Estadísticas

 array:24 [
  "pii" => "S0014256515002751"
  "issn" => "00142565"
  "doi" => "10.1016/j.rce.2015.11.003"
  "estado" => "S300"
  "fechaPublicacion" => "2016-03-01"
  "aid" => "1215"
  "copyright" => "Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI)"
  "copyrightAnyo" => "2015"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Rev Clin Esp. 2016;216:55-61"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 232
    "formatos" => array:2 [
      "HTML" => 19
      "PDF" => 213
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:19 [
      "pii" => "S225488741500123X"
      "issn" => "22548874"
      "doi" => "10.1016/j.rceng.2015.12.002"
      "estado" => "S300"
      "fechaPublicacion" => "2016-03-01"
      "aid" => "1215"
      "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Rev Clin Esp. 2016;216:55-61"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 2
        "PDF" => 2
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
        "titulo" => "Absence of cystatin C involvement in ventricular remodelling and heart failure"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "es"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "55"
            "paginaFinal" => "61"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "es" => array:1 [
            "titulo" => "Ausencia de implicaci&#243;n de la cistatina C en el remodelado ventricular y la insuficiencia cardiaca"
          ]
        ]
        "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" => 1415
                "Ancho" => 1955
                "Tamanyo" => 561871
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry staining of myocardial tissue samples &#40;20&#215;&#41;&#46; &#40;A&#41; Contrast hematoxylin and antibody diluent &#40;check-up&#41;&#46; We can see cardiac myocytes with normal structures and weakly stained nuclei occupying a central position within the cells&#44; with background hematoxylin staining&#46; We can also see lipofuscin pigment in the poles of the nucleus &#40;Ab 20&#215;&#41;&#46; &#40;B&#41; Desmin in fetal myocardium&#58; desmin expression is much weaker than in the adult heart or is negative&#44; which likely translates into a lack of development of the sarcomeres&#46; &#40;C&#41; Desmin in adult myocardium&#58; cross striations throughout the myocardium&#59; the intercalated bands show up as darker&#46; &#40;D&#41; MMP9 in fetal myocardium&#58; the cytoplasmic immunostaining for MMP9 is positive in isolated cells in the interstitium&#46; The muscle cell cytoplasm is negative&#46; &#40;E&#41; MMP9 in adult myocardium&#58; cytoplasmic immunostaining for MMP9 in isolated cells in the interstitium&#59; the muscle cells are negative&#46; &#40;F&#41; CysC in fetal myocardium&#58; We can see a more abundant cellularity than in the adult heart&#44; with a less orderly arrangement of cells and slight cytoplasmic immunostaining of the cardiomyocytes for CysC&#46; There are some small isolated cells in the interstitium that express cystatin in their cytoplasm&#46; &#40;G&#41; CysC in adult myocardium&#58; immunostained cardiomyocytes&#44; with diffuse expression of CysC in the cytoplasm&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "J&#46;I&#46; P&#233;rez-Calvo, T&#46; Castiella Muruz&#225;bal, M&#46; B&#250;car Barjud, C&#46; Josa Laorden, M&#46; S&#225;nchez Marteles, I&#46; Lacambra Blasco, M&#46;C&#46; Asensio L&#243;pez, D&#46;A&#46; Pascual Figal"
            "autores" => array:8 [
              0 => array:2 [
                "nombre" => "J&#46;I&#46;"
                "apellidos" => "P&#233;rez-Calvo"
              ]
              1 => array:2 [
                "nombre" => "T&#46;"
                "apellidos" => "Castiella Muruz&#225;bal"
              ]
              2 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "B&#250;car Barjud"
              ]
              3 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Josa Laorden"
              ]
              4 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "S&#225;nchez Marteles"
              ]
              5 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Lacambra Blasco"
              ]
              6 => array:2 [
                "nombre" => "M&#46;C&#46;"
                "apellidos" => "Asensio L&#243;pez"
              ]
              7 => array:2 [
                "nombre" => "D&#46;A&#46;"
                "apellidos" => "Pascual Figal"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "es" => array:9 [
          "pii" => "S0014256515002751"
          "doi" => "10.1016/j.rce.2015.11.003"
          "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/S0014256515002751?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225488741500123X?idApp=WRCEE"
      "url" => "/22548874/0000021600000002/v1_201603010018/S225488741500123X/v1_201603010018/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0014256515002337"
    "issn" => "00142565"
    "doi" => "10.1016/j.rce.2015.09.007"
    "estado" => "S300"
    "fechaPublicacion" => "2016-03-01"
    "aid" => "1202"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Clin Esp. 2016;216:62-7"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 262
      "formatos" => array:2 [
        "HTML" => 13
        "PDF" => 249
      ]
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Relaci&#243;n entre funci&#243;n y volumen renal en la poliquistosis renal autos&#243;mica dominante&#58; estudio transversal"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "62"
          "paginaFinal" => "67"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Relationship between renal function and renal volume in autosomal dominant polycystic kidney disease&#58; cross-sectional study"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figura 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 924
              "Ancho" => 2540
              "Tamanyo" => 135376
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Representaci&#243;n gr&#225;fica de la asociaci&#243;n entre volumen renal total &#40;VRT&#41; vs&#46; creatinina s&#233;rica y urea en pacientes afectos de poliquistosis renal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46;J&#46; Torres-S&#225;nchez, E&#46; &#193;vila-Barranco, R&#46;J&#46; Esteban de la Rosa, R&#46; Fern&#225;ndez-Castillo, M&#46;A&#46; Esteban, J&#46;J&#46; Carrero, M&#46; Garc&#237;a-Valverde, J&#46;A&#46; Bravo-Soto"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "M&#46;J&#46;"
              "apellidos" => "Torres-S&#225;nchez"
            ]
            1 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "&#193;vila-Barranco"
            ]
            2 => array:2 [
              "nombre" => "R&#46;J&#46;"
              "apellidos" => "Esteban de la Rosa"
            ]
            3 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Fern&#225;ndez-Castillo"
            ]
            4 => array:2 [
              "nombre" => "M&#46;A&#46;"
              "apellidos" => "Esteban"
            ]
            5 => array:2 [
              "nombre" => "J&#46;J&#46;"
              "apellidos" => "Carrero"
            ]
            6 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Garc&#237;a-Valverde"
            ]
            7 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Bravo-Soto"
            ]
            8 => array:1 [
              "colaborador" => "en representaci&#243;n del Grupo para el Estudio de la Enfermedad Poliqu&#237;stica Autos&#243;mica Dominante &#40;GEEPAD&#41;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S225488741500106X"
        "doi" => "10.1016/j.rceng.2015.11.002"
        "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/S225488741500106X?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256515002337?idApp=WRCEE"
    "url" => "/00142565/0000021600000002/v1_201603010019/S0014256515002337/v1_201603010019/es/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:18 [
      "pii" => "S0014256515003008"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2015.12.001"
      "estado" => "S300"
      "fechaPublicacion" => "2016-03-01"
      "aid" => "1225"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "edi"
      "cita" => "Rev Clin Esp. 2016;216:74-5"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 159
        "formatos" => array:2 [
          "HTML" => 7
          "PDF" => 152
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "Cistatina C&#58; una pieza m&#225;s de la compleja interacci&#243;n cardiorrenal en la insuficiencia card&#237;aca"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "74"
            "paginaFinal" => "75"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Cystatin C&#58; One more component of the complex cardiorenal interaction in heart failure"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "J&#46; N&#250;&#241;ez, E&#46; Santas"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "N&#250;&#241;ez"
              ]
              1 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Santas"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256515003008?idApp=WRCEE"
      "url" => "/00142565/0000021600000002/v1_201603010019/S0014256515003008/v1_201603010019/es/main.assets"
    ]
  ]
  "es" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
    "titulo" => "Ausencia de implicaci&#243;n de la cistatina C en el remodelado ventricular y la insuficiencia cardiaca"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "55"
        "paginaFinal" => "61"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "J&#46;I&#46; P&#233;rez-Calvo, T&#46; Castiella Muruz&#225;bal, M&#46; B&#250;car Barjud, C&#46; Josa Laorden, M&#46; S&#225;nchez Marteles, I&#46; Lacambra Blasco, M&#46;C&#46; Asensio L&#243;pez, D&#46;A&#46; Pascual Figal"
        "autores" => array:8 [
          0 => array:4 [
            "nombre" => "J&#46;I&#46;"
            "apellidos" => "P&#233;rez-Calvo"
            "email" => array:1 [
              0 => "jiperez&#64;unizar&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "T&#46;"
            "apellidos" => "Castiella Muruz&#225;bal"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "B&#250;car Barjud"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Josa Laorden"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "S&#225;nchez Marteles"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Lacambra Blasco"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "M&#46;C&#46;"
            "apellidos" => "Asensio L&#243;pez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "D&#46;A&#46;"
            "apellidos" => "Pascual Figal"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Cl&#237;nico Universitario Lozano Blesa Facultad de Medicina&#44; Instituto de investigaci&#243;n Sanitaria de Arag&#243;n &#40;IIS Arag&#243;n&#41;&#44; Zaragoza&#44; Espa&#241;a"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Anatom&#237;a Patol&#243;gica&#44; Hospital Cl&#237;nico Universitario Lozano Blesa Facultad de Medicina&#44; Zaragoza&#44; Espa&#241;a"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Cl&#237;nico Universitario Lozano Blesa&#44; Instituto de investigaci&#243;n Sanitaria de Arag&#243;n &#40;IIS Arag&#243;n&#41;&#44; Zaragoza&#44; Espa&#241;a"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Cardiolog&#237;a&#44; Hospital Cl&#237;nico Universitario Lozano Blesa&#44; Zaragoza&#44; Espa&#241;a"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Cardiolog&#237;a&#44; Hospital Universitario Virgen de la Arrixaca Facultad de Medicina&#44; Murcia&#44; Espa&#241;a"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspondencia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Absence of cystatin C involvement in ventricular remodelling and heart failure"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1415
            "Ancho" => 1954
            "Tamanyo" => 575850
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Tinci&#243;n inmunohistoqu&#237;mica de las muestras de tejido mioc&#225;rdico &#40;x20&#41;&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A&#41; Hematoxilina de contraste y diluyente de anticuerpos &#40;control&#41;&#46; Se observan miocitos cardiacos de estructura normal con los n&#250;cleos te&#241;idos d&#233;bilmente ocupando una posici&#243;n central dentro de la c&#233;lula&#44; con tinci&#243;n de fondo de hematoxilina&#46; Tambi&#233;n se observa pigmento de lipofuscina en los polos del n&#250;cleo &#40;Ac x20&#41;&#46; B&#41; Desmina en miocardio fetal&#58; la expresi&#243;n de desmina es mucho m&#225;s d&#233;bil que en el coraz&#243;n adulto o es negativa traduciendo probablemente una falta de desarrollo de las sarc&#243;meras&#46; C&#41; Desmina en miocardio adulto&#58; estriaci&#243;n transversal de todo el miocardio&#59; las bandas intercalares destacan m&#225;s oscuras&#46; D&#41; MMP9 en miocardio fetal&#58; la inmunotinci&#243;n citopl&#225;smica para MMP9 es positiva en c&#233;lulas aisladas en el intersticio&#46; El citoplasma de las c&#233;lulas musculares es negativo&#46; E&#41; MMP9 en miocardio adulto&#58; inmunotinci&#243;n citopl&#225;smica para MMP9 en c&#233;lulas aisladas en el intersticio&#59; las c&#233;lulas musculares son negativas&#46; F&#41; CisC en miocardio fetal&#58; se aprecia una celularidad m&#225;s abundante que en el coraz&#243;n adulto con disposici&#243;n menos ordenada de las c&#233;lulas y una leve inmunotinci&#243;n citopl&#225;smica de los miocardiocitos para CisC&#46; Existe alguna c&#233;lula peque&#241;a aislada en el intersticio que expresa cistatina en su citoplasma&#46; G&#41; CisC en miocardio adulto&#58; cardiomiocitos inmunote&#241;idos con expresi&#243;n difusa de CisC en el citoplasma&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La cistatina C &#40;CisC&#41; es una prote&#237;na inhibidora de proteasas ricas en ciste&#237;na&#44; que est&#225; ampliamente distribuida en fluidos biol&#243;gicos humanos<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">1</span></a>&#46; Tiene un bajo peso molecular y est&#225; formada por 120 amino&#225;cidos en una cadena &#250;nica&#46; Se sintetiza como preprote&#237;na y emite un p&#233;ptido se&#241;al representativo de su funci&#243;n extracelular<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a>&#46; El gen que la codifica se localiza en el cromosoma 20<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">3</span></a> y pertenece a los denominados genes de mantenimiento <span class="elsevierStyleItalic">&#40;</span>&#171;<span class="elsevierStyleItalic">housekeeping genes&#187;&#41;</span>&#46; Por ello&#44; no existe una expresi&#243;n espec&#237;fica en ning&#250;n tejido&#44; sino que su distribuci&#243;n es ubicua &#40;ri&#241;&#243;n&#44; h&#237;gado&#44; p&#225;ncreas&#44; intestino&#44; est&#243;mago&#44; pulm&#243;n&#44; placenta y ves&#237;culas seminales&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">4</span></a>&#46; La funci&#243;n fisiol&#243;gica principal de la CisC es la regulaci&#243;n de la actividad de las ciste&#237;nas-proteasas extracelulares<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Debido a su participaci&#243;n en el equilibrio entre proteasas y antiproteasas&#44; se ha sugerido que la CisC est&#225; implicada en el remodelado tisular<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">7</span></a>&#44; la arterioesclerosis&#44; los aneurismas de aorta<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a> y la hipertrofia del ventr&#237;culo izquierdo &#40;VI&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">9</span></a> y&#44; en consecuencia&#44; en la patogenia de la insuficiencia cardiaca &#40;IC&#41;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">10&#44;11</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La CisC se comporta como un factor pron&#243;stico relacionado inversamente con la calidad del envejecimiento<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a> y directamente&#44; en la poblaci&#243;n general&#44; con la aparici&#243;n de eventos cardiovasculares<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> y la incidencia de IC<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">14&#8211;16</span></a>&#46; Entre quienes ya padecen una IC&#44; la CisC es un marcador pron&#243;stico robusto de mortalidad&#44; tanto en la IC aguda<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">17&#8211;19</span></a> como cr&#243;nica<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">20</span></a>&#44; independiente de la fracci&#243;n de eyecci&#243;n &#40;FE&#41;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">21</span></a>&#46; Se desconoce si su capacidad pron&#243;stica es debida a su implicaci&#243;n en el remodelado ventricular&#44; tal y como sugiere Pate et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">10</span></a>&#44; o a su mayor precisi&#243;n en la estimaci&#243;n del filtrado glomerular &#40;FG&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">22</span></a>&#44; cuya capacidad pron&#243;stica en la IC es bien conocida<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El presente estudio se dise&#241;&#243; para analizar si existen cambios en la expresi&#243;n de CisC en el miocardio ventricular dependientes de la edad y el estado de salud cardiovascular y&#44; en segundo lugar&#44; si las concentraciones plasm&#225;ticas de CisC guardan alguna relaci&#243;n con las modificaciones estructurales del coraz&#243;n en la IC ya establecida&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Pacientes y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se estudiaron dos grupos de pacientes no relacionados entre s&#237;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">An&#225;lisis de CisC en el tejido mioc&#225;rdico</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se seleccionaron 9 muestras de tejido mioc&#225;rdico obtenido de autopsias cl&#237;nicas &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; sobre las que se realiz&#243; una tinci&#243;n inmunohistoqu&#237;mica para CisC&#44; metaloproteinasa de matriz 9 &#40;MMP9&#41; y desmina&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">La expresi&#243;n de los genes de mantenimiento es muy constante ya que codifican prote&#237;nas con funciones esenciales para el mantenimiento de la vida celular&#46; En consecuencia&#44; la s&#237;ntesis y liberaci&#243;n de sus productos proteicos se altera en circunstancias excepcionales&#59; por ejemplo&#44; en las distintas etapas del desarrollo fetal o en trastornos patol&#243;gicos de la vida adulta en las que est&#225;n directamente implicados&#46; Por este motivo se incluyeron en el estudio muestras de tejido cardiaco de 4 fetos con diferentes edades gestacionales&#44; y de 5 adultos&#44; de los que una autopsia demostr&#243; que bien no ten&#237;an una enfermedad estructural cardiaca conocida &#40;3 pacientes&#41; o padec&#237;an una cardiopat&#237;a &#40;un paciente con hipertrofia del VI y&#44; por tanto&#44; con un remodelado patol&#243;gico sin evidencia previa de disfunci&#243;n cardiaca&#44; y otro con un shock cardiog&#233;nico&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Para garantizar que las muestras de tejido eran viables para su an&#225;lisis inmunohistoqu&#237;mico se ti&#241;&#243; una prote&#237;na de expresi&#243;n obligada &#40;desmina&#41; y otra con expresi&#243;n putativa relacionada con el remodelado cardiaco &#40;MMP9&#41;&#46; Para el an&#225;lisis inmunohistoqu&#237;mico se emplearon reactivos comerciales&#58; anticuerpo monoclonal &#40;Clone D33&#44; soluci&#243;n 1&#58;100&#41; para desmina&#59; anticuerpo policlonal &#40;ab3898&#44; 1&#58;100&#41; para MMP9&#59; ambos de Dako y Abcam &#40;Cambridge&#44; MA&#44; Estados Unidos de Am&#233;rica&#41; respectivamente&#59; y anticuerpos de Novus Biologicals &#40;Cambridge&#44; Reino Unido&#41; para CISC &#40;Antibody 2C8&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">An&#225;lisis de la relaci&#243;n entre la concentraci&#243;n s&#233;rica de CisC y la estructura cardiaca</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se analiz&#243; una cohorte de pacientes consecutivamente ingresados por una descompensaci&#243;n aguda de su IC&#46; Se midieron las concentraciones s&#233;ricas de CisC durante las primeras 48 h del ingreso y se realiz&#243; un estudio ecocardiogr&#225;fico bidimensional&#46; Los pacientes fueron seleccionados en el Servicio de Medicina Interna del Hospital Cl&#237;nico Universitario Lozano Blesa y dieron su consentimiento para el estudio&#44; que hab&#237;a sido aprobado por el Comit&#233; de &#201;tica de Arag&#243;n &#40;PI10&#47;038&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se defini&#243; agudizaci&#243;n de la IC como el inicio gradual o r&#225;pido de signos y s&#237;ntomas de IC que requirieron un ingreso hospitalario no planificado&#46; Se incluyeron tanto pacientes con IC &#171;de novo&#187;&#44; como IC cr&#243;nicas descompensadas<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a>&#46; Para asegurar el diagn&#243;stico de IC&#44; especialmente en pacientes con FE preservada&#44; solo se incluyeron aquellos con una concentraci&#243;n s&#233;rica del fragmento amino terminal del prop&#233;ptido natriur&#233;tico cerebral &#40;NT-proBNP&#41; superior a 900<span class="elsevierStyleHsp" style=""></span>pg&#47;ml<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La ecocardiograf&#237;a se realiz&#243; seg&#250;n los protocolos est&#225;ndar<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">26</span></a> por un cardi&#243;logo experto que desconoc&#237;a los datos cl&#237;nicos y anal&#237;ticos de los pacientes&#46; La determinaci&#243;n de CisC y NT-proBNP se realiz&#243; en el laboratorio de Bioqu&#237;mica Cl&#237;nica del Hospital Cl&#237;nico Universitario Lozano Blesa con un analizador BN ProSpec &#40;Dade Behring GmbH&#44; Liederbach&#44; Alemania&#41; y un equipo Modular Analytics E170 &#40;Roche Diagnostics GmbH&#44; Mannheim&#44; Alemania&#41;&#44; respectivamente&#44; siguiendo las especificaciones de los fabricantes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Para las variables cualitativas se midi&#243; la tendencia central y la dispersi&#243;n &#40;media y desviaci&#243;n est&#225;ndar o mediana y rango intercuart&#237;lico&#44; seg&#250;n la distribuci&#243;n fuera normal o no&#41;&#46; Para el an&#225;lisis bivariante se emple&#243; el test del Chi cuadrado y para los an&#225;lisis de asociaci&#243;n entre variables cualitativas se aplic&#243; el test exacto de Fisher&#46; Para las variables cuantitativas se aplic&#243; la t de Student&#44; el test de ANOVA y el de Mann-Whitney o el de Kruskal-Wallis&#59; para las correlaciones&#44; los test de Spearman o Pearson si la distribuci&#243;n era normal&#46; Se consideraron significativos los valores de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Se empleo el software Statistical Package Social Sciences &#40;SPSS 20&#46;0&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Inmunohistoqu&#237;mica mioc&#225;rdica &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Al contrario que las muestras de tejido adulto&#44; las fetales mostraban una mayor riqueza celular y un patr&#243;n estructural desordenado&#46; La d&#233;bil expresi&#243;n de la desmina en el miocardio fetal se explica por un estadio de desarrollo sarcom&#233;rico todav&#237;a temprano &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#44; panel B&#41;&#46; En los tejidos adultos la desmina fue positiva en todas las muestras&#44; mostrando una estriaci&#243;n transversal correspondiente a discos intercalares &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#44; panel C&#41;&#46; La MMP9 mostr&#243; una inmunotinci&#243;n similar en las muestras fetales &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#44; panel D&#41; y de adultos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#44; panel E&#41;&#46; Se encontraron algunas c&#233;lulas intersticiales que captaron pigmento pero la tinci&#243;n fue negativa para MMP9&#46; Todos los cardiomiocitos&#44; fetales &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#44; panel F&#41; y adultos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#44; panel G&#41;&#44; mostraron una tinci&#243;n d&#233;bil y difusa para la CisC independientemente de la edad fetal y del estado de salud de los pacientes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Relaci&#243;n entre CisC s&#233;rica y estructura cardiaca</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se estudiaron 351 pacientes&#44; 245 &#40;70&#37;&#41; con IC y FE preservada &#40;ICFEP&#41; y 106 &#40;30&#37;&#41; con IC y FE reducida &#40;ICFER&#41;&#46; Las caracter&#237;sticas cl&#237;nicas de la cohorte se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">No se encontr&#243; ninguna correlaci&#243;n significativa entre la CisC y los par&#225;metros ecocardiogr&#225;ficos &#40;<a class="elsevierStyleCrossRefs" href="#tbl0015">tablas 3 y 4</a>&#41;&#46; Aunque no fue el prop&#243;sito del estudio&#44; se analiz&#243; la informaci&#243;n pron&#243;stica ofrecida por la CisC s&#233;rica y su correlaci&#243;n con el FG estimado por la f&#243;rmula de &#171;<span class="elsevierStyleItalic">modification diet in renal diseases formula&#187;</span>&#44; basada en 4 par&#225;metros&#46; La concentraci&#243;n de CisC tuvo una correlaci&#243;n directa con la mortalidad por cualquier causa al a&#241;o y con el FG estimado&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran que la CisC no cambia su patr&#243;n de expresi&#243;n en el miocardio ventricular durante distintas etapas del desarrollo fetal&#44; ni en el sujeto adulto en funci&#243;n de su estado de salud cardiovascular&#46; La tinci&#243;n inmunohistoqu&#237;mica para CisC&#44; d&#233;bil y generalizada en todas las muestras mioc&#225;rdicas analizadas&#44; sugiere que esta proteasa se sintetiza de modo constitutivo&#44; no inducido&#44; y se secreta al torrente circulatorio&#46; Este patr&#243;n est&#225; en consonancia con las acciones biol&#243;gicas&#44; fundamentalmente extracelulares&#44; de la CisC<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; El hecho de que la tinci&#243;n de CisC en el miocardio ventricular de pacientes con hipertrofia del VI o IC&#44; no denoten cambios de distribuci&#243;n&#44; sugiere que la CisC no est&#225; involucrada en la progresi&#243;n de la hipertensi&#243;n hacia IC&#46; Aunque la cohorte cl&#237;nica evaluada no ten&#237;a relaci&#243;n con los pacientes de los que proced&#237;an las muestras tisulares&#44; la ausencia de correlaci&#243;n entre las concentraciones de CisC s&#233;rica y la estructura cardiaca tambi&#233;n debe ser interpretada en este contexto&#46; La CisC no se relaciona con las anomal&#237;as morfol&#243;gicas cardiacas&#44; medidas por ecocardiograf&#237;a&#44; en la etapa evolutiva final del remodelado cardiaco&#59; es decir&#44; en presencia de IC&#46; Sin embargo&#44; las concentraciones de CisC tienen un valor pron&#243;stico incuestionable en la IC<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">10&#44;11&#44;14&#8211;22</span></a>&#46; Por su peque&#241;o tama&#241;o molecular y carga el&#233;ctrica&#44; la CisC se filtra libremente en el glom&#233;rulo y se cataboliza en el t&#250;bulo contorneado proximal&#44; sin sufrir ulteriores modificaciones&#44; que s&#237; ocurren con la urea o la creatinina<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">11</span></a>&#46; Estas razones hacen que la CisC sea particularmente precisa para estimar el FG en la disfunci&#243;n renal con aclaramientos entre 40 y 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46;&#44; m&#225;rgenes en los que la creatinina proporciona valores de FG muy poco precisos&#46; De hecho&#44; la CISC permite estimar de modo m&#225;s preciso el riesgo de muerte en pacientes con IC que poseen estos rangos de FG<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">22&#44;27</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La posibilidad de que la CisC est&#233; implicada en etapas precoces del remodelado cardiaco surge de los resultados de una cohorte poblacional del <span class="elsevierStyleItalic">Dallas Heart Study</span><a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">10</span></a>&#46; En ella se estudi&#243; mediante resonancia magn&#233;tica cardiaca una poblaci&#243;n de 2&#46;548 sujetos no seleccionados y se encontr&#243; una relaci&#243;n lineal entre las concentraciones s&#233;ricas de esta proteasa&#44; el espesor de la pared posterior del VI y el cociente entre la masa y el volumen telediast&#243;lico del VI&#44; un par&#225;metro novedoso al que los autores denominaron &#171;concentricidad&#187; cardiaca&#46; Los autores sugieren que la CisC ser&#237;a un par&#225;metro &#250;til para identificar individuos con alteraciones precl&#237;nicas en la estructura cardiaca&#44; concretamente con un fenotipo espec&#237;fico de hipertrofia VI conc&#233;ntrica que&#44; de acuerdo con su hip&#243;tesis&#44; preceder&#237;a en a&#241;os a la aparici&#243;n de disfunci&#243;n diast&#243;lica o IC<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">10</span></a>&#46; En algunos estudios se ha sugerido que este fenotipo de hipertrofia VI conc&#233;ntrica depende del equilibrio entre las ciste&#237;na-proteinasas &#40;catepsina B&#44; S y K&#41; y sus inhibidores &#40;CisC&#41;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">9&#44;28&#44;29</span></a>&#46; Sin embargo&#44; en nuestro estudio no encontramos cambios en el patr&#243;n de tinci&#243;n de la CisC mioc&#225;rdica&#44; ni entre sus concentraciones s&#233;ricas y los par&#225;metros ecocardiogr&#225;ficos que apoyen esta interpretaci&#243;n&#46; Estas discrepancias pueden explicarse&#44; al menos en parte&#44; por las diferencias en la metodolog&#237;a y poblaciones de ambos estudios&#46; Aunque en el estudio de Patel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">10</span></a> se utiliz&#243; una t&#233;cnica precisa como la resonancia magn&#233;tica&#44; debe resaltarse que el remodelado es un proceso local y que las concentraciones s&#233;ricas de CisC podr&#237;an no reflejar lo que ocurre en el tejido<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a>&#44; algo que apoyan los resultados de la inmunohistoqu&#237;mica de nuestro estudio&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La importancia del equilibrio entre proteasas y antiproteasas en la fisiopatolog&#237;a del remodelado cardiaco se ha estudiado previamente<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">31</span></a>&#46; Algunos autores atribuyen al balance entre las metaloproteinasas de la matriz y sus inhibidores un papel clave en la diferenciaci&#243;n de los fenotipos de ICFEP e ICFER<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">32</span></a>&#46; Stypman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a> analizaron la histolog&#237;a y los cambios histomorfom&#233;tricos en los corazones de 40 ratones con ausencia del gen codificante de la catepsina L&#46; Al cabo de un a&#241;o&#44; los ratones deficientes mostraban&#44; en comparaci&#243;n con los controles&#44; un crecimiento significativo de la aur&#237;cula y del ventr&#237;culo&#44; secundario a fibrosis del intersticio mioc&#225;rdico&#46; Estas anomal&#237;as se reflejaban en la ecocardiograf&#237;a como un deterioro importante de la contractilidad del VI&#44; interpretado como una respuesta adaptativa a los cambios histol&#243;gicos experimentados por el rat&#243;n deficitario en catepsina L<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a>&#46; Tambi&#233;n se ha encontrado un incremento en la expresi&#243;n de la catepsina B&#44; tanto a nivel del RNA mensajero como de la prote&#237;na&#44; en un grupo de 20 pacientes con miocardiopat&#237;a dilatada grave&#44; en comparaci&#243;n con 5 sujetos donantes de coraz&#243;n<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a>&#46; Por lo tanto&#44; existen indicios de que algunas proteasas lisosomales participan en el remodelado cardiaco&#59; no obstante&#44; el papel de las antiproteasas no se analiz&#243; en estos estudios&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En cualquier caso&#44; las familias de proteasas y antiproteasas son numerosas y sus papeles fisiol&#243;gicos variados&#44; por lo que el comportamiento de algunas de ellas puede no ser extrapolable&#46; Cheng et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">9</span></a> analizaron por PCR en tiempo real&#44; inmunoblot e inmunohistoqu&#237;mica&#44; la expresi&#243;n de catepsina S y K y su antiproteasa&#44; la CisC&#44; en corazones hipertr&#243;ficos humanos y murinos&#46; Encontraron que la expresi&#243;n de catepsinas era mayor en los corazones de sujetos con IC&#44; que en aquellos que solo ten&#237;an hipertrofia del VI&#44; o en el grupo control&#46; Sin embargo&#44; la expresi&#243;n de CisC no aument&#243; en ning&#250;n esp&#233;cimen de tejido de los sujetos analizados<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">9</span></a>&#46; Estos resultados coinciden con los que hemos encontrado en el presente estudio&#46; Existen algunas explicaciones que justifican la ausencia de expresi&#243;n de CisC en el remodelado ventricular&#46; En primer lugar&#44; podr&#237;a ser que la secreci&#243;n de CisC en respuesta al incremento de la producci&#243;n de catepsinas sea defectuoso&#46; En este caso&#44; la ausencia de acci&#243;n de la CisC conducir&#237;a a un aumento de la actividad elastol&#237;tica de las catepsinas&#44; lo que indirectamente favorecer&#237;a la dilataci&#243;n ventricular y la IC&#46; En segundo lugar&#44; es posible que determinados factores locales sean decisivos en la localizaci&#243;n de la actividad de la CisC&#46; Se sabe que un pH neutro extracelular reduce la actividad de las catepsinas y se ha demostrado que la enzima H<span class="elsevierStyleSup">&#43;</span>-ATPasa lisosomal se trasloca a la membrana<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">33</span></a> y crea un ambiente &#225;cido que favorece la activaci&#243;n de las catepsinas activadoras de metaloproteinasas de la matriz<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">34</span></a>&#46; Es posible que algo similar ocurra con la CisC&#46; De hecho&#44; esta proteasa ejerce sus acciones fisiol&#243;gicas en los fluidos corporales&#44; lejos de las c&#233;lulas que la producen<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Este estudio tiene limitaciones&#46; El n&#250;mero de muestras tisulares estudiadas es peque&#241;o y la tinci&#243;n inmunohistoqu&#237;mica&#44; adem&#225;s de ser un m&#233;todo cualitativo&#44; puede no reflejar de modo suficientemente sensible lo que ocurre a nivel tisular en procesos biol&#243;gicos complejos y din&#225;micos&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el patr&#243;n de distribuci&#243;n d&#233;bil y homog&#233;neo de la tinci&#243;n inmunohistoqu&#237;mica para CisC en el miocardio de fetos de diferentes edades&#59; de adultos con y sin enfermedades cardiacas&#59; as&#237; como&#44; de modo indirecto&#44; la ausencia de relaci&#243;n entre las concentraciones s&#233;ricas de CisC y los par&#225;metros morfol&#243;gicos y funcionales obtenidos por ecocardiograf&#237;a en pacientes con IC&#44; a&#241;aden un elemento de discusi&#243;n al debate&#44; todav&#237;a sin conclusi&#243;n&#44; acerca del papel de la CisC en el remodelado cardiaco&#46; Nuestros resultados sugieren que la CisC no est&#225; implicada directamente en el remodelado cardiaco que conduce a la IC&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0105" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres611135"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Pacientes y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec625124"
          "titulo" => "Palabras clave"
        ]
        2 => array:3 [
          "identificador" => "xres611134"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:1 [
              "identificador" => "abst0025"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Patients and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec625123"
          "titulo" => "Keywords"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introducci&#243;n"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Pacientes y m&#233;todos"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "An&#225;lisis de CisC en el tejido mioc&#225;rdico"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "An&#225;lisis de la relaci&#243;n entre la concentraci&#243;n s&#233;rica de CisC y la estructura cardiaca"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "An&#225;lisis estad&#237;stico"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Resultados"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Inmunohistoqu&#237;mica mioc&#225;rdica &#40;fig&#46; 1&#41;"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Relaci&#243;n entre CisC s&#233;rica y estructura cardiaca"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Discusi&#243;n"
        ]
        8 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflicto de intereses"
        ]
        9 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-08-30"
    "fechaAceptado" => "2015-11-01"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec625124"
          "palabras" => array:5 [
            0 => "Cistatina C"
            1 => "Insuficiencia cardiaca"
            2 => "Remodelado ventricular"
            3 => "Genes de mantenimiento"
            4 => "Ciste&#237;n proteasas"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec625123"
          "palabras" => array:5 [
            0 => "Cystatin C"
            1 => "Heart failure"
            2 => "Ventricular remodeling"
            3 => "Housekeeping genes"
            4 => "Cystein proteases"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La cistatina C &#40;CisC&#41; es una proteasa codificada por genes de mantenimiento &#40;&#171;<span class="elsevierStyleItalic">housekeeping genes&#187;</span>&#41;&#46; Aunque su valor pron&#243;stico en la insuficiencia cardiaca &#40;IC&#41; es bien conocido&#44; se debate si es debido a su mayor precisi&#243;n en la estimaci&#243;n del filtrado glomerular&#44; o a su implicaci&#243;n en el remodelado ventricular patol&#243;gico&#46; El prop&#243;sito de este estudio fue comprobar si la expresi&#243;n de CisC se modificaba en el miocardio de fetos de diferentes edades y en el de adultos con diversas enfermedades cardiovasculares&#44; as&#237; como analizar la correlaci&#243;n entre sus concentraciones s&#233;ricas y la estructura y morfolog&#237;a cardiaca en un grupo de pacientes con IC&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se analizaron las correlaciones &#40;test de Pearson y Spearman&#41; entre la CisC s&#233;rica y los par&#225;metros ecocardiogr&#225;ficos de 351 pacientes con IC&#46; Tambi&#233;n se realiz&#243; una tinci&#243;n inmunohistoqu&#237;mica para CisC&#44; metaloproteinasa 9 &#40;MMP-9&#41; y desmina en 9 muestras de tejido cardiaco procedentes de las autopsias de 4 fetos con diferente edad gestacional y 5 adultos sanos o con enfermedad cardiovascular&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En pacientes con IC no se encontr&#243; correlaci&#243;n entre las concentraciones de CisC y los par&#225;metros cardiacos medidos por ecocardiograf&#237;a 2<span class="elsevierStyleHsp" style=""></span>D&#46; La inmunohistoqu&#237;mica mostr&#243; una d&#233;bil tinci&#243;n de fondo para CisC en todas las muestras&#44; independientemente de la edad y la presencia o no de enfermedades cardiovasculares&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Nuestros resultados sugieren que la CisC no tiene un papel significativo en el remodelado patol&#243;gico del ventr&#237;culo izquierdo en la IC&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:1 [
            "identificador" => "abst0005"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Pacientes y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Cystatin C &#40;CysC&#41; is a protease encoded by housekeeping genes&#46; Although its prognostic value in heart failure &#40;HF&#41; is well known&#44; it is debatable whether this value is due to the greater accuracy of CysC in calculating the glomerular filtration rate or to its involvement in pathological ventricular remodelling&#46; The aim of this study was to determine whether CysC expression changes in the myocardium of foetuses of different ages and in the myocardium of adults with various cardiovascular diseases&#44; as well as to analyse the correlation between its serum concentrations and cardiac structure and morphology in a patient group with HF&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We analysed the correlations &#40;Pearson&#39;s r and Spearman&#39;s test&#41; between the serum CysC levels and echocardiographic parameters of 351 patients with HF&#46; We also performed immunohistochemical staining for CysC&#44; metalloproteinase-9 &#40;MMP-9&#41; and desmin in 9 cardiac tissue samples from autopsies of 4 foetuses of different gestational ages and 5 healthy adults or adults with cardiovascular disease&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">For the patients with HF&#44; there was no correlation between the CysC concentrations and the cardiac parameters measured by 2<span class="elsevierStyleHsp" style=""></span>D echocardiography&#46; The immunohistochemistry showed a weak background staining for CysC in all samples&#44; regardless of age and the presence or absence of cardiovascular diseases&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Our results suggest that CysC does not have a significant role in the pathological remodelling of the left ventricle in HF&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:1 [
            "identificador" => "abst0025"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1415
            "Ancho" => 1954
            "Tamanyo" => 575850
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Tinci&#243;n inmunohistoqu&#237;mica de las muestras de tejido mioc&#225;rdico &#40;x20&#41;&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A&#41; Hematoxilina de contraste y diluyente de anticuerpos &#40;control&#41;&#46; Se observan miocitos cardiacos de estructura normal con los n&#250;cleos te&#241;idos d&#233;bilmente ocupando una posici&#243;n central dentro de la c&#233;lula&#44; con tinci&#243;n de fondo de hematoxilina&#46; Tambi&#233;n se observa pigmento de lipofuscina en los polos del n&#250;cleo &#40;Ac x20&#41;&#46; B&#41; Desmina en miocardio fetal&#58; la expresi&#243;n de desmina es mucho m&#225;s d&#233;bil que en el coraz&#243;n adulto o es negativa traduciendo probablemente una falta de desarrollo de las sarc&#243;meras&#46; C&#41; Desmina en miocardio adulto&#58; estriaci&#243;n transversal de todo el miocardio&#59; las bandas intercalares destacan m&#225;s oscuras&#46; D&#41; MMP9 en miocardio fetal&#58; la inmunotinci&#243;n citopl&#225;smica para MMP9 es positiva en c&#233;lulas aisladas en el intersticio&#46; El citoplasma de las c&#233;lulas musculares es negativo&#46; E&#41; MMP9 en miocardio adulto&#58; inmunotinci&#243;n citopl&#225;smica para MMP9 en c&#233;lulas aisladas en el intersticio&#59; las c&#233;lulas musculares son negativas&#46; F&#41; CisC en miocardio fetal&#58; se aprecia una celularidad m&#225;s abundante que en el coraz&#243;n adulto con disposici&#243;n menos ordenada de las c&#233;lulas y una leve inmunotinci&#243;n citopl&#225;smica de los miocardiocitos para CisC&#46; Existe alguna c&#233;lula peque&#241;a aislada en el intersticio que expresa cistatina en su citoplasma&#46; G&#41; CisC en miocardio adulto&#58; cardiomiocitos inmunote&#241;idos con expresi&#243;n difusa de CisC en el citoplasma&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">IAM&#58; infarto agudo de miocardio&#59; VI&#58; ventr&#237;culo izquierdo&#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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Muestras fetales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Muestras de adultos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Edad gestacional 20 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mujer de 50 a&#241;os con coraz&#243;n sano &#40;control&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Edad gestacional 22 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n de 71 a&#241;os con coraz&#243;n sano &#40;control&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Edad gestacional 30 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n de 84 a&#241;os con coraz&#243;n sano &#40;control&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Edad gestacional 33 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n de 53 a&#241;os con hipertrofia del VI secundaria a hipertensi&#243;n arterial&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="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Var&#243;n de 80 a&#241;os con shock cardiog&#233;nico por un IAM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1001154.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas generales de las muestras de miocardio</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Los valores se expresan como media &#40;desviaci&#243;n est&#225;ndar&#41; o n&#250;mero &#40;porcentaje&#41; seg&#250;n corresponda&#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="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Cohorte cl&#237;nica&#40;n&#61; 351&#41;&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ICFER</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">106 &#40;30&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Edad&#44; a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#44;41 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sexo masculino</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">170 &#40;48&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">IMC&#44; kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>&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;86 &#40;10&#44;6&#41;&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="2" align="char" valign="top"><span class="elsevierStyleItalic">Etiolog&#237;a</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hipertensiva&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;44&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiopat&#237;a isqu&#233;mica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;22&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Otras<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&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;32&#44;6&#41;&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="2" 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="2" align="char" valign="top"><span class="elsevierStyleItalic">Clase funcional NYHA</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">I</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;10&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">II</span>&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;53&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">III</span>&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;33&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">IV</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;1&#44;7&#41;&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="2" 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="2" align="char" valign="top"><span class="elsevierStyleItalic">Comorbilidad</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hipertensi&#243;n arterial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">255 &#40;72&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fibrilaci&#243;n auricular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">205 &#40;58&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">136 &#40;38&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>EPOC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71 &#40;20&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sodio&#44; mEq&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">141&#44;7 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemoglobina&#44; g&#47;dl&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;12 &#40;0&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FGe&#44; ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#40;MDRD-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">52&#44;16 &#40;21&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cistatina&#44; mg&#47;l&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;5 &#40;0&#44;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NT-proBNP&#44; pg&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6183 &#40;9575&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1001152.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Algunos pacientes pueden tener varias etiolog&#237;as simult&#225;neas&#46;</p> <p class="elsevierStyleNotepara" id="npar0010">EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#59; FGe&#58; filtrado glomerular estimado&#59; ICFER&#58; insuficiencia cardiaca con fracci&#243;n de eyecci&#243;n reducida&#59; IMC&#58; &#237;ndice de masa corporal&#59; MDRD&#58; <span class="elsevierStyleItalic">modification diet in renal disease</span> f&#243;rmula basada en 4 par&#225;metros&#59; NT-proBNP&#58; fragmento aminoterminal del prop&#233;ptido natriur&#233;tico cerebral&#59; NYHA&#58; <span class="elsevierStyleItalic">New York Heart Association</span>&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas basales de la cohorte cl&#237;nica</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">DTDVI&#58; di&#225;metro telediast&#243;lico del VI&#59; DTSVI&#58; di&#225;metro telesist&#243;lico del VI&#59; VI&#58; ventr&#237;culo izquierdo&#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="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&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">Correlaci&#243;n con CisC</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">N&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">Media &#40;DE&#41;&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">R<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&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">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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fracci&#243;n eyecci&#243;n VI &#40;&#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">348&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#44;75 &#40;13&#44;81&#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;071&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;197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Di&#225;metro auricular izquierdo &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">272&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#44;77 &#40;9&#44;26&#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;082&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;179&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DTDVI &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">268&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#44;24 &#40;9&#44;62&#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;012&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;844&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DTSVI &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">263&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#44;47 &#40;11&#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;033&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;599&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grosor septal &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">271&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;53 &#40;2&#44;21&#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;101&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;099&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pared posterior &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">268&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;43 &#40;2&#44;03&#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;006&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;928&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Masa ventricular izquierda &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">265&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">205&#44;61 &#40;82&#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;008&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;903&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Masa del VI indexada &#40;g&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">265&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">118&#44;85 &#40;45&#44;35&#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;000&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;856&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#171;<span class="elsevierStyleItalic">Concentricidad</span>&#187;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;</span></a>&#40;g&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">265&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;68 &#40;1&#44;16&#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;081&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;197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onda E &#40;m&#47;sg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">200&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;99 &#40;0&#44;36&#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;07&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;325&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onda A<span class="elsevierStyleSup">&#42;&#42;&#42;</span>&#40;m&#47;sg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&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;82 &#40;0&#44;33&#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;117&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;340&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Relaci&#243;n E&#47;A<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&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;25 &#40;0&#44;75&#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;013&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;907&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Presi&#243;n sist&#243;lica arteria pulmonar &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#44;5 &#40;16&#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;063&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;509&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1001155.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Rho de Spearman&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "&#42;&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">&#171;<span class="elsevierStyleItalic">Concentricidad</span>&#187;&#58; relaci&#243;n entre masa del VI&#47;DTVI LV&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "&#42;&#42;&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Solo en pacientes en ritmo sinusal&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Par&#225;metros ecocardiogr&#225;ficos &#40;cohorte cl&#237;nica&#41; y correlaci&#243;n con las concentraciones s&#233;ricas de CisC</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">AI&#58; auricular izquierda&#59; FE del VI&#58; fracci&#243;n de eyecci&#243;n del ventr&#237;culo izquierdo&#59; PSAP&#58; presi&#243;n sist&#243;lica arterial pulmonar&#59; VTDVI&#58; volumen telediast&#243;lico del ventr&#237;culo izquierdo&#59; VTSVI&#58; volumen telesist&#243;lico del ventr&#237;culo izquierdo&#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="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Cohorte completa&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">Q1&#8804;1&#44;1mg&#47;dl&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">Q21&#44;11-1&#44;35mg&#47;dl&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">Q31&#44;36-1&#44;75mg&#47;dl&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">Q4&#62;1&#44;75mg&#47;dl&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">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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FE del VI &#40;&#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">51&#44;7 &#40;13&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#44;55 &#40;13&#44;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#44;65 &#40;14&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#44;07 &#40;14&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#44;77 &#40;12&#44;82&#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;075&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Di&#225;metro AI &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#44;74 &#40;9&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#44;36 &#40;9&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#44;95 &#40;8&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#44;38 &#40;10&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#44;31 &#40;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;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VTDVI &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#44;25 &#40;9&#44;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#44;43 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#44;36 &#40;9&#44;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#44;56 &#40;9&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#44;61 &#40;8&#44;39&#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;204&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VTSVI&#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#44;51 &#40;11&#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">38&#44;8 &#40;12&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;10&#44;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#44;45 &#40;11&#44;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#44;9 &#40;9&#44;66&#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;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grosor tabique &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;52 &#40;2&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;18 &#40;2&#44;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;66 &#40;2&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;56 &#40;2&#44;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;68 &#40;1&#44;99&#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;539&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grosor pared posterior &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;42 &#40;2&#44;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;47 &#40;2&#44;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;38 &#40;1&#44;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;49 &#40;1&#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">10&#44;35 &#40;1&#44;62&#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;971&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Masa VI &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">204&#44;09 &#40;82&#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">198&#44;33 &#40;91&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">206&#44;48 &#40;82&#44;76&#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&#44;71 &#40;86&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">197&#44;32 &#40;70&#44;76&#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;628&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#205;ndice de masa del VI &#40;g&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115&#44;5 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">114&#44;2 &#40;48&#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">115 &#40;41&#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">121&#44;7 &#40;45&#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">111&#44;2 &#40;36&#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;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#171;Concentricidad&#187;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">&#42;</span></a> &#40;g&#47;ml&#41;&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;66 &#40;1&#44;15&#41;&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;64 &#40;1&#44;46&#41;&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;67 &#40;1&#44;16&#41;&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;72 &#40;1&#44;04&#41;&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;63 &#40;0&#44;96&#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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onda E&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;99 &#40;0&#44;36&#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 &#40;0&#44;34&#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 &#40;0&#44;26&#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;98 &#40;0&#44;43&#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;04 &#40;0&#44;36&#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;786&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Onda A<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">&#42;&#42;</span></a>&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;82 &#40;0&#44;33&#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;81 &#40;0&#44;28&#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;72 &#40;0&#44;27&#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;91 &#40;0&#44;38&#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;83 &#40;0&#44;33&#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;378&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">E&#47;A<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">&#42;&#42;</span></a>&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;25 &#40;0&#44;75&#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;37 &#40;1&#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">1&#44;28 &#40;0&#44;55&#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;03 &#40;0&#44;53&#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;37 &#40;0&#44;79&#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;342&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PSAP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#44;6 &#40;16&#44;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#44;81 &#40;13&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#44;14 &#40;14&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#44;81 &#40;21&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#44;03 &#40;15&#44;71&#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;504&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1001153.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">&#171;Concentricidad&#187;&#58; masa del VI&#47;di&#225;metro diast&#243;lico del VI&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "&#42;&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Solo en pacientes en ritmo sinusal&#46; Los valores entre par&#233;ntesis reflejan la desviaci&#243;n est&#225;ndar&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Correlaci&#243;n entre las concentraciones de cistatina s&#233;rica y los par&#225;metros ecocardiogr&#225;ficos</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:34 [
            0 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nomenclature and classification of the proteins homologous with the cysteine-proteinase inhibitor chicken cystatin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Barrett"
                            1 => "H&#46; Fritz"
                            2 => "A&#46; Grubb"
                            3 => "S&#46; Isemura"
                            4 => "M&#46; Jarvinen"
                            5 => "N&#46; Katunuma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Biochem J"
                        "fecha" => "1986"
                        "volumen" => "236"
                        "paginaInicial" => "312"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3491603"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular cloning and sequence analysis of cDNA coding for the precursor of the human cysteine proteinase inhibitor cystatin C"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Abrahamson"
                            1 => "A&#46; Grubb"
                            2 => "I&#46; Olafsson"
                            3 => "A&#46; Lundwall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "FEBS Lett"
                        "fecha" => "1987"
                        "volumen" => "216"
                        "paginaInicial" => "229"
                        "paginaFinal" => "233"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3495457"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The human cystatin C gene &#40;CST3&#41;&#44; mutated in hereditary cystatin C amyloid angiopathy&#44; is located on chromosome 20"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Abrahamson"
                            1 => "M&#46;Q&#46; Islam"
                            2 => "J&#46; Szpirer"
                            3 => "C&#46; Szpirer"
                            4 => "G&#46; Levan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Genet"
                        "fecha" => "1989"
                        "volumen" => "82"
                        "paginaInicial" => "223"
                        "paginaFinal" => "226"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2567273"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Structure and expression of the human cystatin C gene"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Abrhamson"
                            1 => "I&#46; Olafsson"
                            2 => "A&#46; Palsdottir"
                            3 => "M&#46; Ulvsb&#228;ck"
                            4 => "A&#46; Lundwall"
                            5 => "O&#46; Jensson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Biochem J"
                        "fecha" => "1990"
                        "volumen" => "268"
                        "paginaInicial" => "287"
                        "paginaFinal" => "294"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2363674"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The place of human gamma-trace &#40;cystatin<span class="elsevierStyleHsp" style=""></span>C&#41; amongst the cysteine proteinase inhibitors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;J&#46; Barrett"
                            1 => "M&#46;E&#46; Davies"
                            2 => "A&#46; Grubb"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Biochem Biophys Res Commun"
                        "fecha" => "1984"
                        "volumen" => "120"
                        "paginaInicial" => "631"
                        "paginaFinal" => "636"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6203523"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Human cystatin C forms an inactive dimer during intracellular trafficking in transfected CHO cells"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;S&#46; Merz"
                            1 => "E&#46; Benedikz"
                            2 => "V&#46; Schwenk"
                            3 => "T&#46;E&#46; Johansen"
                            4 => "L&#46;K&#46; Vogel"
                            5 => "J&#46;I&#46; Rushbrook"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/(SICI)1097-4652(199712)173:3<423::AID-JCP15>3.0.CO;2-C"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cell Physiol"
                        "fecha" => "1997"
                        "volumen" => "173"
                        "paginaInicial" => "423"
                        "paginaFinal" => "432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9369956"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extracellular matrix remodeling during morphogenesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Z&#46; Werb"
                            1 => "J&#46;R&#46; Chin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann NY Acad Sci"
                        "fecha" => "1998"
                        "volumen" => "857"
                        "paginaInicial" => "110"
                        "paginaFinal" => "118"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9917836"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cystatin C deficiency in human aterosclerosis and aortic aneurysms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;P&#46; Shi"
                            1 => "G&#46;K&#46; Sukhova"
                            2 => "A&#46; Grubb"
                            3 => "L&#46;H&#46; Rhode"
                            4 => "R&#46;T&#46; Lee"
                            5 => "P&#46;M&#46; Ridker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1172/JCI7709"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Invest"
                        "fecha" => "1999"
                        "volumen" => "104"
                        "paginaInicial" => "1191"
                        "paginaFinal" => "1197"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10545518"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Elastolytic cathepsin induction&#47;activation system exists in myocardium and is upregulated in hypertensive heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "X&#46;W&#46; Cheng"
                            1 => "K&#46; Obata"
                            2 => "M&#46; Kuzuya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.HYP.0000242331.99369.2f"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "2006"
                        "volumen" => "48"
                        "paginaInicial" => "979"
                        "paginaFinal" => "987"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16982960"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of cystatin C with left ventricular structure and function&#58; The Dallas Heart Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;C&#46; Patel"
                            1 => "C&#46;R&#46; Ayers"
                            2 => "S&#46;A&#46; Murphy"
                            3 => "R&#46; Peshock"
                            4 => "A&#46; Khera"
                            5 => "J&#46;A&#46; de Lemos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCHEARTFAILURE.108.807271"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Heart Fail"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "98"
                        "paginaFinal" => "104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19808324"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serum Cystatin C renal function and left ventricular remodeling"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;D&#46; McMurray"
                            1 => "J&#46;E&#46; Trivax"
                            2 => "P&#46;A&#46; McCullough"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCHEARTFAILURE.109.856393"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Heart Fail"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "86"
                        "paginaFinal" => "89"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19808322"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cystatin C and aging success"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Cardiovascular Health Study"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Sarnak"
                            1 => "R&#46; Katz"
                            2 => "L&#46;F&#46; Fried"
                            3 => "D&#46; Siscovich"
                            4 => "B&#46; Kestenbaum"
                            5 => "S&#46; Seliger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archinternmed.2007.40"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Intern Med"
                        "fecha" => "2008"
                        "volumen" => "168"
                        "paginaInicial" => "147"
                        "paginaFinal" => "153"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18227360"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cystatin C and the risk of death and cardiovascular events among elderly persons"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;G&#46; Shlipak"
                            1 => "M&#46;J&#46; Sarnak"
                            2 => "R&#46; Katz"
                            3 => "L&#46;F&#46; Fried"
                            4 => "S&#46;L&#46; Seliger"
                            5 => "A&#46;B&#46; Newman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa043161"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2005"
                        "volumen" => "352"
                        "paginaInicial" => "2049"
                        "paginaFinal" => "2060"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15901858"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cystatin C concentration as a risk factor for heart failure in older adults"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Cardiovascular Health Study"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Sarnak"
                            1 => "R&#46; Katz"
                            2 => "C&#46;O&#46; Stehman-Breen"
                            3 => "L&#46;F&#46; Fried"
                            4 => "N&#46;S&#46; Jenny"
                            5 => "B&#46;M&#46; Psaty"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2005"
                        "volumen" => "142"
                        "paginaInicial" => "497"
                        "paginaFinal" => "505"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15809461"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cystatin C and risk of heart failure in the Physicians&#8217; Health Study &#40;PHS&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Djouss&#233;"
                            1 => "T&#46; Kurth"
                            2 => "J&#46;M&#46; Gaziano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ahj.2007.08.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2008"
                        "volumen" => "155"
                        "paginaInicial" => "182"
                        "paginaFinal" => "186"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18082511"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Concentration as a predictor of systolic and diastolic heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Moran"
                            1 => "R&#46; Katz"
                            2 => "N&#46;L&#46; Smith"
                            3 => "L&#46;F&#46; Fried"
                            4 => "M&#46;J&#46; Sarnak"
                            5 => "S&#46;L&#46; Seliger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cardfail.2007.09.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Card Fail"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "paginaInicial" => "19"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18226769"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health ABC study&#46; Kidney dysfunction and fatal cardiovascular disease&#8211;an association independent of atherosclerotic events&#58; Results from the Health&#44; Aging&#44; and Body Composition &#40;Health ABC&#41; study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Deo"
                            1 => "C&#46;L&#46; Fyr"
                            2 => "L&#46;F&#46; Fried"
                            3 => "A&#46;B&#46; Newman"
                            4 => "T&#46;B&#46; Harris"
                            5 => "S&#46; Angleman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ahj.2007.08.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2008"
                        "volumen" => "155"
                        "paginaInicial" => "62"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18082491"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cystatin-C and mortality in elderly persons with heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;G&#46; Shlipak"
                            1 => "R&#46; Katz"
                            2 => "L&#46;F&#46; Fried"
                            3 => "N&#46;S&#46; Jenny"
                            4 => "C&#46;O&#46; Stehman-Breen"
                            5 => "A&#46;B&#46; Newman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2004.09.061"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2005"
                        "volumen" => "45"
                        "paginaInicial" => "268"
                        "paginaFinal" => "271"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15653026"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic value of serum cystatin c and N-terminal pro B-type natriuretic peptide in patients with acute heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; P&#233;rez-Calvo"
                            1 => "F&#46; Ruiz-Ruiz"
                            2 => "J&#46; Francisco"
                            3 => "J&#46; Carrasco-S&#225;nchez"
                            4 => "J&#46;L&#46; Morales-Rull"
                            5 => "S&#46; Manzano-Fern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejim.2012.06.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Intern Med"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "599"
                        "paginaFinal" => "603"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22939803"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term prognostic value for patients with chronic heart failure of estimated glomerular filtration rate calculated with the new CKD-EPI equations containing cystatin C"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Zamora"
                            1 => "J&#46; Lup&#243;n"
                            2 => "M&#46; de Antonio"
                            3 => "J&#46; Vila"
                            4 => "J&#46; Pe&#241;afiel"
                            5 => "A&#46; Gal&#225;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1373/clinchem.2013.212951"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Chem"
                        "fecha" => "2014"
                        "volumen" => "60"
                        "paginaInicial" => "481"
                        "paginaFinal" => "489"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24255081"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic value of cystatin C on admission in heart failure with preserved ejection fraction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;J&#46; Carrasco-S&#225;nchez"
                            1 => "L&#46; Galisteo-Almeda"
                            2 => "I&#46; P&#225;ez-Rubio"
                            3 => "F&#46;J&#46; Mart&#237;nez-Marcos"
                            4 => "C&#46; Camacho-V&#225;zquez"
                            5 => "C&#46; Ruiz-Frutos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cardfail.2010.07.248"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Card Fail"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "31"
                        "paginaFinal" => "38"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21187262"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of risk prediction with the CKD-EPI and MDRD equations in acute decompensated heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Manzano-Fern&#225;ndez"
                            1 => "P&#46;J&#46; Flores-Blanco"
                            2 => "J&#46;I&#46; P&#233;rez-Calvo"
                            3 => "F&#46;J&#46; Ruiz-Ruiz"
                            4 => "F&#46;J&#46; Carrasco-S&#225;nchez"
                            5 => "J&#46;L&#46; Morales-Rull"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cardfail.2013.05.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Card Fail"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "583"
                        "paginaFinal" => "591"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23910589"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal function&#44; neurohormonal activation&#44; and survival in patients with chronic heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;L&#46; Hillege"
                            1 => "A&#46;R&#46; Girbes"
                            2 => "P&#46;J&#46; de Kam"
                            3 => "F&#46; Boomsma"
                            4 => "D&#46; de Zeeuw"
                            5 => "A&#46; Charlesworth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2000"
                        "volumen" => "102"
                        "paginaInicial" => "203"
                        "paginaFinal" => "210"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10889132"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Executive summary of the guidelines on the diagnosis and treatment of acute heart failure&#58; the task force on acute heart failure of the European Society of Cardiology"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "ESC Committe for Practice Guideline &#40;CPG&#41;"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;S&#46; Nieminen"
                            1 => "M&#46; Bohm"
                            2 => "M&#46;R&#46; Cowie"
                            3 => "H&#46; Drexler"
                            4 => "G&#46;S&#46; Filippatos"
                            5 => "G&#46; Jondeau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehi044"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "384"
                        "paginaFinal" => "416"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15681577"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure&#58; an international pooled analysis of 1256 patients&#58; the International Collaborative of NT-proBNP Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Januzzi"
                            1 => "R&#46; van Kimmenade"
                            2 => "J&#46; Lainchbury"
                            3 => "A&#46; Bayes-Genis"
                            4 => "J&#46; Ordonez-Llanos"
                            5 => "M&#46; Santalo-Bel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehi631"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2006"
                        "volumen" => "27"
                        "paginaInicial" => "330"
                        "paginaFinal" => "337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16293638"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "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 [
                        0 => array:3 [
                          "colaboracion" => "ESC Committee for Practice Guidelines"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; McMurray"
                            1 => "S&#46; Adamopoulos"
                            2 => "S&#46;D&#46; Anker"
                            3 => "A&#46; Auricchio"
                            4 => "M&#46; B&#246;hm"
                            5 => "K&#46; Dickstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurjhf/hfs105"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2012"
                        "volumen" => "14"
                        "paginaInicial" => "803"
                        "paginaFinal" => "869"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22828712"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Limited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Zamora"
                            1 => "J&#46; Lup&#243;n"
                            2 => "M&#46; de Antonio"
                            3 => "J&#46; Vila"
                            4 => "A&#46; Gal&#225;n"
                            5 => "P&#46; Gastelurrutia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0051234"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2012"
                        "volumen" => "7"
                        "paginaInicial" => "e51234"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23240006"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dilated cardiomyopathy in mice deficient for the lysosomal cysteine peptidase cathepsin L"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Stypmann"
                            1 => "K&#46; Glaser"
                            2 => "W&#46; Roth"
                            3 => "D&#46;J&#46; Tobin"
                            4 => "I&#46; Petermann"
                            5 => "R&#46; Matthias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1073/pnas.092637699"
                      "Revista" => array:6 [
                        "tituloSerie" => "Proc Natl Acad Sci USA"
                        "fecha" => "2002"
                        "volumen" => "99"
                        "paginaInicial" => "6234"
                        "paginaFinal" => "6239"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11972068"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enhanced myocardial cathepsin B expression in patients with dilated cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Ge"
                            1 => "G&#46; Zhao"
                            2 => "R&#46; Chen"
                            3 => "S&#46; Li"
                            4 => "S&#46; Wang"
                            5 => "X&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejheart.2005.09.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2006"
                        "volumen" => "8"
                        "paginaInicial" => "284"
                        "paginaFinal" => "289"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16480925"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Local expression of myocardial galectin-3 does not correlate with its serum levels in patients undergoing heart transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Beiras-Fernandez"
                            1 => "F&#46; Weis"
                            2 => "J&#46; Rothkopf"
                            3 => "I&#46; Kaczmarek"
                            4 => "C&#46; Ledderose"
                            5 => "A&#46; Dick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Transplant"
                        "fecha" => "2013"
                        "volumen" => "22"
                        "paginaInicial" => "643"
                        "paginaFinal" => "650"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alterations in the pattern of collagen deposition may contribute to the deterioration of systolic function in hypertensive patients with heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46; L&#243;pez"
                            1 => "A&#46; Gonz&#225;lez"
                            2 => "R&#46; Querejeta"
                            3 => "M&#46; Larman"
                            4 => "J&#46; D&#237;ez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2006.01.077"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2006"
                        "volumen" => "48"
                        "paginaInicial" => "89"
                        "paginaFinal" => "96"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16814653"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extracellular matrix remodeling in hypertensive heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Shirwany"
                            1 => "K&#46;T&#46; Weber"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2006.04.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2006"
                        "volumen" => "48"
                        "paginaInicial" => "97"
                        "paginaFinal" => "98"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16814654"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Regulation of elastinolytic cysteine proteinase activity in normal and cathepsin K-deficient human macrophages"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Punturieri"
                            1 => "S&#46; Filippov"
                            2 => "E&#46; Allen"
                            3 => "I&#46; Caras"
                            4 => "R&#46; Murray"
                            5 => "V&#46; Reddy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Exp Med"
                        "fecha" => "2000"
                        "volumen" => "192"
                        "paginaInicial" => "789"
                        "paginaFinal" => "799"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10993910"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Digesting the remodeled heart role of lysosomal cysteine proteases in heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46; Sam"
                            1 => "D&#46;A&#46; Siwik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.HYP.0000242332.19693.e4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "2006"
                        "volumen" => "48"
                        "paginaInicial" => "830"
                        "paginaFinal" => "831"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16982959"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "es"
  "url" => "/00142565/0000021600000002/v1_201603010019/S0014256515002751/v1_201603010019/es/main.assets"
  "Apartado" => array:4 [
    "identificador" => "1062"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Originales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/00142565/0000021600000002/v1_201603010019/S0014256515002751/v1_201603010019/es/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256515002751?idApp=WRCEE"
]