forma parte esencial del tratamiento de base de la insuficiencia cardiaca &#40;IC&#41; sist&#243;lica&#46; En concreto&#44; espironolactona y eplerenona han demostrado un claro beneficio en la morbimortalidad de estos pacientes<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1&#8211;3</span></a>&#44; de manera que las gu&#237;as europeas y americanas recomiendan su uso en todos los pacientes con IC sintom&#225;tica &#40;clase funcional II de la NYHA o superior&#41;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Varios estudios han demostrado que el tratamiento con un f&#225;rmaco inhibidor de la aldosterona puede reducir la fibrosis mioc&#225;rdica y el estr&#233;s oxidativo&#44; y mejorar los par&#225;metros ecocardiogr&#225;ficos relacionados con la funci&#243;n diast&#243;lica mioc&#225;rdica<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6&#8211;9</span></a>&#46; As&#237; mismo&#44; la espironolactona es el primer f&#225;rmaco que ha demostrado mejorar la funci&#243;n diast&#243;lica y el remodelado ventricular izquierdo en los pacientes con <span class="elsevierStyleItalic">ICFEP &#40;insuficiencia cardiaca con fracci&#243;n de eyecci&#243;n preservada&#41;</span><a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a>&#46; Sin embargo&#44; la evidencia sobre el beneficio de esta terapia en la ICFEP en cuanto a morbimortalidad es escasa y controvertida<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es analizar la prescripci&#243;n de espironolactona y su implicaci&#243;n pron&#243;stica durante un a&#241;o de seguimiento en una cohorte de pacientes de la vida real con ICFEP procedentes de los servicios de Medicina Interna&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pacientes y m&#233;todos</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Selecci&#243;n de pacientes</span><p id="par0045" class="elsevierStylePara elsevierViewall">Los datos de los pacientes fueron recogidos entre el 9 de marzo de 2008 y el 31 de enero del 2013 a trav&#233;s del Registro Nacional de Insuficiencia Cardiaca &#40;RICA&#41;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">12&#8211;14</span></a> coordinado por el Grupo de Trabajo de Insuficiencia Cardiaca de la Sociedad Espa&#241;ola de Medicina Interna&#46; Este es un estudio multic&#233;ntrico prospectivo y de cohortes que incluye datos de 52 hospitales p&#250;blicos y privados en Espa&#241;a&#44; que entraron en el estudio de manera voluntaria&#46; El protocolo del estudio fue aprobado por el Comit&#233; de &#201;tica del Hospital Universitario Reina Sof&#237;a de C&#243;rdoba&#44; y se obtuvo un consentimiento informado de todos los pacientes antes de su inclusi&#243;n en el estudio de acuerdo a los requerimientos de los Comit&#233;s &#201;ticos de cada hospital&#46; Se incluyeron todos los pacientes ingresados en Unidades de Medicina Interna por IC descompensada y que estuvieran a cargo de m&#233;dicos que participaban en el registro&#44; de los cuales solo aquellos que ten&#237;an una ICFEP &#40;considerado cuando la fracci&#243;n de eyecci&#243;n era superior al 50&#37;&#41; fueron incluidos en el presente estudio&#46; Adem&#225;s de dar su consentimiento informado&#44; los pacientes ten&#237;an que reunir los siguientes criterios&#58; ser mayor de 50 a&#241;os y haber ingresado por IC descompensada seg&#250;n los criterios de la <span class="elsevierStyleItalic">European Society of Cardiology</span><a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se consideraron criterios de exclusi&#243;n la IC debida a hipertensi&#243;n pulmonar&#44; la negaci&#243;n a participar en el estudio y el fallecimiento durante el ingreso &#237;ndice&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Los pacientes fueron incluidos en el registro en el momento de ingresar por IC&#46; El seguimiento consisti&#243; en un m&#237;nimo de dos visitas programadas a los tres y a los doce meses&#46; Se permit&#237;an visitas adicionales&#44; siempre que fuera necesario y seg&#250;n precisara la situaci&#243;n cl&#237;nica del paciente&#46; Las variables de valoraci&#243;n fueron los ingresos hospitalarios y el fallecimiento por todas las causas&#44; as&#237; como la combinaci&#243;n de ambos eventos&#44; las cuales se registraron en las visitas ambulatorias durante el a&#241;o de seguimiento&#46; Los datos fueron recogidos en la p&#225;gina web&#58; <a href="http://www.registrorica.org/">http&#58;&#47;&#47;www&#46;registrorica&#46;org</a>&#44; que contiene la base de datos&#44; siendo precisa una contrase&#241;a para el acceso a la misma&#46; La confidencialidad est&#225; garantizada ya que ning&#250;n dato personal fue almacenado&#44; excepto la fecha de nacimiento y las iniciales del nombre para evitar la duplicaci&#243;n de datos&#46; En el estudio actual se incluyeron los datos de aquellos pacientes que cumplieron un a&#241;o de seguimiento&#44; y de aquellos pacientes que fallecieron o reingresaron durante ese tiempo&#46; Se realiz&#243; una monitorizaci&#243;n central de los datos para control de calidad de los mismos&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables de estudio</span><p id="par0060" class="elsevierStylePara elsevierViewall">El registro incluy&#243; datos sociodemogr&#225;ficos&#44; antecedentes cl&#237;nicos&#44; comorbilidades &#40;&#237;ndice de Charlson&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">16</span></a>&#44; el estado para las actividades b&#225;sicas de la vida diaria &#40;&#237;ndice de Barthel&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a> previo a la descompensaci&#243;n que motiv&#243; el ingreso &#40;rango 0-100&#41;&#44; datos cl&#237;nicos &#40;presi&#243;n arterial&#44; frecuencia cardiaca&#44; peso y altura&#41;&#44; complicaciones durante el ingreso y tratamiento prescrito al alta de hospitalizaci&#243;n&#46; Con respecto a la severidad de la IC se valor&#243; la clase funcional previa al ingreso &#237;ndice &#40;escala de <span class="elsevierStyleItalic">New York Heart Association</span> &#91;NYHA&#93;&#41;&#44; la fracci&#243;n de eyecci&#243;n del ventr&#237;culo izquierdo &#40;FEVI&#41; se valor&#243; mediante ecocardiograf&#237;a y se consider&#243; preservada si era mayor o igual al 50&#37;&#46; El &#237;ndice cardiaco se determin&#243; mediante una placa de t&#243;rax&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En la primera determinaci&#243;n anal&#237;tica al ingreso se recogieron variables bioqu&#237;micas que incluyeron funci&#243;n renal&#44; perfiles lip&#237;dico y gluc&#233;mico&#44; &#225;cido &#250;rico&#44; troponina&#44; iones&#44; hemoglobina y p&#233;ptidos natriur&#233;ticos cuando estaban disponibles&#46; El filtrado glomerular renal estimado se calcul&#243; utilizando la ecuaci&#243;n <span class="elsevierStyleItalic">Modification of Diet in Renal Disease</span>&#44; definiendo disfunci&#243;n renal cuando el filtrado glomerular renal estimado era menor de 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min por 1&#44;73 m<span class="elsevierStyleSup">2</span>&#46; Se recogi&#243; la medicaci&#243;n al alta de los pacientes incluyendo inhibidores de la enzima convertidora de angiotensina&#44; antagonistas del receptor de angiotensina &#40;ARA II&#41;&#44; betabloqueantes&#44; diur&#233;ticos&#44; digoxina&#44; estatina y f&#225;rmacos antivitamina K&#46; Los pacientes se dividieron en dos grupos&#58; pacientes en los que incluyera espironolactona en el tratamiento al alta y pacientes en los que no incluyera al alta tal f&#225;rmaco&#46; Se recogi&#243; la tasa de mortalidad y reingresos en un a&#241;o de seguimiento desde el momento del alta hospitalaria&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de la muestra utilizando media y desviaci&#243;n est&#225;ndar para las variables cuantitativas y porcentaje para las variables categ&#243;ricas&#46; Los pacientes fueron divididos en dos grupos&#58; pacientes en tratamiento con espironolactona y pacientes sin tratamiento con espironolactona al alta hospitalaria&#44; y se compararon las caracter&#237;sticas basales de ambos grupos utilizando las pruebas de Anova y de Chi-cuadrado para las variables cuantitativas y categ&#243;ricas respectivamente&#46; Se analiz&#243; la mortalidad&#44; los reingresos y la combinaci&#243;n de mortalidad&#47;reingresos a un a&#241;o de seguimiento en los dos grupos de pacientes&#44; y mediante el m&#233;todo de Kaplan-Meier se realizaron las curvas de eventos acumulados para observar las diferencias pron&#243;sticas entre los dos grupos&#46; Se realiz&#243; un an&#225;lisis multivariante de riesgos proporcionales de regresi&#243;n de &#91;Cox&#93; por el m&#233;todo hacia atr&#225;s condicional para las variables que en el an&#225;lisis univariante mostraban una relaci&#243;n significativamente estad&#237;stica con la probabilidad de reingreso o muerte&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El nivel de significaci&#243;n estad&#237;stica se estableci&#243; en p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Para el an&#225;lisis de los datos se utiliz&#243; el paquete estad&#237;stico IBM SPSS &#40;Statistic versi&#243;n 21&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Muestra de pacientes analizados</span><p id="par0080" class="elsevierStylePara elsevierViewall">La cohorte de este estudio incluye 1212 pacientes con ICFEP de un total de 2051 pacientes &#40;59&#37;&#41; dados de alta tras un ingreso por descompensaci&#243;n por IC&#44; y que tras el alta fallecieron o tuvieron un seguimiento de al menos un a&#241;o&#46; La edad media de nuestros pacientes fue de 79 a&#241;os &#40;desviaci&#243;n est&#225;ndar 7&#44;9&#41; existiendo un predominio de mujeres &#40;64&#44;1&#37;&#41;&#44; y siendo la cardiopat&#237;a hipertensiva la etiolog&#237;a predominante de la IC &#40;50&#44;7&#37;&#41;&#46; Las caracter&#237;sticas basales y las diferencias seg&#250;n recibieran tratamiento &#40;26&#44;7&#37;&#41; o no &#40;73&#44;3&#37;&#41; con espironolactona al alta se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Caracter&#237;sticas de los pacientes en el momento del alta hospitalaria</span><p id="par0085" class="elsevierStylePara elsevierViewall">No hubo diferencias entre ambos grupos en cuanto a la edad media y al g&#233;nero&#46; La prevalencia de fibrilaci&#243;n auricular fue significativamente m&#225;s elevada en el grupo de espironolactona &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Otros par&#225;metros m&#225;s frecuentes en este grupo&#44; aunque sin alcanzar la significaci&#243;n estad&#237;stica&#44; fueron diabetes&#44; hipertensi&#243;n arterial y dislipemia&#46; As&#237; mismo&#44; en los pacientes que tomaron espironolactona hubo una tendencia no significativa a presentar cifras menores de hemoglobina y mayor filtrado glomerular &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">En cuanto a los s&#237;ntomas por IC&#44; los pacientes tratados con espironolactona presentaron una clase funcional claramente m&#225;s avanzada &#40;50&#37; en clase funcional III-IV de la NYHA&#44; frente al 33&#37; de los pacientes que no tomaron espironolactona&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Tampoco hubo diferencias entre ambos grupos en la medicaci&#243;n cardiovascular concomitante&#44; salvo en la prescripci&#243;n de diur&#233;ticos de asa&#44; digoxina y antivitamina K&#44; que fue m&#225;s elevada en el grupo de espironolactona &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Prescripci&#243;n de espironolactona y tasa de eventos durante el seguimiento</span><p id="par0100" class="elsevierStylePara elsevierViewall">Los pacientes que recibieron tratamiento con antagonistas de la aldosterona presentaron una mayor tasa de reingresos al a&#241;o &#40;44&#44;3 vs&#46; 29&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; al igual que del objetivo combinado de reingresos&#47;&#233;xitus &#40;39&#44;0 vs&#46; 29&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1 y 2</a>&#41;&#46; En la variable de mortalidad al a&#241;o se obtuvo un peor resultado en los paciente tratados &#40;19&#44;5 vs&#46; 17&#44;5&#37;&#41; sin alcanzar diferencias estad&#237;sticamente significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Por otra parte&#44; las concentraciones s&#233;ricas de potasio fueron estad&#237;sticamente m&#225;s elevadas en el seguimiento a los 3&#44; 6 y 12 meses en los pacientes con espironolactona &#40;4&#44;56 vs&#46; 4&#44;43&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#59; 4&#44;61 vs&#46; 4&#44;44&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019 y 4&#44;60 vs&#46; 4&#44;50&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">An&#225;lisis multivariante de los factores predictores de mortalidad</span><p id="par0105" class="elsevierStylePara elsevierViewall">Los resultados del an&#225;lisis multivariante mostraron una tendencia no significativa entre la administraci&#243;n de espironolactona y un incremento de la variable combinada de mortalidad o reingresos hospitalarios &#40;RR 1&#44;9&#59; IC 95&#37; 0&#44;9-1&#44;4&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;07&#41;&#46; Adem&#225;s del uso de espironolactona&#44; otros factores que se asociaron con un aumento del evento combinado fueron el sexo masculino &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#44; un IMC<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; la disminuci&#243;n del filtrado glomerular &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; una clase funcional m&#225;s avanzada de la NYHA &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; hiperlipidemia &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;036&#41;&#44; hipertrofia ventricular izquierda &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41; y el tratamiento con f&#225;rmacos antivitamina K &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;047&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En cuanto a los reingresos&#44; el an&#225;lisis multivariante demostr&#243; que al corregir por edad&#44; &#237;ndice de masa corporal&#44; funci&#243;n renal&#44; toma de diur&#233;ticos&#44; clase funcional de la NYHA e hiperlipidemia&#44; la relaci&#243;n entre espironolactona y los reingresos segu&#237;a mostrando significaci&#243;n estad&#237;stica&#46; As&#237; espironolactona de forma significativa&#44; se asoci&#243; a un riesgo de reingresos aumentado en un 40&#37; con una confianza del 95&#37; &#40;RR 1&#44;4&#59; IC 95&#37; 1&#44;16-1&#44;78&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discusi&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">Los resultados del presente an&#225;lisis en pacientes de edad avanzada con ICFEP&#44; a diferencia de lo descrito en otras cohortes de pacientes de caracter&#237;sticas similares en los que la prescripci&#243;n de inhibidores de la aldosterona no se asoci&#243; con mayor mortalidad ni mayor tasa de reingresos<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a>&#44; demuestran que el uso de espironolactona se asocia a un incremento de los reingresos por todas las causas y a un aumento significativo del objetivo combinado de reingresos y muerte&#46; Sin embargo&#44; el uso de espironolactona no tuvo influencia en la mortalidad total&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La aldosterona&#44; agonista mineralocorticoide&#44; posee actividad fibr&#243;tica e hipertr&#243;fica asociada a un peor pron&#243;stico cardiovascular<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a>&#46; Los f&#225;rmacos inhibidores de la aldosterona han demostrado mejorar la mortalidad y los reingresos en los pacientes con ICFEP<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; Sin embargo&#44; en este estudio dichos f&#225;rmacos no han demostrado mejorar el pron&#243;stico en los pacientes con ICFEP&#46; Estos efectos tan discordantes son similares a lo ocurrido con otros f&#225;rmacos como los IECA o ARAII que tampoco demostraron beneficios en los pacientes con ICFEP<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">20&#8211;22</span></a>&#46; Estas diferencias pueden deberse a la mayor comorbilidad de los pacientes con ICFEP y a las diferencias en las causas de mortalidad entre ambos grupos&#44; siendo la causa cardiovascular y por insuficiencia cardiaca m&#225;s frecuente en los pacientes con ICFEP<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Recientemente&#44; se han publicado los resultados del ensayo cl&#237;nico TOPCAT &#40;Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist&#41; en el que tras una media de seguimiento de 3&#44;3 a&#241;os&#44; no hubo diferencias estad&#237;sticamente significativas en el objetivo principal combinado de muerte cardiovascular&#44; parada cardiorrespiratoria recuperada u hospitalizaciones por IC &#40;18&#44;6 vs&#46; 20&#44;4&#37;&#59; HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;89&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37; 0&#44;77-1&#44;04&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;138&#41;&#46; Sin embargo&#44; s&#237; hubo una reducci&#243;n significativa de la hospitalizaci&#243;n por IC en el grupo de pacientes con espironolactona &#40;12 vs&#46; 14&#44;2&#37;&#59; HR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;83&#59; IC 0&#44;69-0&#44;99&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Nuestra cohorte es una muestra representativa de los pacientes con ICFEP en la vida real&#58; edad avanzada&#44; etiolog&#237;a predominante hipertensiva&#44; comorbilidad marcada y mayor porcentaje de mujeres&#44; y presenta claras diferencias respecto al estudio TOPCAT&#46; En concreto&#44; los enfermos del registro RICA son de edad m&#225;s avanzada &#40;10 a&#241;os superior&#41; y presentan mayor comorbilidad que los incluidos en el estudio TOPCAT&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Una posible explicaci&#243;n del incremento en los reingresos de los pacientes tratados con espironolactona en el registro RICA podr&#237;a ser la aparici&#243;n de hiperpotasemia durante el seguimiento&#44; como se ha constatado en otros estudios<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; Lamentablemente&#44; en el registro RICA no se recogi&#243; espec&#237;ficamente la hiperpotasemia como causa de reingreso&#46; Por otra parte&#44; debe destacarse que no se detect&#243; un empeoramiento significativo de la funci&#243;n renal en los pacientes tratados con espironolactona&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Debemos destacar que el presente estudio ha sido realizado sobre un amplio grupo de pacientes que representan la realidad de los pacientes ingresados sin los sesgos de selecci&#243;n y exclusi&#243;n que se pueden llevar a cabo en los ensayos cl&#237;nicos&#46; Entre las limitaciones&#44; debe comentarse que &#250;nicamente se seleccionaron pacientes en tratamiento con espironolactona&#44; desconoci&#233;ndose los pacientes en tratamiento con eplerenona&#44; por lo que el presente estudio no se puede generalizar a todos los f&#225;rmacos inhibidores de la aldosterona&#46; Adem&#225;s&#44; no se diferenciaron dosis y &#250;nicamente se incluy&#243; a pacientes que al alta se encontraban con espironolactona sin especificar si los pacientes estuvieron con dicho f&#225;rmaco antes o durante el ingreso&#44; o se produjo su suspensi&#243;n&#44; inicio o cambio de dosis del mismo durante el seguimiento&#46; No se diferenciaron las causas de mortalidad ni de reingresos&#44; por lo que no se puede especificar entre causas de origen cardiovascular&#44; por otras causas&#44; o por hiperpotasemia secundaria al uso de espironolactona&#46; Finalmente&#44; se debe comentar que se trata de un estudio observacional&#44; en el que el uso de espironolactona no fue controlado&#44; por lo que sus resultados deber&#237;an confirmarse mediante un ensayo cl&#237;nico aleatorizado&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0145" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        2 => array:3 [
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          "titulo" => "Abstract"
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            0 => array:2 [
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            1 => array:2 [
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            0 => array:2 [
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              "titulo" => "Selecci&#243;n de pacientes"
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              "titulo" => "Variables de estudio"
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          "secciones" => array:4 [
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              "titulo" => "Muestra de pacientes analizados"
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            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Caracter&#237;sticas de los pacientes en el momento del alta hospitalaria"
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            2 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Prescripci&#243;n de espironolactona y tasa de eventos durante el seguimiento"
            ]
            3 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "An&#225;lisis multivariante de los factores predictores de mortalidad"
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          "titulo" => "Discusi&#243;n"
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          "titulo" => "Agradecimientos"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-09-30"
    "fechaAceptado" => "2014-12-14"
    "PalabrasClave" => array:2 [
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          "identificador" => "xpalclavsec557434"
          "palabras" => array:4 [
            0 => "Insuficiencia cardiaca diast&#243;lica"
            1 => "Espironolactona"
            2 => "Antagonistas de la aldosterona"
            3 => "Pron&#243;stico"
          ]
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Diastolic heart failure"
            1 => "Spironolactone"
            2 => "Aldosterone antagonists"
            3 => "Prognosis"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los inhibidores de la aldosterona han demostrado ser beneficiosos en pacientes con insuficiencia cardiaca sist&#243;lica&#46; Sin embargo&#44; la evidencia en enfermos con insuficiencia cardiaca y fracci&#243;n de eyecci&#243;n preservada &#40;ICFEP&#41; es muy limitada&#46; Hemos evaluado el protagonismo de la espironolactona en el pron&#243;stico de una cohorte de pacientes con ICFEP&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Analizamos la evoluci&#243;n de los pacientes ingresados por ICFEP en 52 servicios de Medicina Interna del Registro espa&#241;ol RICA seg&#250;n la toma o no de espironolactona&#46; Se recogi&#243; la tasa de mortalidad poshospitalaria y reingresos a un a&#241;o&#44; y se realiz&#243; un an&#225;lisis de supervivencia multivariante&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 1212 pacientes con ICFEP con una edad media de 79 a&#241;os &#40;desviaci&#243;n est&#225;ndar 7&#44;9&#41;&#44; &#40;64&#44;1&#37; mujeres&#41;&#44; la mayor&#237;a con cardiopat&#237;a hipertensiva &#40;50&#44;7&#37;&#41;&#46; Los pacientes tratados con espironolactona&#44; en comparaci&#243;n con los que no recibieron este diur&#233;tico&#44; presentaron una clase funcional m&#225;s avanzada&#44; mayor n&#250;mero de reingresos &#40;44&#44;3 vs&#46; 29&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; y mayor tasa en la variable combinada de reingresos&#47;mortalidad &#40;39&#44;0 vs&#46; 29&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En el an&#225;lisis multivariante&#44; la administraci&#243;n de espironolactona se asoci&#243; a un aumento de los reingresos &#40;RR 1&#44;4&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#44; 1&#44;16-1&#44;78&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En pacientes con ICFEP&#44; la administraci&#243;n de espironolactona se asoci&#243; a un incremento de los reingresos por cualquier causa&#44; tal vez en relaci&#243;n con la mayor tasa de hiperpotasemia&#46;</p></span>"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Pacientes y m&#233;todos"
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          2 => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Aldosterone inhibitors have been shown to be beneficial for patients with systolic heart failure&#46; However&#44; the evidence from patients with heart failure and preserved ejection fraction &#40;HFPEF&#41; is limited&#46; We evaluated the role of spironolactone in the prognosis of a cohort of patients with HFPEF&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We analyzed the outcomes of patients hospitalized for HFPEF in 52 departments of internal medicine of the Spanish RICA registry according to those who did and did not take spironolactone&#46; We recorded the posthospital mortality rate and readmissions at 1 year and performed a multivariate survival analysis&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We included 1212 patients with HFPEF&#44; with a mean age of 79 years &#40;standard deviation&#44; 7&#46;9&#41;&#44; &#40;64&#46;1&#37; women&#41;&#44; the majority of whom had hypertensive heart disease &#40;50&#46;7&#37;&#41;&#46; The patients treated with spironolactone&#44; compared with those who were not treated with this diuretic&#44; had a more advanced functional class&#44; a higher number of readmissions &#40;44&#46;3 vs&#46; 29&#46;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">0</span>&#46;001&#41; and a higher rate in the combined variable of readmissions&#47;mortality &#40;39&#46;0 vs&#46; 29&#46;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">0</span>&#46;001&#41;&#46; In the multivariate analysis&#44; the administration of spironolactone was associated with an increase in readmissions &#40;RR&#44; 1&#46;4&#59; 95&#37; CI&#44; 1&#46;16-1&#46;78&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">0</span>&#46;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">For patients with HFPEF&#44; the administration of spironolactone was associated with an increase in all-cause readmission&#44; perhaps due to the higher rate of hyperpotassemia&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">M&#225;s informaci&#243;n sobre los componentes del registro RICA est&#225; disponible en el <a class="elsevierStyleCrossRef" href="#sec0075">Ap&#233;ndice</a>&#46;</p>"
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            "apendice" => "<p id="par0155" class="elsevierStylePara elsevierViewall">Anarte L&#44; Aramburu O&#44; Ar&#233;valo-Lorido JC&#44; Bas F&#44; Carrera M&#44; Ceresuela LM&#44; Cerqueiro JM&#44; Conde A&#44; D&#225;vila MF&#44; D&#237;ez-Manglano J&#44; Epelde F&#44; Formiga F&#44; Franco J&#44; Gallego J&#44; Gonz&#225;lez-Franco A&#44; Llacer P&#44; L&#243;pez-Castellanos G&#44; Manzano L&#44; Mendoza HF&#44; Montero-P&#233;rez-Barquero M&#44; Murado I&#44; Oropesa R&#44; P&#233;rez-Bocanegra C&#44; P&#233;rez-Calvo JI&#44; Quesada MA&#44; Ruiz-Laiglesia F&#44; Ruiz Ortega R&#44; S&#225;nchez-Marteles M&#44; S&#225;nchez-S&#225;nchez C&#44; Satu&#233; JA&#44; Soldevila L&#44; Su&#225;rez I&#44; Trull&#225;s JC&#46;</p>"
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            "titulo" => "Miembros del Registro RICA&#58;"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Curva de Kaplan-Meier para el reingreso de los pacientes con y sin tratamiento con espironolactona&#46; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#46;</p>"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Curva de Kaplan-Meier para mortalidad por todas las causas o reingreso de los pacientes con y sin tratamiento con espironolactona&#46; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Todos N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1212&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Con espironolactona N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>323&#59; 26&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#44;3 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#44;3 &#40;10&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hipertensi&#243;n n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1060 &#40;87&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">274 &#40;84&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">786 &#40;88&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Diabetes n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">514 &#40;42&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">141 &#40;43&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">373 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Dislipemia n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">538 &#40;44&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">125 &#40;38&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">413 &#40;46&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">EPOC &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">308 &#40;25&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;25&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">225 &#40;25&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Fibrilaci&#243;n auricular n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">704 &#40;58&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">213 &#40;65&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">491 &#40;55&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">IAM previo n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">162 &#40;13&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;13&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119 &#40;13&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Fracci&#243;n eyecci&#243;n&#59;media &#40;DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#44;7 &#40;7&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#44;3 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#44;8 &#40;7&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">An&#225;lisis&#59; media &#40;DS&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemoglobina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;0 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#44;7 &#40;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;1 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Creatinina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;3 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;4 &#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;3 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sodio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">139&#44;0 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138&#44;5 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">139&#44;1 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Potasio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;2 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;2 &#40;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;2 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BNP &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>161&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">785 &#40;764&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">854 &#40;726&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">748 &#40;785&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ProBNP &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>494&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5340 &#40;10590&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4184 &#40;5219&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5719 &#40;11812&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">MDRD&#59; media &#40;DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#44;9 &#40;25&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#44;1 &#40;25&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#44;0 &#40;25&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Etiolog&#237;a</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hipertensi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">615 &#40;50&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138 &#40;42&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">477 &#40;53&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Isquemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">175 &#40;14&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;13&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131 &#40;14&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;712&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Valvular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">259 &#40;21&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95 &#40;29&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">164 &#40;18&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#205;ndice Barthel</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#44;1 &#40;20&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#44;1 &#40;22&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#44;8 &#40;20&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;043&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#205;ndice Charlson</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;6 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;5 &#40;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;6 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;373&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">NYHA n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">114 &#40;9&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;5&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95 &#40;10&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">642 &#40;53&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">143 &#40;44&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">499 &#40;56&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">407 &#40;33&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">143 &#40;44&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">264 &#40;29&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;3&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;5&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;3&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Tratamiento al ingreso&#46; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IECA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">566 &#40;46&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">157 &#40;48&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">409 &#40;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;430&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ARAII&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">438 &#40;36&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">126 &#40;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">312 &#40;35&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Betabloqueantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">674 &#40;55&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">189 &#40;58&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">485 &#40;55&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diur&#233;ticos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1083&#40;89&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">315 &#40;97&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">768 &#40;86&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Digoxina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">340 &#40;28&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124 &#40;38&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">216 &#40;24&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Estatinas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">466 &#40;38&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">123 &#40;38&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">343 &#40;38&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Antivitamina K&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">687 &#40;56&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">212 &#40;65&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">475 &#40;53&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab863825.png"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas basales de la muestra</p>"
        ]
      ]
      3 => array:7 [
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Variables incluidas en el an&#225;lisis&#58; espironolactona&#44; edad&#44; diabetes&#44; sexo&#44; &#237;ndice de masa corporal&#44; presi&#243;n diast&#243;lica&#44; hemoglobina&#44; estimaci&#243;n del filtrado glomerular por la f&#243;rmula MDRD&#44; sodio&#44; presi&#243;n arterial sist&#243;lica&#44; fibrilaci&#243;n auricular&#44; digoxina&#44; diur&#233;ticos&#44; clase funcional NYHA&#44; hiperlipidemia&#44; hipertrofia ventricular izquierda&#44; antagonistas vitaminaK&#44; hipertensi&#243;n&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">IC&#58; intervalo de confianza&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;IC del 95&#37;&#41;</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Espironolactona&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;191&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;981&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;447&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sexo &#40;masculino&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;045&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;503&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">IMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;967&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;951&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;984&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">TAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;988&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;998&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">MDRD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;992&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;988&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">NYHA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">NYHA II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;688&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;532&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">NYHA III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;375&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;572&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;586&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">NYHA IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;536&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;065&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;057&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hiperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;446&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">HVI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;242&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;505&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">AntivitaminaK&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;433&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;047&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis multivariante&#46; Modelo de riesgos proporcionales&#58; mortalidad o reingresos al a&#241;o</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Variables incluidas en el an&#225;lisis&#58; espironolactona&#44; edad&#44; diabetes&#44; sexo&#44; &#237;ndice de masa corporal&#44; presi&#243;n diast&#243;lica&#44; hemoglobina&#44; estimaci&#243;n del filtrado glomerular por la f&#243;rmula MDRD&#44; sodio&#44; presi&#243;n arterial sist&#243;lica&#44; fibrilaci&#243;n auricular&#44; digoxina&#44; diur&#233;ticos&#44; clase funcional NYHA&#44; hiperlipidemia&#44; hipertrofia ventricular izquierda&#44; antagonistas vitamina K&#44; hipertensi&#243;n&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">IC&#58; intervalo de confianza&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;IC del 95&#37;&#41;</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Espironolactona&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;444&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;167&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;787&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Edad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;982&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;970&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">IMC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">MDRD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;993&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;591&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;527&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;111&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;053&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;578&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;014&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis multivariante&#46; Modelo de riesgos proporcionales&#58; reingresos al a&#241;o</p>"
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#191;Qu&#233; sabemos&#63;</span><p id="par0010" class="elsevierStylePara elsevierViewall">Los inhibidores de la aldosterona son eficaces en paciente con insuficiencia cardiaca y fracci&#243;n de eyecci&#243;n deprimida&#44; pero su utilidad en los enfermos con fracci&#243;n de eyecci&#243;n preservada no se ha establecido de forma concluyente&#46; El registro espa&#241;ol de insuficiencia cardiaca &#40;RICA&#41; ha permitido evaluar la relevancia pron&#243;stica de la espironolactona en pacientes con insuficiencia cardiaca y fracci&#243;n de eyecci&#243;n preservada&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">&#191;Qu&#233; aporta este estudio&#63;</span><p id="par0015" class="elsevierStylePara elsevierViewall">En una cohorte de 1212 pacientes &#40;edad media 70 a&#241;os&#41;&#44; los pacientes tratados con espironolactona&#44; en comparaci&#243;n con los que no recibieron este diur&#233;tico&#44; presentaron una mayor tasa de reingresos hospitalarios&#44; clase funcional m&#225;s avanzada y mayor tasa de reingresos y mortalidad combinada&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En el an&#225;lisis multivariante&#44; la administraci&#243;n de espironolactona se asoci&#243; a un aumento del n&#250;mero de reingresos &#40;RR&#44; 1&#44;4&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#44; 1&#44;16-1&#44;78&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los Editores</p></span></span>"
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            0 => array:3 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            1 => "F&#46; Zannad"
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                            5 => "A&#46; Perez"
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                      "doi" => "10.1056/NEJM199909023411001"
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                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "1999"
                        "volumen" => "341"
                        "paginaInicial" => "709"
                        "paginaFinal" => "717"
                        "link" => array:1 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eplerenone&#44; a selective aldosterone blocker&#44; in patients with left ventricular dysfunction after myocardial infarction"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Pitt"
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                            2 => "F&#46; Zannad"
                            3 => "J&#46; Neaton"
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                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa030207"
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                            0 => "F&#46; Zannad"
                            1 => "J&#46;J&#46; McMurray"
                            2 => "H&#46; Krum"
                            3 => "D&#46;J&#46; van Veldhuisen"
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                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1009492"
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                        "tituloSerie" => "N Engl J Med&#46;"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21073363"
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                    0 => array:2 [
                      "titulo" => "2013 ACCF&#47;AHA guideline for the management of heart failure&#58; a report of the American College of Cardiology Foundation&#47;American Heart Association Task Force on Practice Guidelines"
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                            0 => "C&#46;W&#46; Yanci"
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                            2 => "B&#46; Bozkurt"
                            3 => "J&#46; Butler"
                            4 => "D&#46;E&#46; Casey"
                            5 => "M&#46;H&#46; Drazner"
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                      "titulo" => "ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012&#58; The task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology&#46; Developed in collaboration with the Heart Failure Association &#40;HFA&#41; of the ESC"
                      "autores" => array:1 [
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                          "etal" => true
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                            0 => "J&#46;J&#46; Mc Murray"
                            1 => "S&#46; Adamopoulos"
                            2 => "S&#46;D&#46; Anker"
                            3 => "A&#46; Auricchio"
                            4 => "M&#46; B&#246;hm"
                            5 => "K&#46; Dickstein"
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                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurjhf/hfs105"
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                        "tituloSerie" => "Eur J Heart Fail&#46;"
                        "fecha" => "2012"
                        "volumen" => "14"
                        "paginaInicial" => "803"
                        "paginaFinal" => "869"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22828712"
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                    0 => array:2 [
                      "titulo" => "Effects of long-term monotherapy with eplerenone&#44; a novel aldosterone blocker&#44; on progression of left ventricular dysfunction and remodeling in dogs with heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Suzuki"
                            1 => "H&#46; Morita"
                            2 => "T&#46; Mishima"
                            3 => "V&#46;G&#46; Sharov"
                            4 => "A&#46; Todor"
                            5 => "E&#46;J&#46; Tanhehco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation&#46;"
                        "fecha" => "2002"
                        "volumen" => "106"
                        "paginaInicial" => "2967"
                        "paginaFinal" => "2972"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12460880"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mineralocorticoid receptor antagonism amioloriates left ventricular diastolic dysfunction and myocardial fibrosis in mildly symptomatic patients with idiopathic dilated cardiomyopathy&#58; a pilot study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Izawa"
                            1 => "T&#46; Murohara"
                            2 => "K&#46; Nagata"
                            3 => "S&#46; Isobe"
                            4 => "H&#46; Asano"
                            5 => "T&#46; Amano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.105.571653"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16275882"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Effect of aldosterone antagonism on myocardial dysfunction in hypertensive patients with diastolic heart failue"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46;M&#46; Mottram"
                            1 => "B&#46; Haluska"
                            2 => "R&#46; Leano"
                            3 => "D&#46; Cowly"
                            4 => "M&#46; Stowasser"
                            5 => "T&#46;H&#46; Marwick"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000138680.89536.A9"
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                        "tituloSerie" => "Circulation&#46;"
                        "fecha" => "2004"
                        "volumen" => "110"
                        "paginaInicial" => "558"
                        "paginaFinal" => "565"
                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mineralocorticoid receptor blockade improves diastolic function independent of blood pressure reduction in a transgenic model of RAAS overexpression"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Habibi"
                            1 => "V&#46;G&#46; Demarco"
                            2 => "L&#46; Ma"
                            3 => "L&#46; Pulakat"
                            4 => "W&#46;E&#46; Rainey"
                            5 => "A&#46;T&#46; Whaley-Connell"
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                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Physiol Heart Circ Physiol&#46;"
                        "fecha" => "2011"
                        "volumen" => "300"
                        "paginaInicial" => "H1484"
                        "paginaFinal" => "H1491"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21239636"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction&#58; the Aldo-DHF randomized controlled trial"
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                        0 => array:3 [
                          "colaboracion" => "Aldo-DHF Investigators"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Edelmann"
                            1 => "R&#46; Wachter"
                            2 => "A&#46;G&#46; Schmidt"
                            3 => "E&#46; Kraigher-Krainer"
                            4 => "C&#46; Colantonio"
                            5 => "W&#46; Kamke"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2013.905"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA&#46;"
                        "fecha" => "2013"
                        "volumen" => "309"
                        "paginaInicial" => "781"
                        "paginaFinal" => "791"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23443441"
                            "web" => "Medline"
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              "identificador" => "bib0175"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypertension and diastolic heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
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