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El conocimiento sobre los factores relacionados con el riesgo de reingreso de estos pacientes es a&#250;n limitado&#46; Adem&#225;s&#44; tradicionalmente los modelos predictivos desarrollados en IC han evaluado el riesgo hasta la aparici&#243;n del primer evento&#44; ignorando las rehospitalizaciones posteriores que acontecen en la historia natural de un paciente con IC&#46; En este sentido&#44; diversos autores abogan por implementar metodolog&#237;as estad&#237;sticas que permitan evaluar todas las hospitalizaciones que tienen lugar de manera recurrente en el paciente con IC&#44; obteniendo por tanto una visi&#243;n m&#225;s real de la carga de morbilidad relacionada con los reingresos<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La troponina de alta sensibilidad es un biomarcador de da&#241;o mioc&#225;rdico ampliamente disponible&#44; fundamentalmente utilizado para el diagn&#243;stico del infarto agudo de miocardio &#40;IAM&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a>&#46; Tambi&#233;n se eleva en un n&#250;mero significativo de pacientes con ICA&#44; incluso en ausencia de signos o s&#237;ntomas de isquemia mioc&#225;rdica<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">9</span></a>&#46; El aumento de troponina T ultrasensible &#40;TnT-us&#41; se asocia con un mayor riesgo de un primer reingreso y mortalidad en el seguimiento de estos pacientes<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">10&#8211;18</span></a>&#46; Sin embargo&#44; no disponemos de datos sobre su valor en la predicci&#243;n de ingresos recurrentes a lo largo de todo el seguimiento&#46; El objetivo de nuestro estudio fue evaluar la asociaci&#243;n entre los valores de TnT-us al ingreso en pacientes con ICA&#44; y el riesgo posterior de hospitalizaciones durante el seguimiento&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Protocolo y grupo de estudio</span><p id="par0015" class="elsevierStylePara elsevierViewall">Incluimos de manera prospectiva a una cohorte consecutiva de 645 pacientes ingresados en el Servicio de Cardiolog&#237;a del Hospital Cl&#237;nico Universitario de Valencia con el diagn&#243;stico de ICA&#44; entre el 1 de enero de 2012 y el 1 de marzo de 2014&#46; La ICA se defini&#243; seg&#250;n las Gu&#237;as de Pr&#225;ctica Cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a>&#46; Se incluyeron tanto pacientes con IC de <span class="elsevierStyleItalic">novo</span> como con descompensaci&#243;n aguda de una IC cr&#243;nica&#46; Se excluyeron los pacientes con IAM<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a>&#46; La atenci&#243;n cl&#237;nica de los pacientes durante la hospitalizaci&#243;n fue individualizada&#44; de acuerdo al criterio del facultativo responsable&#44; quien pod&#237;a solicitar las exploraciones complementarias pertinentes para el diagn&#243;stico de etiolog&#237;a isqu&#233;mica aguda seg&#250;n su sospecha cl&#237;nica&#46; De esta forma&#44; se excluyeron del presente an&#225;lisis 24 pacientes cuyo diagn&#243;stico final al alta fue de IAM&#44; siendo la muestra estudiada finalmente de 621 pacientes&#46; A lo largo de la hospitalizaci&#243;n &#237;ndice se evaluaron un amplio n&#250;mero de variables cl&#237;nicas&#44; demogr&#225;ficas&#44; bioqu&#237;micas&#44; par&#225;metros ecocardiogr&#225;ficos&#44; electrocardiograma de 12 derivaciones&#44; y tratamientos recibidos&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Determinaci&#243;n de TnT-us</span><p id="par0020" class="elsevierStylePara elsevierViewall">La medici&#243;n sangu&#237;nea de los valores de TnT-us se realiz&#243; en el momento del primer contacto m&#233;dico en el servicio de urgencias durante el episodio &#237;ndice&#44; mediante el test inmunol&#243;gico <span class="elsevierStyleItalic">in vitro</span> disponible &#40;Elecsys Troponin T hs STAT Cobas&#174; de Roche Diagnostics GmbH&#41;&#44; con t&#233;cnica s&#225;ndwich de doble anticuerpo monoclonal &#40;sensibilidad 0&#44;1<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41;&#46; Los resultados de TnT-us estuvieron disponibles para el cl&#237;nico responsable del paciente&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Seguimiento y objetivos del estudio</span><p id="par0025" class="elsevierStylePara elsevierViewall">La variable primaria de valoraci&#243;n del estudio fue la cuant&#237;a de hospitalizaciones recurrentes durante el seguimiento&#46; Se evalu&#243; tanto el riesgo de reingreso por todas las causas como&#44; espec&#237;ficamente&#44; por ICA&#46; Se registraron todos los episodios de reingresos hospitalarios de car&#225;cter no programado tras el alta hospitalaria del episodio &#237;ndice&#46; Los investigadores encargados de la adjudicaci&#243;n de eventos desconocieron los valores de TnT-us&#46; El seguimiento de los pacientes se realiz&#243; hasta la &#250;ltima fecha en que se certific&#243; el estado vital del paciente&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El estudio se desarroll&#243; de acuerdo a los principios de la Declaraci&#243;n de Helsinki&#44; y fue aprobado por el comit&#233; &#233;tico de nuestro centro&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis estad&#237;stico</span><p id="par0035" class="elsevierStylePara elsevierViewall">Las variables continuas se expresaron como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar o mediana &#40;rango intercuart&#237;lico &#91;RI&#93;&#41;&#46; Las frecuencias de las variables categ&#243;ricas se expresaron como porcentajes&#46; Las caracter&#237;sticas basales de los pacientes fueron representadas seg&#250;n los cuartiles de los valores de TnT-us&#46; Se determinaron las incidencias acumuladas de reingresos hospitalarios de acuerdo a los cuartiles de TnT-us &#40;TnT-Q&#41;&#46; La asociaci&#243;n independiente entre la transformaci&#243;n logar&#237;tmica de los valores de TnT-us &#40;log-TnT-us&#41; o los TnT-Q con los ingresos recurrentes se evalu&#243; mediante regresi&#243;n binomial multivariante &#40;Nbreg&#41;&#44; y sus estimaciones de riesgo se expresaron como cociente de las tasas de incidencia &#40;<span class="elsevierStyleItalic">incident rate ratios</span> &#91;IRR&#93;&#41;&#46; La muerte se incluy&#243; como una hospitalizaci&#243;n adicional en el modelo Nbreg&#44; pero solo si esta ocurr&#237;a fuera de una hospitalizaci&#243;n&#44; como recientemente se ha sugerido en la literatura<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El modelo multivariante final incluy&#243; las siguientes covariables&#58; edad&#44; ingresos previos por IC&#44; etiolog&#237;a isqu&#233;mica&#44; antecedentes de enfermedad pulmonar obstructiva cr&#243;nica&#44; fracci&#243;n de eyecci&#243;n ventricular izquierda &#40;FEVI&#41; &#60;35&#37;&#44; presi&#243;n arterial sist&#243;lica al ingreso&#44; hemoglobina&#44; urea&#44; p&#233;ptido natriur&#233;tico NT-proBNP y tratamiento con bloqueadores beta&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se consider&#243; estad&#237;sticamente significativo para todos los an&#225;lisis un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Se utiliz&#243; el software estad&#237;stico STATA 14 para los c&#225;lculos &#40;StataCorp&#44; College Station&#44; TX&#44; EE&#46; UU&#46;&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Caracter&#237;sticas basales de los pacientes</span><p id="par0050" class="elsevierStylePara elsevierViewall">La edad media de la muestra fue de 73&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;8 a&#241;os&#44; el 54&#44;6&#37; fueron varones y el 52&#37; ten&#237;a una FEVI &#8805;50&#37;&#46; La mediana de TnT-us fue de 35&#44;5<span class="elsevierStyleHsp" style=""></span>pg&#47;ml &#40;RI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22-67&#41;&#44; y el 90&#37; de los pacientes presentaron valores considerados elevados &#40;&#8805; 14<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#41;&#46; La mediana de NT-proBNP fue de 3&#46;795<span class="elsevierStyleHsp" style=""></span>pg&#47;ml &#40;RI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;111-7&#46;464&#41;&#46; Con respecto a la funci&#243;n renal&#44; la media de creatinina s&#233;rica y de filtrado glomerular estimado fueron de 1&#44;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;56<span class="elsevierStyleHsp" style=""></span>mg&#47;dl y 65&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&#44;4<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; respectivamente&#44; de forma que 270 pacientes &#40;43&#44;4&#37;&#41; presentaron una tasa de filtrado glomerular &#60;60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46; Las caracter&#237;sticas basales de la muestra&#44; representadas seg&#250;n los cuartiles de TnT-us al ingreso&#44; se detallan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Los pacientes con valores elevados de TnT-us ten&#237;an m&#225;s edad y presentaron mayor prevalencia de hipertensi&#243;n arterial&#44; cardiopat&#237;a isqu&#233;mica cr&#243;nica&#44; disfunci&#243;n sist&#243;lica ventricular izquierda e insuficiencia renal&#44; as&#237; como valores m&#225;s elevados de NT-proBNP&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Incidencia de mortalidad y hospitalizaciones recurrentes</span><p id="par0055" class="elsevierStylePara elsevierViewall">Tras una mediana de seguimiento de 1&#44;2 a&#241;os &#40;RI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;4-2&#44;4&#41;&#44; se registraron 153 muertes &#40;24&#44;6&#37;&#41;&#44; 698 reingresos por todas las causas en 303 pacientes &#40;48&#44;8&#37;&#41;&#44; y 286 reingresos por IC en 163 pacientes &#40;26&#44;3&#37;&#41;&#46; De las muertes&#44; 109 fueron de causa cardiovascular y de ellas 56 debidas a IC&#46; La distribuci&#243;n del n&#250;mero de ingresos por todas las causas fue la siguiente&#58; 1&#61; 134 &#40;21&#44;6&#37;&#41;&#59; 2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>76 &#40;12&#44;2&#37;&#41;&#59; 3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31 &#40;5&#37;&#41;&#59; 4<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29 &#40;4&#44;7&#37;&#41; y &#8805;5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33 &#40;5&#44;3&#37;&#41;&#46; Para el n&#250;mero de reingresos por IC&#44; la distribuci&#243;n fue la siguiente&#58; 1&#61; 101 &#40;16&#44;3&#37;&#41;&#59; 2&#61; 28 &#40;4&#44;5&#37;&#41;&#59; 3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19 &#40;3&#44;1&#37;&#41;&#59; 4<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9 &#40;1&#44;5&#37;&#41; y &#8805;5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6 &#40;1&#37;&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">TnT-us y hospitalizaciones recurrentes</span><p id="par0060" class="elsevierStylePara elsevierViewall">La incidencia acumulada de ingresos por todas las causas &#40;por 10 personas-a&#241;o de seguimiento&#41; aument&#243; escalonada y significativamente desde el cuartil inferior al superior de TnT-us &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#46; Este mismo hecho&#44; e incluso con una diferencia de mayor magnitud&#44; se constat&#243; para los reingresos por ICA &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#44; as&#237; como para la mortalidad total &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Los valores elevados de TnT-us tambi&#233;n se asociaron tanto con el riesgo de muerte cardiovascular &#40;log-rank test&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; como por IC &#40;log-rank test&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En el an&#225;lisis multivariante&#44; estas diferencias se mantuvieron significativas&#44; de manera que el log-TnT-us se asoci&#243; de manera directa e independiente con un mayor riesgo de hospitalizaciones recurrentes&#44; tanto por todas las causas como por IC &#40;IRR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;16&#59; IC del 95&#37;&#44; 1&#44;01-1&#44;36&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#59; IRR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;23&#59; IC del 95&#37;&#44; 1&#44;04-1&#44;46&#59; p&#61; 0&#44;018&#44; respectivamente&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Al evaluar el riesgo de reingreso por todas las causas atribuibles a los TnT-Q&#44; con respecto a aquellos pacientes pertenecientes al cuartil inferior &#40;&#8804; 22<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#41;&#44; se observ&#243; un incremento progresivo del riesgo desde el TnT-Q2 hasta el TnT-Q4&#44; aunque de magnitud moderada &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>A&#41;&#46; Cuando se analiz&#243; la asociaci&#243;n entre TnT-Q y el riesgo de reingreso espec&#237;fico por IC&#44; se constat&#243; una mayor intensidad de esta asociaci&#243;n&#44; observ&#225;ndose un incremento llamativo del riesgo para aquellos pacientes pertenecientes a TnT-Q3 y TnT-Q4 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">En relaci&#243;n a las rehospitalizaciones por todas las causas&#44; no se hallaron diferencias sobre el valor pron&#243;stico de la TnT-us entre los pacientes con IC y funci&#243;n sist&#243;lica deprimida &#40;FEVI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50&#37;&#41; o conservada &#40;FEVI &#8805;50&#37;&#41; &#40;p para la interacci&#243;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;110&#41;&#46; Sin embargo&#44; al evaluar el riesgo de reingresos por IC&#44; s&#237; se observ&#243; una interacci&#243;n significativa entre la FEVI y la TnT-us &#40;p para la interacci&#243;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#41;&#46; La asociaci&#243;n entre valores de TnT-us y reingresos por IC fue m&#225;s significativa para el subgrupo de pacientes con funci&#243;n sist&#243;lica deprimida &#40;IRR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;61&#44; IC del 95&#37;&#44; 1&#44;21-2&#44;17&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; que para aquellos con funci&#243;n sist&#243;lica conservada &#40;IRR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;09&#44; IC del 95&#37;&#44; 0&#44;89 a 1&#44;33&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;400&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">El presente estudio confirma que los pacientes con ICA presentan valores elevados de TnT-us que se asocian a un mayor riesgo de mortalidad&#44; y ampl&#237;a el conocimiento sobre el valor de este biomarcador como predictor de morbilidad&#46; Concretamente&#44; el estudio muestra que los valores de TnT-us&#44; determinados al ingreso en pacientes no seleccionados con ICA&#44; se asocian de manera directa e independiente con el riesgo de hospitalizaciones recurrentes durante el seguimiento&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Es bien conocido que&#44; tras una hospitalizaci&#243;n por IC&#44; la tasa de reingresos posteriores contin&#250;a siendo muy elevada<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; La historia natural del paciente con IC se caracteriza por numerosos episodios de descompensaci&#243;n que frecuentemente motivan ingresos hospitalarios recurrentes&#44; los cuales condicionan un importante deterioro de la calidad de vida&#44; consumo de recursos sanitarios y menor supervivencia<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">4&#8211;6</span></a>&#46; Cl&#225;sicamente&#44; el efecto pron&#243;stico de un determinado perfil cl&#237;nico o estrategia terap&#233;utica se ha evaluado como el tiempo hasta presentar el primer evento&#44; ignorando gran parte de los eventos adversos que posteriormente acontecen en la evoluci&#243;n de los pacientes con IC&#46; En un intento de perfilar de manera m&#225;s precisa la carga de morbilidad asociada a la IC&#44; al igual que otros autores&#44; consideramos que la evaluaci&#243;n de la historia natural del paciente con IC debe incluir todos los episodios adversos de rehospitalizaci&#243;n durante el seguimiento<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">7&#44;22</span></a>&#46; Aunque la experiencia en aplicar esta metodolog&#237;a es todav&#237;a escasa&#44; se ha empleado ya en an&#225;lisis post-hoc de diversos ensayos cl&#237;nicos de IC &#40;CHARM&#44; CORONA&#44; SHIFT o EMPHASIS-HF&#41;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">20&#44;21&#44;23&#44;24</span></a>&#44; y se define como criterio de valoraci&#243;n principal en estudios actualmente en marcha como el PARAGON-HF<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La troponina es un biomarcador de da&#241;o mioc&#225;rdico cl&#225;sicamente utilizada para el diagn&#243;stico del IAM y la estratificaci&#243;n pron&#243;stica de pacientes con cardiopat&#237;a isqu&#233;mica aguda<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">8</span></a>&#46; Sin embargo&#44; tanto en pacientes con ICA como cr&#243;nica es com&#250;n observar valores elevados de troponina<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">9</span></a>&#46; Esta situaci&#243;n es todav&#237;a m&#225;s frecuente cuando se utilizan reactivos de alta sensibilidad&#44; como la TnT-us&#46; Por ejemplo&#44; en el estudio RELAX-AHF&#44; de manera comparable a nuestro estudio&#44; el 90&#37; de los pacientes incluidos presentaban valores de TnT-us por encima del percentil 99 de referencia<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Los mecanismos responsables de la elevaci&#243;n de troponina en pacientes con IC son controvertidos e incluyen&#44; entre otros&#44; la isquemia subendoc&#225;rdica y consecuente necrosis celular&#44; el da&#241;o de los cardiomiocitos mediado por citocinas&#44; o el estr&#233;s oxidativo<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">9&#44;26&#8211;28</span></a>&#46; Una interesante hip&#243;tesis fisiopatol&#243;gica sostiene que el incremento de las cifras de troponina en la IC ser&#237;a un reflejo de fen&#243;menos de prote&#243;lisis de las prote&#237;nas contr&#225;ctiles card&#237;acas&#44; que podr&#237;an estar desencadenados por el estr&#233;s parietal&#44; el estr&#233;s oxidativo&#44; la activaci&#243;n neurohormonal o la isquemia microvascular&#44; todos ellos fen&#243;menos habitualmente presentes en la IC<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a>&#46; Los fen&#243;menos de apoptosis se han descrito en pacientes con IC&#44; pero no est&#225; claramente establecido que provoquen la liberaci&#243;n de troponina<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a>&#46; En resumen&#44; los mecanismos fisiopatol&#243;gicos implicados en la elevaci&#243;n de TnT-us en la ICA siguen siendo en gran parte desconocidos&#46; Probablemente&#44; ser&#237;an necesarios estudios experimentales adicionales para alcanzar una mejor compresi&#243;n de los mecanismos subyacentes de la presencia de valores elevados de troponina en la IC&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Aunque existe una gran heterogeneidad entre los diferentes estudios que han evaluado el papel pron&#243;stico de la troponina en la IC &#40;tanto por los diferentes reactivos evaluados&#44; momento de su determinaci&#243;n&#44; o perfil cl&#237;nico de la poblaci&#243;n analizada&#41;&#44; existe un amplio consenso en que valores elevados de troponina se asocian con un mayor riesgo de mortalidad en pacientes con ICA<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">10&#8211;18</span></a>&#46; Por ejemplo&#44; un an&#225;lisis reciente del estudio RELAX-AHF mostr&#243; que&#44; tanto los valores basales como los cambios de la TnT-us durante la hospitalizaci&#243;n &#237;ndice por ICA se asociaron con un mayor riesgo de mortalidad cardiovascular a los 180 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a>&#46; Nuestros resultados apoyan y ampl&#237;an la evidencia disponible&#44; mostrando que los valores de TnT-us se asocian de manera independiente con la mortalidad durante el seguimiento&#44; pero tambi&#233;n con la carga de morbilidad y reingresos&#46; En este sentido&#44; aunque algunos estudios previos ya hab&#237;an mostrado una asociaci&#243;n entre el riesgo de un primer reingreso &#40;evaluado como tiempo hasta el primer evento&#41; y los valores de troponina<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">10&#44;13&#44;14&#44;17&#44;18</span></a>&#44; nuestro estudio es el primero que avala la asociaci&#243;n estrecha entre las concentraciones plasm&#225;ticas de TnT-us y el riesgo de ingresos repetidos tras un episodio de ICA&#46; Esta asociaci&#243;n fue significativa tanto para reingresos por cualquier causa como por descompensaci&#243;n de IC&#44; y se observ&#243; fundamentalmente en el subgrupo de pacientes con funci&#243;n sist&#243;lica deprimida&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Aunque no ha sido un objetivo evaluado en el presente trabajo&#44; la troponina puede tener un valor pron&#243;stico complementario a otros biomarcadores de IC&#46; En esta serie el valor pron&#243;stico de la TnT-us fue independiente de los valores de NT-proBNP&#46; En este sentido&#44; Vorovich et al&#46; evaluaron la utilidad de un panel de 9 biomarcadores como predictores de reingreso de causa cardiaca en m&#225;s de 1&#46;500 pacientes con IC estable&#44; obteniendo la asociaci&#243;n m&#225;s significativa para BNP y TnI<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">31</span></a>&#46; Datos similares obtuvieron Tentzeris et al&#46; en cuanto al uso combinado de copeptina y TnT para predecir muerte y reingreso en pacientes con IC cr&#243;nica<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">32</span></a>&#46; Por otra parte&#44; Pascual-Figal et al&#46; mostraron en 107 pacientes con ICA que tanto TnT-us&#44; NT-proBNP como ST-2 aportan informaci&#243;n pron&#243;stica independiente para la mortalidad&#44; pero que el uso conjunto de los 3 biomarcadores permite optimizar la estratificaci&#243;n de riesgo en la IC<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En esta serie encontramos una prevalencia elevada de pacientes con insuficiencia renal &#40;43&#44;4&#37;&#41;&#46; Existe controversia acerca de la precisi&#243;n y la interpretaci&#243;n de los valores de TnT-us para el diagn&#243;stico de IAM en el paciente con enfermedad renal&#44; situaci&#243;n en la que los puntos de corte del biomarcador podr&#237;an ser m&#225;s elevados que para la poblaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">33</span></a>&#46; Sin embargo&#44; en pacientes con insuficiencia renal el valor pron&#243;stico de la troponina no parece afectarse por el uso de reactivos de alta sensibilidad&#46; En estudios previos&#44; la TnT-us mantuvo su valor pron&#243;stico&#44; y valores elevados del biomarcador fueron predictores de desarrollo de IC y mortalidad en series amplias de pacientes con enfermedad renal cr&#243;nica<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">34</span></a>&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Limitaciones</span><p id="par0110" class="elsevierStylePara elsevierViewall">Las principales limitaciones de este estudio son las relacionadas con su car&#225;cter unic&#233;ntrico&#46; Adem&#225;s&#44; aunque los pacientes con diagn&#243;stico final de IAM fueron excluidos del an&#225;lisis&#44; de acuerdo a las Gu&#237;as de Pr&#225;ctica Cl&#237;nica<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">8&#44;19</span></a>&#44; no se realiz&#243; una b&#250;squeda sistem&#225;tica de la etiolog&#237;a isqu&#233;mica aguda en todos los pacientes con valores elevados de TnT-us&#44; sino que esta dependi&#243; de la sospecha cl&#237;nica de s&#237;ndrome coronario agudo por parte del facultativo responsable del paciente en la hospitalizaci&#243;n &#237;ndice&#46; Esta variabilidad cl&#237;nica en la atenci&#243;n de los pacientes inherente a un estudio realizado en el contexto de la pr&#225;ctica cl&#237;nica diaria no permite descartar con total seguridad la existencia de pacientes con s&#237;ndrome coronario agudo&#46; No se realiz&#243; determinaci&#243;n seriada de TnT-us en todos los pacientes incluidos&#44; lo que impide conocer cu&#225;l puede ser el momento m&#225;s &#243;ptimo para su determinaci&#243;n&#44; o si las determinaciones seriadas del biomarcador pueden tener un valor predictivo adicional&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Perspectivas futuras</span><p id="par0115" class="elsevierStylePara elsevierViewall">Los datos sugieren que la determinaci&#243;n TnT-us deber&#237;a incorporarse a las herramientas disponibles para la estratificaci&#243;n de riesgo del paciente con ICA&#46; Adem&#225;s de su valor ya conocido como predictor de mortalidad&#44; este estudio confirma su utilidad en la predicci&#243;n de las hospitalizaciones recurrentes durante el seguimiento de estos pacientes&#46; Estudios futuros deber&#225;n esclarecer si medidas como la intensificaci&#243;n en el tratamiento&#44; la b&#250;squeda de nuevas estrategias terap&#233;uticas&#44; o un seguimiento m&#225;s estrecho de los pacientes con elevaci&#243;n de TnT-us podr&#237;an tener un impacto en mejorar el pron&#243;stico&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Financiaci&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">Este estudio ha sido financiado en parte por becas del Instituto de Salud Carlos <span class="elsevierStyleSmallCaps">III</span> y de FEDER&#44; Red de Investigaci&#243;n Cardiovascular&#44; Programa 7 &#40;RD12&#47;0042&#47;0010&#41; y PIE15&#47;00013&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicto de intereses</span><p id="par0125" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Caracter&#237;sticas basales de los pacientes"
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              "titulo" => "Incidencia de mortalidad y hospitalizaciones recurrentes"
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              "titulo" => "TnT-us y hospitalizaciones recurrentes"
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    "fechaRecibido" => "2016-05-02"
    "fechaAceptado" => "2016-10-18"
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            0 => "Troponina ultrasensible"
            1 => "Insuficiencia card&#237;aca"
            2 => "Hospitalizaciones recurrentes&#46;"
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            0 => "Ultrasensitive troponin"
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    "resumen" => array:2 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La troponina de alta sensibilidad es un biomarcador de da&#241;o mioc&#225;rdico que se asocia a un mayor riesgo de mortalidad y progresi&#243;n de la enfermedad en pacientes con insuficiencia card&#237;aca aguda &#40;ICA&#41;&#46; Sin embargo&#44; su relaci&#243;n con el riesgo de futuras rehospitalizaciones es menos conocido&#46; El objetivo de este estudio fue evaluar la asociaci&#243;n entre los valores de troponina T ultrasensible &#40;TnT-us&#41; en pacientes con ICA y el riesgo de hospitalizaciones recurrentes en el seguimiento&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; prospectivamente una cohorte de 621 pacientes consecutivos con ICA&#44; excluy&#233;ndose pacientes con s&#237;ndrome coronario agudo&#46; Se determin&#243; la TnT-us obtenida en el primer contacto m&#233;dico en urgencias&#46; El riesgo de reingresos acumulados se evalu&#243; mediante regresi&#243;n binomial negativa&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La edad media de los sujetos fue de 73&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;8 a&#241;os&#44; el 54&#44;6&#37; eran varones y el 52&#37; ten&#237;an una funci&#243;n sist&#243;lica ventricular izquierda &#8805;50&#37;&#46; La mediana de TnT-us fue de 35&#44;5<span class="elsevierStyleHsp" style=""></span>pg&#47;ml &#40;rango intercuart&#237;lico &#91;RI&#93;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22-67&#41;&#46; Tras una mediana de seguimiento de 1&#44;2 a&#241;os &#40;RI&#61; 0&#44;4-2&#44;4&#41; se registraron 153 muertes &#40;24&#44;6&#37;&#41;&#44; 689 reingresos por todas las causas en 303 pacientes &#40;48&#44;8&#37;&#41;&#44; y 286 reingresos por IC en 163 pacientes &#40;26&#44;3&#37;&#41;&#46; En el an&#225;lisis multivariante&#44; los valores elevados de TnT-us se asociaron con un aumento del riesgo de reingreso&#44; tanto por todas las causas como por IC &#40;cociente de las tasas de incidencia &#91;IRR&#93; &#61;1&#44;16&#59; intervalo de confianza del 95&#37;&#44; 1&#44;02-1&#44;36&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#59; IRR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;23&#59; intervalo de confianza del 95&#37;&#44; 1&#44;04-1&#44;46&#59; p&#61; 0&#44;018&#44; respectivamente&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En pacientes con ICA&#44; el aumento de los valores de TnT-us se asoci&#243; de manera independiente con el riesgo de hospitalizaciones recurrentes durante el seguimiento&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">High-sensitivity troponin is a biomarker of myocardial damage and is associated with a greater risk of mortality and disease progression in patients with acute heart failure &#40;AHF&#41;&#46; However&#44; its relationship with the risk of future readmissions is less known<span class="elsevierStyleBold">&#46;</span> The aim of this study was to assess the association between ultrasensitive troponin T &#40;TnT-us&#41; values in patients with AHF and the risk of recurrent readmissions in the follow-up&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We prospectively included a cohort of 621 consecutive patients with AHF&#44; excluding those patients with acute coronary syndrome&#46; We measured the TnT-us levels obtained during the first medical contact in the emergency department&#46; The risk of cumulative readmissions was assessed using negative binomial regression&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The mean age of the participants was 73&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;8 years&#44; 54&#46;6&#37; were men&#44; and 52&#37; had a left ventricular systolic function &#8805;50&#37;&#46; The median TnT-us level was 35&#46;5<span class="elsevierStyleHsp" style=""></span>pg&#47;ml &#40;interquartile range &#91;IQR&#93;&#44; 22-67&#41;&#46; After a median follow-up of 1&#46;2 years &#40;IQR&#44; 0&#46;4-2&#46;4&#41;&#44; a total of 153 deaths &#40;24&#46;6&#37;&#41; were recorded&#44; as well as 689 readmissions for all causes in 303 patients &#40;48&#46;8&#37;&#41; and 286 readmissions for HF in 163 patients &#40;26&#46;3&#37;&#41;&#46; In the multivariate analysis&#44; the high TnT-us values were associated with an increased risk of readmission&#44; both for all causes and for HF &#40;incidence rate ratio &#91;IRR&#93;&#44; 1&#46;16&#59; 95&#37; confidence interval&#44; 1&#46;02-1&#46;36&#59; p&#61;&#46;029 and IRR&#44; 1&#46;23&#59; 95&#37; confidence interval&#44; 1&#46;04-1&#46;46&#59; p&#61;&#46;018&#44; respectively&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">For patients with AHF&#44; the increase in TnT-us levels was independently associated with a risk of recurrent readmissions during the follow-up&#46;</p></span>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Incidencia de hospitalizaciones recurrentes en funci&#243;n de los valores de TnT-us&#46; A&#41; Hospitalizaciones por todas las causas&#46; B&#41; Hospitalizaciones por insuficiencia card&#237;aca&#46; TnT-Q&#58; cuartiles de troponina T&#59; TnT-us&#58; troponina T ultrasensible&#46;</p>"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Curvas de mortalidad de Kaplan-Meier en funci&#243;n de los cuartiles de TnT-us&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">TnT-Q&#58; cuartiles de troponina T&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Valores para variables continuas expresadas como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">ACV&#58; accidente cerebrovascular&#59; AI&#58; aur&#237;cula izquierda&#59; ARA-<span class="elsevierStyleSmallCaps">II</span>&#58; antagonistas de los receptores de angiotensina <span class="elsevierStyleSmallCaps">II</span>&#59; DTDVI&#58; di&#225;metro telediast&#243;lico ventricular izquierdo&#59; EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#59; FEVI&#58; fracci&#243;n de eyecci&#243;n ventricular izquierda&#59; FGR&#58; filtrado glomerular renal&#59; IC&#58; insuficiencia card&#237;aca&#59; IECA&#58; inhibidores de la enzima convertidora de angiotensina&#59; NT-proBNP&#58; fracci&#243;n N-terminal del p&#233;ptido natriur&#233;tico tipo B&#59; PAD&#58; presi&#243;n arterial diast&#243;lica&#59; PAS&#58; presi&#243;n arterial sist&#243;lica&#59; TAPSE&#58; desplazamiento sist&#243;lico del plano del anillo tricusp&#237;deo&#59; TnT-us&#58; troponina T ultrasensible&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TnT-us &#40;pg&#47;ml&#41;</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Valor de la p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">Q1<br>&#40;&#8804; 22&#41;<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>155&#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">Q2<br>&#40;22-35&#44;4&#41;<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>155&#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">Q3<br>&#40;35&#44;5-67&#41;<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>156&#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">Q4<br>&#40;&#62; 67&#41;<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>155&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Historia cl&#237;nica y caracter&#237;sticas demogr&#225;ficas</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>Edad&#44; a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&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></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>Sexo var&#243;n&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65 &#40;41&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91 &#40;58&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97 &#40;61&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86 &#40;55&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;014&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>Primer ingreso por IC&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111&#40;71&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94 &#40;60&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108 &#40;69&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">103 &#40;66&#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;684&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>Hipertensi&#243;n&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">113 &#40;72&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">127 &#40;81&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">137 &#40;87&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">136 &#40;87&#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">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 &#40;47&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81 &#40;51&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80 &#40;51&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;121&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>Dislipemia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 &#40;47&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81 &#40;51&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80 &#40;51&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;030&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>Tabaquismo activo&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;11&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;15&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;14&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;14&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;506&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&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;28&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;37&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72 &#40;46&#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;003&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&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;18&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;21&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;23&#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;196&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>ACV previo&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;11&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;9&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;10&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;636&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>Arteriopat&#237;a perif&#233;rica&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;11&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;12&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;12&#44;3&#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;253&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="6" 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="6" align="left" valign="top">Signos vitales</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>Frecuencia card&#237;aca&#44; lpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">102&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#44;2&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;078&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>PAS&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">144&#44;6 &#177;28&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">148&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">153&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">149&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&#44;8&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;148&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>PAD&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;5&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;079&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="6" 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="6" align="left" valign="top">Electrocardiograma</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>QRS &#62;120 mseg&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;23&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63 &#40;40&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;35&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;30&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;327&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&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87 &#40;56&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;37&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;34&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 &#40;32&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" 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="6" align="left" valign="top"><span class="elsevierStyleItalic">Laboratorio</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>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="left" valign="top">12&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;648<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;810&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;672<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;422&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">137&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">137&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NT-proBNP&#44; pg&#47;ml<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="left" valign="top">2&#46;321 &#40;3&#46;578&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;795 &#40;4&#46;531&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;274 &#40;5&#46;375&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;029 &#40;8&#46;439&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Creatinina al ingreso&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;43<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urea&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>38&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FGR&#44; mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" 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="6" align="left" valign="top">Ecocardiograma</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>FEVI&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;13&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;32&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;24&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;094&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>AI&#44; mm&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">119 &#40;76&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46 &#40;29&#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;929&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71 &#40;45&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;35&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65 &#40;41&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "identificador" => "bib0175"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of heart failure in Spain over the last 20 years"
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                          "autores" => array:3 [
                            0 => "I&#46; Sayago-Silva"
                            1 => "F&#46; Garc&#237;a-L&#243;pez"
                            2 => "J&#46; Segovia-Cubero"
                          ]
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                      "doi" => "10.1016/j.rec.2013.03.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2013"
                        "volumen" => "66"
                        "paginaInicial" => "649"
                        "paginaFinal" => "656"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24776334"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0180"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rehospitalization for heart failure&#46; Problems and perspectives"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Gheorghiade"
                            1 => "M&#46; Vaduganathan"
                            2 => "G&#46;C&#46; Fonarow"
                            3 => "R&#46;O&#46; Bonow"
                          ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2012.09.038"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2013"
                        "volumen" => "61"
                        "paginaInicial" => "391"
                        "paginaFinal" => "393"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23219302"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0185"
              "etiqueta" => "3"
              "referencia" => array:1 [
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                    0 => array:2 [
                      "titulo" => "Rehospitalization for heart failure&#46; Predict or prevent&#63;"
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                          "autores" => array:2 [
                            0 => "A&#46;S&#46; Desai"
                            1 => "L&#46;W&#46; Stevenson"
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                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2012"
                        "volumen" => "126"
                        "paginaInicial" => "501"
                        "paginaFinal" => "506"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22825412"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0190"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased mortality after an acute heart failure episode&#58; new pathophysiological insights from the RELAX-AHF study and beyond"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:3 [
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                            1 => "O&#46; Milo"
                            2 => "B&#46;A&#46; Davison"
                          ]
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                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Heart Fail Rep"
                        "fecha" => "2014"
                        "volumen" => "11"
                        "paginaInicial" => "19"
                        "paginaFinal" => "30"
                        "link" => array:1 [
                          0 => array:2 [
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              "identificador" => "bib0195"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health care and nonhealth care costs in the treatment of patients with symptomatic chronic heart failure in Spain"
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                          "etal" => true
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                            1 => "J&#46; Oliva"
                            2 => "M&#46; Llano"
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                            4 => "J&#46;J&#46; Grillo"
                            5 => "J&#46; Com&#237;n-Colet"
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                        "fecha" => "2014"
                        "volumen" => "67"
                        "paginaInicial" => "643"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25037543"
                            "web" => "Medline"
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              "identificador" => "bib0200"
              "etiqueta" => "6"
              "referencia" => array:1 [
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                      "titulo" => "Hospitalizations after heart failure diagnosis&#58; a community perspective"
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                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Dunlay"
                            1 => "M&#46;M&#46; Redfield"
                            2 => "S&#46;A&#46; Weston"
                            3 => "T&#46;M&#46; Therneau"
                            4 => "K&#46;H&#46; Long"
                            5 => "N&#46;D&#46; Shah"
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                      "doi" => "10.1016/j.jacc.2009.08.019"
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                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2009"
                        "volumen" => "54"
                        "paginaInicial" => "1695"
                        "paginaFinal" => "1702"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19850209"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
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              "etiqueta" => "7"
              "referencia" => array:1 [
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                    0 => array:2 [
                      "titulo" => "Time to move on from time-to-first&#58; should all events be included in the analysis of clinical trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;D&#46; Anker"
                            1 => "J&#46; McMurray"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs277"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "2764"
                        "paginaFinal" => "2765"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22927554"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0210"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Third universal definition of myocardial infarction"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Writing Group on behalf of the Joint ESC&#47;ACCF&#47;AHA&#47;WHF Task Force for the Universal Definition of Myocardial Infarction"
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46; Thygesen"
                            1 => "J&#46;S&#46; Alpert"
                            2 => "A&#46;S&#46; Jaffe"
                            3 => "M&#46;L&#46; Simoons"
                            4 => "B&#46;R&#46; Chaitman"
                            5 => "H&#46;D&#46; White"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs184"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "2551"
                        "paginaFinal" => "2567"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922414"
                            "web" => "Medline"
                          ]
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                  ]
                ]
              ]
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              "identificador" => "bib0215"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Troponin elevation in heart failure prevalence&#44; mechanisms&#44; and clinical implications"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;D&#46; Kociol"
                            1 => "P&#46;S&#46; Pang"
                            2 => "M&#46; Gheorghiade"
                            3 => "G&#46;C&#46; Fonarow"
                            4 => "C&#46;M&#46; O&#8217;Connor"
                            5 => "G&#46;M&#46; Felker"
                          ]
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                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2010"
                        "volumen" => "56"
                        "paginaInicial" => "1071"
                        "paginaFinal" => "1078"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20863950"
                            "web" => "Medline"
                          ]
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                  ]
                ]
              ]
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              "identificador" => "bib0220"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of serial troponin release on outcomes in patients with acute heart failure&#58; analysis from the PROTECT pilot study"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
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                            1 => "M&#46; Fiuzat"
                            2 => "C&#46; Lombardi"
                            3 => "K&#46; Fujita"
                            4 => "G&#46; Jia"
                            5 => "B&#46;A&#46; Davison"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCHEARTFAILURE.111.961581"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Heart Fail"
                        "fecha" => "2011"
                        "volumen" => "4"
                        "paginaInicial" => "724"
                        "paginaFinal" => "732"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21900185"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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            10 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac troponin and outcome in acute heart failure"
                      "autores" => array:1 [
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                            1 => "M&#46;T&#46; De"
                            2 => "G&#46;C&#46; Fonarow"
                            3 => "D&#46; Diercks"
                            4 => "J&#46; Wynne"
                            5 => "F&#46;S&#46; Apple"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0706824"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2008"
                        "volumen" => "358"
                        "paginaInicial" => "2117"
                        "paginaFinal" => "2126"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18480204"
                            "web" => "Medline"
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                ]
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              "identificador" => "bib0230"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serial high sensitivity cardiac troponin T measurement in acute heart failure&#58; insights from the RELAX-AHF study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "R&#46;J&#46; Mentz"
                            2 => "J&#46;R&#46; Teerlink"
                            3 => "A&#46;A&#46; Voors"
                            4 => "P&#46;S&#46; Pang"
                            5 => "P&#46; Ponikowski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2015"
                        "volumen" => "17"
                        "paginaInicial" => "1261"
                        "paginaFinal" => "1270"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0235"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serial changes in high-sensitive troponina I predict outcome in patients with decompensated heart failure"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Xue"
                            1 => "P&#46; Vlopton"
                            2 => "W&#46; Peacock"
                            3 => "A&#46; Maisel"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurjhf/hfq210"
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                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2011"
                        "volumen" => "13"
                        "paginaInicial" => "37"
                        "paginaFinal" => "42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21149316"
                            "web" => "Medline"
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                ]
              ]
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              "identificador" => "bib0240"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of plasma biomarkers in acute heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Metra"
                            1 => "S&#46; Nodari"
                            2 => "G&#46; Parrinello"
                            3 => "C&#46; Specchia"
                            4 => "L&#46; Brentana"
                            5 => "P&#46; Rocca"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Serial changes and independent prognostic values of NT-proBNP and cardiac troponin T Eur J Heart Fail"
                        "fecha" => "2007"
                        "volumen" => "9"
                        "paginaInicial" => "776"
                        "paginaFinal" => "786"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0245"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relation between cardiac troponin I and mortality in acute decompensated heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;J&#46; You"
                            1 => "P&#46;C&#46; Austin"
                            2 => "D&#46;A&#46; Alter"
                            3 => "D&#46;T&#46; Ko"
                            4 => "J&#46;V&#46; Tu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2007"
                        "volumen" => "153"
                        "paginaInicial" => "462"
                        "paginaFinal" => "470"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17383280"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Soluble ST2&#44; high-sensitivity troponin T and N-terminal pro-B-type natriuretic peptide&#58; complementary role for risk stratification in acutely decompensated heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
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                          "autores" => array:6 [
                            0 => "D&#46; Pascual-Figal"
                            1 => "S&#46; Manzano-Fern&#225;ndez"
                            2 => "M&#46; Boronat"
                            3 => "T&#46; Casas"
                            4 => "I&#46;P&#46; Garrido"
                            5 => "J&#46;C&#46; Bonaque"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurjhf/hfr047"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2011"
                        "volumen" => "13"
                        "paginaInicial" => "718"
                        "paginaFinal" => "725"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21551163"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-sensitive troponin T in chronic heart failure correlates with severity of symptons&#44; left ventricular dysfunction and prognosis indepently from N-terminal pro-b-type natriuretic peptide"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;G&#46; Jungbauer"
                            1 => "J&#46; Riedlinger"
                            2 => "S&#46; Buchner"
                            3 => "C&#46; Birner"
                            4 => "M&#46; Resch"
                            5 => "M&#46; Lubnow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1515/CCLM.2011.251"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Chem Lab Med"
                        "fecha" => "2011"
                        "volumen" => "49"
                        "paginaInicial" => "1899"
                        "paginaFinal" => "1906"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21892905"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic and long-term prognostic value of sensitive troponin I in symptomatic patients suspected of acute heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "F&#46; Espeter"
                            2 => "U&#46; Hoffmann"
                            3 => "S&#46; Lang"
                            4 => "M&#46; Brueckmann"
                            5 => "I&#46; Akin"
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                  "host" => array:1 [
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                      "Revista" => array:6 [
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                        "paginaFinal" => "1747"
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                      "titulo" => "ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012&#58; The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology&#46; Developed in collaboration with the Heart Failure Association &#40;HFA&#41; of the ESC"
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                            2 => "S&#46; Anker"
                            3 => "A&#46; Auricchio"
                            4 => "M&#46; B&#246;hm"
                            5 => "K&#46; Dickstein"
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                    0 => array:2 [
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                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "1787"
                        "paginaFinal" => "1847"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22611136"
                            "web" => "Medline"
                          ]
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              ]
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                      "titulo" => "Analysing recurrent hospitalizations in heart failure&#58; a review of statistical methodology&#44;with application to CHARM-Preserved"
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                          "autores" => array:6 [
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                            1 => "S&#46;J&#46; Pocock"
                            2 => "J&#46;J&#46;V&#46; McMurray"
                            3 => "C&#46;B&#46; Granger"
                            4 => "E&#46;L&#46; Michelson"
                            5 => "J&#46; &#214;stergren"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1002/ejhf.29"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2014"
                        "volumen" => "16"
                        "paginaInicial" => "33"
                        "paginaFinal" => "40"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24453096"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Effect of rosuvastatin on repeat heart failure hospitalizations&#58; the CORONA trial &#40;Controlled rosuvastatin multinational trial in heart failure&#41;"
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                            2 => "A-C&#46; P&#233;rez"
                            3 => "M&#46; Bohm"
                            4 => "J&#46;G&#46; Cleland"
                            5 => "L&#46; Gullestad"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.jchf.2013.12.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "JACC Heart Fail"
                        "fecha" => "2014"
                        "volumen" => "2"
                        "paginaInicial" => "289"
                        "paginaFinal" => "297"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24952697"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Espironolactona en pacientes con insuficiencia card&#237;aca y fracci&#243;n de eyecci&#243;n preservada"
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                        0 => array:2 [
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                            2 => "J&#46; Sanchis"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2015.10.005"
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2016"
                        "volumen" => "216"
                        "paginaInicial" => "111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26704171"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Effect of ivabradine on recurrent hospitalizations for worsening heart failure in patients with chronic systolic heart failure&#58; the SHIFT Study"
                      "autores" => array:1 [
                        0 => array:2 [
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                          "autores" => array:6 [
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                            1 => "M&#46; Bohm"
                            2 => "I&#46; Ford"
                            3 => "M&#46; Komajda"
                            4 => "L&#46; Tavazzi"
                            5 => "J&#46;L&#46; L&#243;pez-Sendon"
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                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs259"
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                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "2813"
                        "paginaFinal" => "2820"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22927555"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
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                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Eplerenone in patients with systolic heart failure and mild symptoms&#46; Analysis of repeat hospitalizations"
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                          "etal" => true
                          "autores" => array:6 [
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                            1 => "J&#46;J&#46; McMurray"
                            2 => "S&#46;J&#46; Pocock"
                            3 => "F&#46; Zannad"
                            4 => "H&#46; Krum"
                            5 => "D&#46;J&#46; van Veldhuisen"
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                        ]
                      ]
                    ]
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                      "doi" => "10.1161/CIRCULATIONAHA.112.110536"
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                        "tituloSerie" => "Circulation"
                        "fecha" => "2012"
                        "volumen" => "126"
                        "paginaInicial" => "2317"
                        "paginaFinal" => "2323"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23042980"
                            "web" => "Medline"
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                      ]
                    ]
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                    0 => array:2 [
                      "titulo" => "Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure&#58; rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial &#40;PARADIGM-HF&#41;"
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                            3 => "J&#46; Gong"
                            4 => "M&#46;P&#46; Lefkowitz"
                            5 => "A&#46;R&#46; Rizkala"
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                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1093/eurjhf/hft052"
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                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2013"
                        "volumen" => "15"
                        "paginaInicial" => "1062"
                        "paginaFinal" => "1073"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23563576"
                            "web" => "Medline"
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                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Fisiopatolog&#237;a de la insuficiencia card&#237;aca aguda&#58; un mundo por conocer"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "I&#46; Gim&#233;nez L&#243;pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2015.09.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp"
                        "fecha" => "2016"
                        "volumen" => "216"
                        "paginaInicial" => "38"
                        "paginaFinal" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26541707"
                            "web" => "Medline"
                          ]
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                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Biochemical markers of myocyte injury in heart failure"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Sato"
                            1 => "T&#46; Kita"
                            2 => "Y&#46; Takatsu"
                            3 => "T&#46; Kimura"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/hrt.2003.023895"
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                        "tituloSerie" => "Heart"
                        "fecha" => "2004"
                        "volumen" => "90"
                        "paginaInicial" => "1110"
                        "paginaFinal" => "1113"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15367501"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Evidence of cardiac myolysis in severe nonischemic heart failure and the potential role of increased wall strain"
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                            4 => "M&#46; Leban"
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                        ]
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2001"
                        "volumen" => "141"
                        "paginaInicial" => "247"
                        "paginaFinal" => "253"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11174339"
                            "web" => "Medline"
                          ]
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                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Significance of circulating troponins in heart failure"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46;J&#46; Wang"
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                    0 => array:2 [
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                        "tituloSerie" => "Circulation"
                        "fecha" => "2007"
                        "volumen" => "116"
                        "paginaInicial" => "1217"
                        "paginaFinal" => "1220"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17846340"
                            "web" => "Medline"
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                      "titulo" => "Ingenuous interpretation of elevated blood levels of macromolecular markers of myocardial injury&#58; a recipe for confusion"
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                        ]
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                    ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
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                        "volumen" => "35"
                        "paginaInicial" => "1355"
                        "paginaFinal" => "1358"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10758980"
                            "web" => "Medline"
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                ]
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                    0 => array:2 [
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                            4 => "J&#46;C&#46; Fang"
                            5 => "N&#46;K&#46; Sweitzer"
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                        ]
                      ]
                    ]
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                        "paginaFinal" => "576"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24929121"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Complementary role of copeptin and high-sensitivity troponin in predicting outcome in patients with stable chronic heart failure"
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                        "tituloSerie" => "Eur J Heart Fail"
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                        "paginaInicial" => "726"
                        "paginaFinal" => "733"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21616953"
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                        "paginaFinal" => "2050"
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