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como la radiograf&#237;a simple de t&#243;rax&#44; la determinaci&#243;n anal&#237;tica de p&#233;ptidos natriur&#233;ticos o el ecocardiograma transtor&#225;cico<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Por ello&#44; surge la necesidad de incorporar nuevas t&#233;cnicas diagn&#243;sticas que permitan estimar el estado de hidrataci&#243;n de los pacientes con IC de forma sencilla y reproducible&#44; con una relaci&#243;n costo-beneficio favorable y una amplia disponibilidad&#46; Esta situaci&#243;n se ve reforzada por la evidencia que sugiere que muchos pacientes ingresados por IC reciben el alta domiciliaria con cierto grado de congesti&#243;n sist&#233;mica&#44; lo que podr&#237;a favorecer nuevos episodios de descompensaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En este contexto&#44; el an&#225;lisis del vector de bioimpedancia &#40;<span class="elsevierStyleItalic">bioelectrical impedance vector analysis</span> &#91;BIVA&#93;&#41; permite la valoraci&#243;n de la composici&#243;n del organismo y la estimaci&#243;n del agua corporal total &#40;ACT&#41;&#44; analizando la resistencia que ofrece el organismo al paso de una corriente el&#233;ctrica alterna&#46; El ACT estimada por BIVA se correlaciona con la presi&#243;n venosa central<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>&#44; y ha mostrado su utilidad cl&#237;nica en el diagn&#243;stico diferencial de pacientes con valores l&#237;mite de p&#233;ptidos natriur&#233;ticos&#44; proporcionando incluso informaci&#243;n pron&#243;stica sobre morbimortalidad a corto plazo<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>&#46; A este respecto&#44; recientemente N&#250;&#241;ez J et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> han demostrado el valor pron&#243;stico a largo plazo del BIVA previo al alta&#46; En dicho estudio&#44; tanto los estados de deshidrataci&#243;n &#40;desH&#41; como de hiperhidrataci&#243;n &#40;hiperH&#41; se asociaron de forma significativa a un mayor riesgo de mortalidad y reingreso por IC&#44; especialmente entre los pacientes con hiperH&#44; con un incremento lineal del riesgo para reingreso por IC &#40;<span class="elsevierStyleItalic">hazard ratio</span> &#91;HR&#93; 1&#44;06 &#91;1&#44;03-1&#44;10&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001 por cada incremento del 1&#37; en el valor del BIVA&#41;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El objetivo del presente estudio fue confirmar&#44; en una nueva cohorte prospectiva&#44; el papel pron&#243;stico de la evaluaci&#243;n de la congesti&#243;n sist&#233;mica mediante BIVA en los pacientes ingresados por descompensaci&#243;n aguda de IC&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se analiz&#243; una cohorte prospectiva de 133 pacientes ingresados en el servicio de cardiolog&#237;a de nuestro centro entre enero y noviembre de 2014&#44; con el diagn&#243;stico de IC <span class="elsevierStyleItalic">de novo</span> o descompensaci&#243;n aguda de IC&#46; Se excluyeron los pacientes que fallecieron &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&#44; se sometieron a cirug&#237;a valvular &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41; durante el ingreso&#44; ten&#237;an una enfermedad coronaria significativa pendiente de revascularizaci&#243;n quir&#250;rgica &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; o disnea no debida a IC &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#46; La muestra final incluy&#243; 105 pacientes&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se registraron los antecedentes personales&#44; par&#225;metros electrocardiogr&#225;ficos y anal&#237;ticos &#40;incluida la fracci&#243;n amino terminal del p&#233;ptido natriur&#233;tico cerebral&#44; NT-proBNP&#41;&#44; y las variables ecocardiogr&#225;ficas&#46; Todos los pacientes recibieron el tratamiento m&#233;dico indicado por el cl&#237;nico responsable&#44; siguiendo las gu&#237;as de recomendaci&#243;n actuales<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#44; incluyendo la administraci&#243;n intravenosa de diur&#233;ticos de asa&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El BIVA se realiz&#243; utilizando un modelo CardioEFG<span class="elsevierStyleSup">&#174;</span> &#40;Akern Srl&#44; Italia&#41; con el paciente en dec&#250;bito supino&#44; y mediante la aplicaci&#243;n de electrodos en la regi&#243;n dorsal de mano y pie homolaterales&#44; seg&#250;n indicaciones del fabricante&#46; Se realizaron 3 mediciones por paciente&#44; utilizando la media de ellas para el an&#225;lisis de resultados&#46; El an&#225;lisis se llev&#243; a cabo tras la estabilizaci&#243;n cl&#237;nica del paciente y previo al alta hospitalaria&#44; ocultando los resultados del BIVA al m&#233;dico responsable&#46; Se dividi&#243; la muestra en 3 grupos preestablecidos seg&#250;n el estado de hidrataci&#243;n determinado por el BIVA obtenido&#58; hiperH &#40;&#62;<span class="elsevierStyleHsp" style=""></span>74&#44;3&#37;&#41;&#44; normohidrataci&#243;n &#91;normoH&#93; &#40;72&#44;7-74&#44;3&#37;&#41; y desH &#40;&#60;<span class="elsevierStyleHsp" style=""></span>72&#44;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&#46; El rango de normalidad lo determina el propio dispositivo&#44; seg&#250;n los valores de referencia para la poblaci&#243;n general &#40;73&#44;3&#37;&#41;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1 desviaci&#243;n est&#225;ndar<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a>&#46; Cada BIVA se refleja en el dispositivo en un hidrograma que permite una valoraci&#243;n inmediata del estado de hidrataci&#243;n&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En el an&#225;lisis estad&#237;stico&#44; las variables cont&#237;nuas se expresaron como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar y las cualitativas como porcentajes&#46; Las caracter&#237;sticas basales se compararon entre los 3 grupos mediante an&#225;lisis de varianza &#40;ANOVA&#41; o test de Kruskal-Wallis para variables sin una distribuci&#243;n normal&#46; En el seguimiento&#44; se consideraron como eventos adversos la mortalidad total&#44; los reingresos por IC y el combinado de ambos&#46; El an&#225;lisis de supervivencia se realiz&#243; por el m&#233;todo de Kaplan-Meier y el riesgo proporcional &#40;HR&#41; mediante el modelo de Cox&#44; en el que se incluyeron todas las variables con p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;10 en el an&#225;lisis univariado&#46; Se consideraron significativos los resultados con un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Se utiliz&#243; el <span class="elsevierStyleItalic">software</span> IBM SPSS<span class="elsevierStyleSup">&#174;</span> Statistics&#44; versi&#243;n 22&#46;0 para el an&#225;lisis estad&#237;stico&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Todos los pacientes firmaron un consentimiento informado&#44; y el estudio fue aprobado por el Comit&#233; de Ensayos Cl&#237;nicos e Investigaci&#243;n Cl&#237;nica de nuestro centro&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas basales de los pacientes se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La edad media de la muestra fue 69&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;2 a&#241;os&#44; y todos los pacientes recibieron el tratamiento farmacol&#243;gico recomendado en las gu&#237;as de pr&#225;ctica cl&#237;nica&#46; Menos de la mitad de los pacientes &#40;47&#44;6&#37;&#41; ten&#237;an un estado de normoH al alta &#40;22&#44;8&#37; hiperH y 29&#44;6&#37; desH&#41;&#46; En los pacientes con hiperH&#44; se observ&#243; peor funci&#243;n renal &#40;creatinina 1&#44;35<span class="elsevierStyleHsp" style=""></span>mg&#47;dl<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;08 vs&#46; 1&#44;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;06 en normoH y 1&#44;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;06 en desH&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#41;&#44; y valores superiores del di&#225;metro telediast&#243;lico de ventr&#237;culo izquierdo &#40;60&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;1<span class="elsevierStyleHsp" style=""></span>mm vs&#46; 54&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;8 en normoH y 53&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;1 en desH&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; de la presi&#243;n sist&#243;lica de la arteria pulmonar &#40;61&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;3<span class="elsevierStyleHsp" style=""></span>mmHg vs&#46; 48&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;9 en normoH y 49&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;6 en desH&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; y del di&#225;metro de la vena cava inferior &#40;23&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;9<span class="elsevierStyleHsp" style=""></span>mm vs&#46; 19&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;9 en normoH y 17&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;2 en desH&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;045&#41; estimados por ecocardiograf&#237;a&#46; Por otro lado&#44; se hall&#243; una mayor prevalencia de mujeres en el grupo desH &#40;65 vs&#46; 32&#37; en normoH y 42&#37; en hiperH&#41;&#46; Los grupos fueron comparables en cuanto a la etiolog&#237;a de la IC&#44; tratamiento farmacol&#243;gico&#44; factores de riesgo cardiovascular&#44; variables anal&#237;ticas y par&#225;metros ecocardiogr&#225;ficos estudiados&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Durante un seguimiento medio de 11 &#40;1-18&#41; meses&#44; se contabilizaron un total de 37 eventos adversos&#58; 29 reingresos por IC y 19 muertes&#46; Al analizar la incidencia del evento combinado en los 3 grupos por el m&#233;todo de Kaplan-Meier&#44; se observ&#243; una tendencia hacia una mayor tasa de eventos en los pacientes hiperH y desH respecto a los normoH &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#46; Al agrupar los pacientes hiperH y desH y compararlos con los normoH&#44; se confirm&#243; una mayor incidencia de eventos durante el seguimiento en el primer grupo &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#46; El incremento del riesgo fue independiente de la edad&#44; de la presencia de fibrilaci&#243;n auricular y de las cifras de creatinina &#40;an&#225;lisis por regresi&#243;n de Cox&#58; grupo desH-hiperH present&#243; HR 2&#44;6 &#91;intervalo de confianza del 95&#37;&#58; 1&#44;05-6&#44;44&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;039&#41;&#44; como variables incluidas en el an&#225;lisis multivariado&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">Los resultados del presente trabajo son concordantes con los publicados por N&#250;&#241;ez J et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&#44; y reafirmar&#237;an el potencial valor cl&#237;nico y pron&#243;stico del BIVA en pacientes con IC&#44; tanto en la monitorizaci&#243;n del ACT que permite una mejor orientaci&#243;n de la terapia diur&#233;tica&#44; como en la estratificaci&#243;n del riesgo al alta&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Los datos de esta cohorte de validaci&#243;n reforzar&#237;an&#44; tambi&#233;n&#44; la importancia pron&#243;stica que tiene alcanzar un estado de normoH sist&#233;mica al alta&#44; de tal forma que tanto la congesti&#243;n sist&#233;mica &#40;valores en rango de hiperH&#41; como la excesiva depleci&#243;n de fluidos &#40;cifras en rango de desH&#41;&#44; incidir&#237;an de forma negativa en la evoluci&#243;n cl&#237;nica&#46; La importancia cl&#237;nica de esta situaci&#243;n ha sido debatida en la literatura<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">12&#44;13</span></a> y&#44; en este contexto&#44; el BIVA podr&#237;a contribuir a definir de forma m&#225;s objetiva y reproducible el estado &#243;ptimo de hidrataci&#243;n sist&#233;mica en la IC&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Si tenemos en cuenta la enorme tasa de reingresos hospitalarios que todav&#237;a genera la IC en nuestro medio&#44; a pesar de la creaci&#243;n de unidades de manejo especializado<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#44; y considerando la congesti&#243;n sist&#233;mica como eje fisiopatol&#243;gico central del episodio de descompensaci&#243;n aguda&#44; el uso de una t&#233;cnica sencilla y disponible como BIVA podr&#237;a tener su papel para optimizar el tratamiento&#44; especialmente si se asocia a la determinaci&#243;n de biomarcadores de congesti&#243;n&#44; como los p&#233;ptidos natriur&#233;ticos o el CA-125&#46; El uso combinado de ambas t&#233;cnicas no invasivas resulta prometedor&#44; aunque son necesarios estudios a mayor escala para definir un consenso definitivo sobre su empleo rutinario<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Las limitaciones del estudio son el reducido tama&#241;o muestral y el car&#225;cter unic&#233;ntrico del trabajo&#46; Asimismo&#44; la necesidad de agrupar los estados de desH e hiperH en comparaci&#243;n con la normoH para obtener la significaci&#243;n estad&#237;stica en los an&#225;lisis de supervivencia puede considerarse una limitaci&#243;n&#44; aunque se alcanza el objetivo de demostrar un mayor riesgo en la incidencia de eventos en los pacientes fuera del rango de normoH&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusiones</span><p id="par0085" class="elsevierStylePara elsevierViewall">En la evaluaci&#243;n de la hidrataci&#243;n sist&#233;mica mediante BIVA previo al alta en pacientes ingresados por descompensaci&#243;n aguda de IC&#44; los estados de desH e hiperH se asocian a un incremento del riesgo de reingreso por IC y mortalidad total respecto a los pacientes normoH en el seguimiento a largo plazo&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financiaci&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">Beca para Investigaci&#243;n Cl&#237;nica de la Sociedad Valenciana de Cardiolog&#237;a&#44; convocatorias 2013 y 2014&#44; concedidas a O&#46; Fabregat-Andr&#233;s y J&#46; N&#252;&#241;ez respecticamente&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicto de intereses</span><p id="par0090" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar el impacto pron&#243;stico del an&#225;lisis del vector de bioimpedancia &#40;<span class="elsevierStyleItalic">bioelectrical impedance vector analysis</span> &#91;BIVA&#93;&#41; en pacientes ingresados por insuficiencia cardiaca &#40;IC&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cohorte prospectiva de 105 pacientes ingresados por IC&#46; El BIVA se realiz&#243; previo al alta&#44; y la muestra final se dividi&#243; en 3 grupos seg&#250;n el valor obtenido&#58; hiperhidrataci&#243;n &#91;hiperH&#93; &#40;&#62;<span class="elsevierStyleHsp" style=""></span>74&#44;3&#37;&#41;&#44; normohidrataci&#243;n &#91;normoH&#93; &#40;72&#44;7-74&#44;3&#37;&#41; y deshidrataci&#243;n &#91;desH&#93; &#40;&#60;<span class="elsevierStyleHsp" style=""></span>72&#44;7&#37;&#41;&#46; En el seguimiento&#44; se consideraron eventos adversos la mortalidad total y los reingresos por IC&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se observ&#243; una mayor incidencia de eventos en los pacientes hiperH y desH respecto a los normoH &#40;Kaplan-Meier&#58; <span class="elsevierStyleItalic">log rank</span> 2&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;&#44; con un incremento de riesgo independiente en el an&#225;lisis multivariado &#40;HR 2&#44;6 &#91;1&#44;05-6&#44;44&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;039&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El an&#225;lisis BIVA en pacientes ingresados por IC permite estratificar el riesgo de reingreso por IC y mortalidad total en el seguimiento a largo plazo&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To assess the prognostic impact of the bioimpedance vector &#40;bioelectrical impedance vector analysis &#91;BIVA&#93;&#41; for patients hospitalized for heart failure &#40;HF&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A prospective cohort of 105 patients hospitalized for HF&#46; BIVA was performed prior to discharge&#44; and the final sample was divided into 3 groups according to the value obtained&#58; hyperhydration &#91;hyperH&#93; &#40;&#62;74&#46;3&#37;&#41;&#44; normal hydration &#91;normoH&#93; &#40;72&#46;7-74&#46;3&#37;&#41; and dehydration &#91;desH&#93; &#40;&#60;72&#46;7&#37;&#41;&#46; In the follow-up&#44; total mortality and readmissions for HF were considered adverse events&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A higher incidence of events was observed among the patients with hyperH and desH compared with those with normoH &#40;Kaplan-Meier&#58; log-rank&#44; 2&#46;1&#59; <span class="elsevierStyleItalic">p</span>&#61;&#46;04&#41;&#44; with an increase in independent risk in the multivariate analysis &#40;HR&#44; 2&#46;6 &#91;1&#46;05&#8211;6&#46;44&#93;&#59; <span class="elsevierStyleItalic">p</span>&#61;&#46;039&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">BIVA helps stratify the risk of readmission for HF and total mortality in the long-term follow-up of patients hospitalized for HF&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1677
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        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A&#46; Muestra dividida en tres grupos&#58; deshidrataci&#243;n &#40;DesH&#41;&#44; normohidrataci&#243;n &#40;NormoH&#41;&#44; e hiperhidrataci&#243;n &#40;HiperH&#41;&#46; B&#46; Muestra dividida en dos grupos&#58; normohidrataci&#243;n &#40;NormoH&#41;&#44; y estados distintos a la normohidrataci&#243;n al alta &#40;DesH m&#225;s HiperH&#41;&#46;</p>"
        ]
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      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Los valores se expresan como n&#250;mero &#40;porcentaje&#41; cuando corresponde&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ARA-II&#58; antagonistas del receptor de la angiotensina <span class="elsevierStyleSmallCaps">II</span>&#59; BCRIHH&#58; bloqueo completo de rama izquierda del haz de His&#59; IECA&#58; inhibidor de la enzima conversora de la angiotensina&#59; NT-proBNP&#58; fracci&#243;n amino terminal&#160;del p&#233;ptido natriur&#233;tico cerebral&#59; <span class="elsevierStyleSmallCaps">VI</span>&#58; ventr&#237;culo izquierdo&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de porcentajes por la prueba de Chi-cuadrado&#44; y comparaci&#243;n de medias por ANOVA&#46; Las variables cuantitativas continuas con distribuci&#243;n normal se expresan como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar&#44; y como mediana<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>rango intercuart&#237;lico si no siguen una distribuci&#243;n normal&#46; Significativo si p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>105&#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">DesH<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#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">NormoH<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#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">HiperH<br>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#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">Valor de p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Factores de riesgo cardiovascular</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">69&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#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">65&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#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">69&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#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">72&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#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">0&#44;17&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 masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59 &#40;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;68&#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;58&#41;&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;02&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 arterial&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;78&#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;71&#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;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;83&#41;&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;45&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;38&#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;38&#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;58&#41;&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;25&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&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;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;63&#41;&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;26&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&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;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#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">0&#44;43&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>H&#225;bito en&#243;lico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;11&#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 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;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">0&#44;84&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>Antecedentes de fibrilaci&#243;n auricular&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;47&#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;44&#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;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;63&#41;&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;14&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>Enfermedad pulmonar cr&#243;nica&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;18&#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 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;20&#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 &#40;15&#41;&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;74&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">Etiolog&#237;a de la insuficiencia cardiaca</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>Cardiopat&#237;a isqu&#233;mica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;26&#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 &#40;16&#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;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#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">0&#44;68&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 valvular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#44;5 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;33&#41;&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;15&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>Idiop&#225;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;11&#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 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;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">0&#44;24&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 hipertensiva&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">4 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;12&#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 &#40;15&#41;&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;62&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">86&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#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">79&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#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">0&#44;24&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">122&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#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">129&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;5&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">12 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#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">13 &#40;55&#41;&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;27&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>BCRIHH&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">7 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;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">0&#44;32&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>Duraci&#243;n QRS&#44; ms&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">110&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">114&#44;1<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">119&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>34&#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">0&#44;72&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">12&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#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">12&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#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">11&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#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">0&#44;27&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&#44; mg&#47;dl&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">1&#44;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;4&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">136&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;3&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">4&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#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">3&#44;95<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#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">0&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NT-proBNP&#44; pg&#47;ml&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">185&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>168&#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">41&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#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">0&#44;67&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">54&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#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">60&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#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">0&#44;02&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>Di&#225;metro telesist&#243;lico del <span class="elsevierStyleSmallCaps">VI</span>&#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">39&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#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">43&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;9&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;28&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">19 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;72&#41;&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;59&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">31 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;94&#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">0&#44;13&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">35 &#40;70&#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;75&#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">0&#44;75&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 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas generales de los pacientes y eventos en el seguimiento seg&#250;n el valor de bioimpedancia vectorial sist&#233;mica&#42;</p>"
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                      "titulo" => "Assessing and grading congestion in acute heart failure&#58; A scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine"
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                            0 => "M&#46; Gheorghiade"
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                            0 => "A&#46; Piccoli"
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                            4 => "L&#46; Pillon"
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                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
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                        "paginaInicial" => "132"
                        "paginaFinal" => "137"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10667512"
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                      "titulo" => "Additive diagnostic and prognostic value of bioelectrical impedance vector analysis &#40;BIVA&#41; to brain natriuretic peptide &#8216;grey-zone&#8217; in patients with acute heart failure in the emergency department"
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                            1 => "I&#46; Lalle"
                            2 => "L&#46; Magrini"
                            3 => "V&#46; Russo"
                            4 => "S&#46; Navarin"
                            5 => "L&#46; Castello"
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                  "host" => array:1 [
                    0 => array:2 [
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                        "fecha" => "2014"
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Vol. 216. Núm. 3.
Páginas 121-125 (abril 2016)
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Vol. 216. Núm. 3.
Páginas 121-125 (abril 2016)
Original breve
Valor pronóstico del análisis del vector de bioimpedancia en pacientes ingresados por descompensación aguda de insuficiencia cardiaca: cohorte de validación
Prognostic value of analysing the bioimpedance vector for patients hospitalised for acute decompensated heart failure: A validation cohort
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233
B. Trejo-Velascoa, Ó. Fabregat-Andrésa,b,
Autor para correspondencia
osfabregat@gmail.com

Autor para correspondencia.
, V. Montaguda, S. Morella, J. Núñezc, L. Fácilaa
a Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, España
b Fundación para la Investigación, Hospital General Universitario de Valencia, Valencia, España
c Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, España
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Tabla 1. Características generales de los pacientes y eventos en el seguimiento según el valor de bioimpedancia vectorial sistémica*
Resumen
Objetivos

Evaluar el impacto pronóstico del análisis del vector de bioimpedancia (bioelectrical impedance vector analysis [BIVA]) en pacientes ingresados por insuficiencia cardiaca (IC).

Material y métodos

Cohorte prospectiva de 105 pacientes ingresados por IC. El BIVA se realizó previo al alta, y la muestra final se dividió en 3 grupos según el valor obtenido: hiperhidratación [hiperH] (>74,3%), normohidratación [normoH] (72,7-74,3%) y deshidratación [desH] (<72,7%). En el seguimiento, se consideraron eventos adversos la mortalidad total y los reingresos por IC.

Resultados

Se observó una mayor incidencia de eventos en los pacientes hiperH y desH respecto a los normoH (Kaplan-Meier: log rank 2,1; p=0,04), con un incremento de riesgo independiente en el análisis multivariado (HR 2,6 [1,05-6,44]; p=0,039).

Conclusiones

El análisis BIVA en pacientes ingresados por IC permite estratificar el riesgo de reingreso por IC y mortalidad total en el seguimiento a largo plazo.

Palabras clave:
Insuficiencia cardiaca
Bioimpedancia
Congestión sistémica
Estratificación pronóstica
Abstract
Objectives

To assess the prognostic impact of the bioimpedance vector (bioelectrical impedance vector analysis [BIVA]) for patients hospitalized for heart failure (HF).

Material and methods

A prospective cohort of 105 patients hospitalized for HF. BIVA was performed prior to discharge, and the final sample was divided into 3 groups according to the value obtained: hyperhydration [hyperH] (>74.3%), normal hydration [normoH] (72.7-74.3%) and dehydration [desH] (<72.7%). In the follow-up, total mortality and readmissions for HF were considered adverse events.

Results

A higher incidence of events was observed among the patients with hyperH and desH compared with those with normoH (Kaplan-Meier: log-rank, 2.1; p=.04), with an increase in independent risk in the multivariate analysis (HR, 2.6 [1.05–6.44]; p=.039).

Conclusions

BIVA helps stratify the risk of readmission for HF and total mortality in the long-term follow-up of patients hospitalized for HF.

Keywords:
Heart failure
Bioimpedance
Systemic congestion
Prognostic stratification

Artículo

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