array:24 [
  "pii" => "S2174204914002281"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2014.02.025"
  "estado" => "S300"
  "fechaPublicacion" => "2014-10-01"
  "aid" => "519"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2013"
  "documento" => "article"
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Cardiol. 2014;33:629-36"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4080
    "formatos" => array:3 [
      "EPUB" => 168
      "HTML" => 3286
      "PDF" => 626
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S0870255114002017"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2014.02.028"
      "estado" => "S300"
      "fechaPublicacion" => "2014-10-01"
      "aid" => "519"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 0
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Cardiol. 2014;33:629-36"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4125
        "formatos" => array:3 [
          "EPUB" => 168
          "HTML" => 3282
          "PDF" => 675
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
        "titulo" => "Role of cardiac multidetector computed tomography in the exclusion of ischemic etiology in heart failure patients"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "629"
            "paginaFinal" => "636"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Papel da tomografia computorizada card&#237;aca na exclus&#227;o de etiologia isqu&#233;mica em pacientes com insufici&#234;ncia card&#237;aca"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figure 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1965
                "Ancho" => 2672
                "Tamanyo" => 165147
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cardiomyopathy etiology of the 100 HF patients who underwent CTA&#46; CAD&#58; coronary artery disease&#59; CTA&#58; multidetector computed tomography coronary angiography&#59; ICA&#58; invasive coronary angiography&#59; MDCT&#58; multidetector computed tomography&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Pedro A&#46; Sousa, Nuno Bettencourt, Nuno Dias Ferreira, M&#243;nica Carvalho, Daniel Leite, Wilson Ferreira, Il&#237;dio de Jesus, Vasco Gama"
            "autores" => array:8 [
              0 => array:2 [
                "nombre" => "Pedro A&#46;"
                "apellidos" => "Sousa"
              ]
              1 => array:2 [
                "nombre" => "Nuno"
                "apellidos" => "Bettencourt"
              ]
              2 => array:2 [
                "nombre" => "Nuno"
                "apellidos" => "Dias Ferreira"
              ]
              3 => array:2 [
                "nombre" => "M&#243;nica"
                "apellidos" => "Carvalho"
              ]
              4 => array:2 [
                "nombre" => "Daniel"
                "apellidos" => "Leite"
              ]
              5 => array:2 [
                "nombre" => "Wilson"
                "apellidos" => "Ferreira"
              ]
              6 => array:2 [
                "nombre" => "Il&#237;dio"
                "apellidos" => "de Jesus"
              ]
              7 => array:2 [
                "nombre" => "Vasco"
                "apellidos" => "Gama"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204914002281"
          "doi" => "10.1016/j.repce.2014.02.025"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002281?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002017?idApp=UINPBA00004E"
      "url" => "/08702551/0000003300000010/v1_201410290045/S0870255114002017/v1_201410290045/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2174204914002293"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2014.03.011"
    "estado" => "S300"
    "fechaPublicacion" => "2014-10-01"
    "aid" => "524"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2014;33:637-40"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3090
      "formatos" => array:3 [
        "EPUB" => 162
        "HTML" => 2371
        "PDF" => 557
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Ventricular septal defect in children and adolescents in Angola&#58; Experience of a tertiary center"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "637"
          "paginaFinal" => "640"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Comunica&#231;&#227;o interventricular em crian&#231;as e adolescentes em Angola&#58; Experi&#234;ncia de um centro terci&#225;rio"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1074
              "Ancho" => 1253
              "Tamanyo" => 58947
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of the sample according to whether ventricular septal defect was associated with other congenital heart defects&#46; CHD&#58; congenital heart defect&#59; VSD&#58; ventricular septal defect&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Valdano Manuel, Humberto Morais, Ana Manuel, Bruna David, Sebastiana Gamboa"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Valdano"
              "apellidos" => "Manuel"
            ]
            1 => array:2 [
              "nombre" => "Humberto"
              "apellidos" => "Morais"
            ]
            2 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Manuel"
            ]
            3 => array:2 [
              "nombre" => "Bruna"
              "apellidos" => "David"
            ]
            4 => array:2 [
              "nombre" => "Sebastiana"
              "apellidos" => "Gamboa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0870255114002066"
        "doi" => "10.1016/j.repc.2014.03.012"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002066?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002293?idApp=UINPBA00004E"
    "url" => "/21742049/0000003300000010/v1_201411060106/S2174204914002293/v1_201411060106/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2174204914002001"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2014.01.022"
    "estado" => "S300"
    "fechaPublicacion" => "2014-10-01"
    "aid" => "509"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2014;33:617-27"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4308
      "formatos" => array:3 [
        "EPUB" => 175
        "HTML" => 3349
        "PDF" => 784
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Non-ST-elevation acute coronary syndromes in octogenarians&#58; Applicability of the GRACE and CRUSADE scores"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "617"
          "paginaFinal" => "627"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "S&#237;ndromes coron&#225;rias agudas sem supradesnivelamento-ST nos octogen&#225;rios&#58; aplicabilidade dos scores GRACE e CRUSADE"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 2063
              "Ancho" => 1667
              "Tamanyo" => 195320
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ROC curve analysis of the CRUSADE score and MB-PM for assessment of major bleeding&#46; AUC&#58; area under the curve&#59; CI&#58; confidence interval&#59; MB-PM&#58; major bleeding prediction model&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ana Faustino, Paula Mota, Joana Silva"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Faustino"
            ]
            1 => array:2 [
              "nombre" => "Paula"
              "apellidos" => "Mota"
            ]
            2 => array:2 [
              "nombre" => "Joana"
              "apellidos" => "Silva"
            ]
            3 => array:1 [
              "colaborador" => "Em nome dos Investigadores do Registo Nacional de S&#237;ndromes Coron&#225;rias Agudas da Sociedade Portuguesa de Cardiologia"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255114001917"
        "doi" => "10.1016/j.repc.2014.01.025"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114001917?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002001?idApp=UINPBA00004E"
    "url" => "/21742049/0000003300000010/v1_201411060106/S2174204914002001/v1_201411060106/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Role of cardiac multidetector computed tomography in the exclusion of ischemic etiology in heart failure patients"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "629"
        "paginaFinal" => "636"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Pedro A&#46; Sousa, Nuno Bettencourt, Nuno Dias Ferreira, M&#243;nica Carvalho, Daniel Leite, Wilson Ferreira, Il&#237;dio de Jesus, Vasco Gama"
        "autores" => array:8 [
          0 => array:4 [
            "nombre" => "Pedro A&#46;"
            "apellidos" => "Sousa"
            "email" => array:1 [
              0 => "Peter&#95;senado2002&#64;yahoo&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Nuno"
            "apellidos" => "Bettencourt"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Nuno"
            "apellidos" => "Dias Ferreira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "M&#243;nica"
            "apellidos" => "Carvalho"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Daniel"
            "apellidos" => "Leite"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Wilson"
            "apellidos" => "Ferreira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Il&#237;dio"
            "apellidos" => "de Jesus"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Vasco"
            "apellidos" => "Gama"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Cardiology Department&#44; Faro Hospital&#44; Faro&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Cardiology Department&#44; Vila Nova de Gaia Hospital&#44; Vila Nova de Gaia&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Papel da tomografia computorizada card&#237;aca na exclus&#227;o de etiologia isqu&#233;mica em pacientes com insufici&#234;ncia card&#237;aca"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1965
            "Ancho" => 2672
            "Tamanyo" => 165147
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cardiomyopathy etiology of the 100 HF patients who underwent CTA&#46; CAD&#58; coronary artery disease&#59; CTA&#58; multidetector computed tomography coronary angiography&#59; ICA&#58; invasive coronary angiography&#59; MDCT&#58; multidetector computed tomography&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Heart failure &#40;HF&#41; is a complex and progressive disease that leads to significant morbidity and mortality&#46; Approximately 1-2&#37; of the adult population in developed countries has HF&#44; the prevalence rising to &#8805;10&#37; among persons aged 70 years or older&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> There are many causes of HF&#44; and these vary in different parts of the world&#46; However&#44; the etiology is routinely categorized as ischemic or non-ischemic&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Patients with ischemic HF may benefit from revascularization<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and so the presence&#44; anatomic characteristics&#44; and functional significance of coronary artery disease &#40;CAD&#41; should be assessed in patients with new-onset HF&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The gold standard diagnostic method for CAD detection has been invasive coronary angiography &#40;ICA&#41;&#46; Multidetector computed tomography &#40;MDCT&#41; has emerged as a robust alternative&#44; demonstrating high diagnostic performance for identifying coronary stenosis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Several recent studies<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a> have shown that it is extremely accurate even in subjects with left ventricular &#40;LV&#41; dysfunction&#46; Therefore&#44; new-onset HF is currently considered an appropriate indication for MDCT&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> However&#44; the performance of coronary MDCT angiography &#40;CTA&#41; for the differentiation of HF etiology in clinical practice has not been fully validated&#44; and few studies have set out to evaluate the role of coronary artery calcium &#40;CAC&#41; score and CTA in patients with LV dysfunction&#46; We sought to assess the value of MDCT in the exclusion of ischemic etiology in HF patients and to test the potential application of the Agatston score as a gatekeeper for CTA in this context&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0020" class="elsevierStylePara elsevierViewall">Between April 2006 and May 2013&#44; 4424 patients underwent cardiac computed tomography &#40;CT&#41; for detection of CAD&#46; Of these we retrospectively selected patients with symptoms and&#47;or signs of HF and systolic dysfunction &#40;defined as left ventricular ejection fraction &#91;LVEF&#93; &#60;50&#37;&#41; who were referred for CTA aiming to exclude an ischemic etiology&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Subjects with previously known CAD or severe valvular disease were excluded from the analysis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patient preparation</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients received oral metoprolol one hour before the MDCT scan according to baseline heart rate &#40;50 mg if &#62;55 and &#60;65 bpm or 100 mg if &#8805;65 bpm&#41;&#46; An additional dose of intravenous metoprolol &#40;2&#46;5&#8211;15 mg&#41; was administered 10 minutes before the scan if heart rate remained &#62;65 bpm&#46; All patients received 0&#46;5 mg of sublingual nitroglycerin five minutes before CTA&#46; Beta-blockers were not given in patients with class III&#47;IV heart failure symptoms&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Assessment of pre-test probability for obstructive coronary artery disease</span><p id="par0030" class="elsevierStylePara elsevierViewall">A modified Morise risk score<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> with exclusion of estrogen status was used to stratify the pre-test risk&#46; Patients were classified as low &#40;score &#60;10&#41;&#44; intermediate &#40;10-16&#41; or high &#40;&#62;16&#41; pre-test probability&#44; according to this risk score&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Scan protocol</span><p id="par0035" class="elsevierStylePara elsevierViewall">All scans were performed using a 64-slice CT scanner &#40;SOMATOM Sensation 64&#44; Siemens Medical Solutions&#44; Forchheim&#44; Germany&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Agatston calcium score quantification</span><p id="par0040" class="elsevierStylePara elsevierViewall">All patients underwent a low-dose scan to assess CAC&#46; The scan parameters for this acquisition were collimation 24&#215;1&#46;2 mm&#44; gantry rotation time 330 ms&#44; pitch 0&#46;2&#44; tube voltage 120 kV and tube current 190 mAs&#46; Image reconstruction of the calcium score acquisition was performed using an effective slice thickness of 3 mm&#46; CAC was reported as the mean Agatston score and was calculated using a detection of 130 HU with semi-automated software &#40;syngo Calcium Scoring&#44; Siemens Medical Solutions&#41; as described previously&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">CAD assessment</span><p id="par0045" class="elsevierStylePara elsevierViewall">In patients with CAC &#8804;400&#44; a CTA acquisition was performed &#40;collimation 64&#215;0&#46;6 mm&#59; tube current 850 mAs&#59; all other parameters as in the CAC acquisition scan&#44; with the exception of tube voltage&#44; which was reduced to 100 kV in lower weight patients&#44; according to the radiographer&#39;s judgment&#41;&#46; Tube current modulation with electrocardiographic pulsing was used to decrease the radiation dose&#44; with full tube current applied at 60&#8211;65&#37; of the RR interval&#46; Depending on the scan time&#44; a bolus of 50&#8211;90 ml of contrast &#40;Ultravist<span class="elsevierStyleSup">&#174;</span>&#44; iopromide 370 mg&#47;ml&#44; Bayer Schering Pharma AG&#44; Berlin&#44; Germany&#41; was injected &#40;4&#46;5&#8211;7 ml&#47;min&#41; via a power injector &#40;Stellant<span class="elsevierStyleSup">&#174;</span> D&#44; Medrad Inc&#46;&#44; Warrendale&#44; PA&#44; USA&#41; followed by a 40-ml saline chaser&#44; using a dedicated antecubital vein 18-gauge access catheter&#46; A bolus-tracking technique was used&#44; with a region of interest placed in the ascending aorta&#44; set to detect a predefined threshold of 150 HU&#46; For assessment of CAD&#44; multiphase sets of the reconstructed CTA images were processed on a dedicated workstation and analyzed for detection of at least one luminal diameter narrowing of &#62;50&#37; in any coronary artery segment&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Severely calcified segments &#40;concentric vessel wall calcification precluding lumen assessment&#41; were classified as positive for CAD&#46; Following the center&#39;s protocol and international consensus&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> CTA was not performed in patients with an Agatston calcium score higher than 400&#46; These patients were considered positive for the presence of CAD&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;12&#44;14&#44;15</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Radiation exposure</span><p id="par0050" class="elsevierStylePara elsevierViewall">Mean radiation exposure was estimated by the method proposed by the European Working Group for guidelines on quality criteria in CT&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The effective radiation doses for the CAC and CTA acquisitions were calculated by the product of the conversion coefficient for cardiac CT &#40;0&#46;014 mSv&#47;mGy cm averaged between male and female models&#41; and the dose-length product obtained during each scan&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Image diagnostic quality</span><p id="par0055" class="elsevierStylePara elsevierViewall">Image quality was subjectively classified by the readers into three groups&#58; good&#44; average and poor&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">All tests were taken into consideration assuming an intention to diagnose and no patients were excluded from analysis based on image quality&#46; Non-diagnostic segments due to poor image quality were assumed positive for CAD for the purposes of the study&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Invasive coronary angiography and ischemia testing</span><p id="par0065" class="elsevierStylePara elsevierViewall">Patients were referred for ICA and non-invasive ischemia testing at the referring physician&#39;s discretion&#46; Data from tests performed in the 12 months after the exam were described&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">For ICA&#44; the same cut-off values described for CTA were used&#58; coronary artery obstruction was defined as &#8805;50&#37; luminal stenosis in at least one major coronary artery&#46; An anatomically-based definition for ischemic cardiomyopathy on ICA was taken as &#8805;75&#37; stenosis in the left main or proximal left anterior descending artery or in &#8805;2 epicardial vessels&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Statistical analyses were performed using SPSS 17&#46;0 &#40;IBM&#44; Chicago&#44; IL&#41; and statistical significance was defined as p&#60;0&#46;05&#46; Categorical variables were presented as frequencies with percentages&#46; Continuous variables were presented as means &#177; standard deviations &#40;SD&#41; if normally distributed or as medians &#40;interquartile range &#91;IQR&#93;&#41; if non-normally distributed&#46; For patient characteristics and imaging parameters&#44; Fisher&#39;s exact test was used to compare categorical variables&#44; and the Student&#39;s t test or the Mann-Whitney test were used for continuous variables&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">Of the 4424 patients who underwent CTA between April 2006 and May 2013&#44; 100 fulfilled the study&#39;s inclusion criteria&#46; Patient data are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Diagnostic quality of CTA was classified as good in 67&#37; of patients&#44; average in 25&#37; and poor in 8&#37;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">According to the MDCT findings&#44; 27 patients presented obstructive CAD&#58; 11 with &#8805;50&#37; luminal stenosis and 16 with CAC &#62;400 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Patients with obstructive CAD presented lower body mass index &#40;25&#46;1 vs&#46; 27&#46;7 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; p&#61;0&#46;01&#41;&#44; less radiation exposure &#40;following the study protocol&#41; &#40;0&#46;9 vs&#46; 5&#46;5 mSv&#44; p&#61;0&#46;005&#41; and lower LVEF &#40;31 vs&#46; 37&#37;&#44; p&#61;0&#46;004&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">All patients with obstructive CAD as assessed by CTA had some degree of calcification &#40;CAC &#62;0&#41; and the patient with the lowest calcium score in this group had a value of 3&#46;3&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Of the 27 patients with CAD as assessed by MDCT&#44; 21 underwent ICA &#40;nine with CAD according to CTA and 12 with Agatston calcium score &#62;400&#41;&#46; Six patients with CAD detected on MDCT did not undergo ICA&#46; Of these&#44; two were referred for non-invasive stress perfusion imaging and ischemia was excluded&#46; In the other four patients the physician&#39;s decision was to correct cardiovascular risk factors and to optimize therapy without further testing&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Of the 21 patients who underwent ICA&#44; 12 had non-obstructive CAD and nine &#40;43&#37;&#41; had obstructive CAD&#46; Of these only six &#40;29&#37;&#41; had criteria for ischemic cardiomyopathy &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Of the seven patients in atrial fibrillation &#40;AF&#41;&#44; one had tachycardia precluding CTA acquisition and only underwent CAC testing&#46; Of the remaining six&#44; three had no CAD&#44; one had &#8805;50&#37; stenosis on CTA and two had CAC &#62;400&#46; Average image quality was reported in all of these CTA cases&#46; The patient with rapid heart rate and the patients with obstructive CAD and CAC &#62;400 underwent ICA&#44; which revealed no obstructive CAD&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">The main finding of our study is that in symptomatic heart failure patients with depressed LV function of unknown etiology&#44; MDCT was able to exclude CAD in the majority of cases &#40;73&#37;&#41;&#46; Furthermore&#44; in our intermediate to low pre-test probability HF population&#44; the absence of coronary calcification was an effective predictor of the absence of CAD and was thus able to confidently exclude an ischemic etiology&#46; According to these findings&#44; a calcium score threshold of zero can be safely used as a gatekeeper for CTA acquisition in these patients &#8211; thus avoiding the small&#44; but non-negligible&#44; risk of complications related to contrast administration and radiation exposure&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Our results are in line with the published literature&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Abunassar et al&#46; reported that in a population of 153 patients with a history of HF and low LVEF &#40;&#60;50&#37;&#41; all the 13 subjects with ischemic etiology had some degree of coronary calcification as assessed by the calcium score&#44; whereas 30&#37; of the subjects with non-ischemic cardiomyopathy had a Agatston score of zero&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">CAD is believed to be the underlying cause in approximately two-thirds of patients with HF and low LVEF&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> The distinction between ischemic and non-ischemic cardiomyopathy and assessment of CAD extent have major clinical implications in patients with dilated cardiomyopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Clinical data and assessment of pre-test probability based on cardiovascular risk factors have been shown to be unreliable in this differentiation&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> Therefore&#44; auxiliary exams are usually necessary&#46; One approach would be the use of functional tests to detect ischemia scar&#44; using nuclear&#44; magnetic resonance or stress echocardiography&#46; Cardiac magnetic resonance &#40;CMR&#41; may be particularly suited for this indication&#44; given its accurate assessment of volumes and biventricular function and its high-resolution ability to detect scarring and to distinguish different patterns of fibrosis according to the underlying etiology&#46; However&#44; the availability of CMR is still limited in some centers and a significant proportion of HF patients are still referred for ICA to assess the coronary tree and to infer the etiology&#46; A recent study demonstrated that nearly two-thirds of patients referred for ICA do not have obstructive CAD &#40;defined as &#8805;50&#37; stenosis in the left main or &#8805;70&#37; in any other coronary artery&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> According to this study&#44; ICA may be unnecessary in many patients &#8211; and MDCT might be used as an effective non-invasive alternative for the exclusion of CAD&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;26</span></a> However&#44; HF patients have distinctive characteristics that may limit the image quality and diagnostic performance of MDCT&#44; particularly reduced apnea capability&#44; higher prevalence of atrial fibrillation and lower cardiac output &#40;which tends to slow the first passage of contrast&#44; leading to contrast dilution and suboptimal vessel opacification&#41;&#46; In our study&#44; MDCT image quality was considered diagnostic in the majority of patients and overall performance appears to support its use for exclusion of CAD in this context&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Only a third of patients presented obstructive CAD on CTA&#44; and only 6&#37; had criteria for ICM&#46; This low prevalence of CAD may be explained by the study design&#44; since patients referred for MDCT are usually those with a relatively low probability of CAD&#46; In our study the majority of patients had a low to intermediate pre-test probability&#44; probably reflecting a good clinical selection of candidates for this test&#44; especially suited for the exclusion of CAD&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">One particular subgroup of HF patients requiring a focused analysis is the population with AF&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> The reported prevalence of AF in modern heart failure series ranges from 13&#37; to 27&#37;&#46; Moreover&#44; the prevalence of AF in patients with HF increases in parallel with disease severity&#44; ranging from 5&#37; in patients with mild HF to 10&#37;&#8211;26&#37; among patients with moderate HF and up to 50&#37; in patients with severe HF&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> In our HF population&#44; with a mean LVEF of 35&#177;7&#46;7&#37;&#44; only 7&#37; of patients presented AF&#46; This low prevalence may be explained&#44; once again&#44; by patient selection&#46; Although AF poses a challenge to MDCT due to typically higher rates and an irregular R-R interval&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> recent studies<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> have demonstrated that MDCT can still be an option in this context&#46; Also&#44; Marwan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> reported that in 60 patients &#40;15&#37; with unexplained LV dysfunction&#41; with controlled AF &#40;range 32-107 bpm&#41; referred for MDCT for exclusion of CAD the sensitivity&#44; specificity&#44; positive predictive value and negative predictive value were 100&#37;&#44; 85&#37;&#44; 67&#37; and 100&#37;&#44; respectively&#46; Our data&#44; although on only seven AF patients&#44; are consistent with these findings&#46;</p><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Study limitations</span><p id="par0145" class="elsevierStylePara elsevierViewall">We acknowledge that our study has various limitations&#46; This is a retrospective study&#44; reflecting a single-center experience of patients referred for CTA during diagnostic workup of heart failure&#46; As such&#44; a clear selection bias has to be reported since only patients without known CAD clinically referred for MDCT were included&#46; This resulted in a relatively small population sample with an intermediate to low pre-test probability of CAD and low prevalence of AF and CAD&#46; Therefore&#44; our results cannot be generalized to other populations&#46; Nevertheless&#44; they may be indicative of the value of MDCT in clinically selected patients&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Additionally&#44; the observational and retrospective nature of the study does not allow determination of the sensitivity and specificity of CAC or CTA for the exclusion of an ischemic etiology&#44; since patients did not systematically undergo CTA or ICA&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Another important limitation is the standard for defining CAD and ischemic cardiomyopathy&#46; The use of CTA and ICA&#44; rather than functional assessment&#44; particularly CMR&#44; may limit the actual discrimination of etiologies&#46; Moreover&#44; obstructive CAD as assessed by angiography may be a concomitant disease rather than the etiology of cardiomyopathy&#46; Conversely&#44; myocardial infarction can complicate non-significant coronary stenosis due to spasm or plaque rupture&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusion</span><p id="par0160" class="elsevierStylePara elsevierViewall">In our intermediate to low pre-test probability HF population&#44; MCDT was able to exclude an ischemic etiology in 73&#37; of cases in a single test&#46; According to our results the Agatston calcium score can serve as a gatekeeper for CTA in patients with HF&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Ethical disclosures</span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Protection of human and animal subjects</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Confidentiality of data</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Right to privacy and informed consent</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Authorship</span><p id="par0185" class="elsevierStylePara elsevierViewall">PAS&#44; NB&#44; NDF&#44; MC&#44; DL and WF performed the CTA&#46; NDF performed the statistical analysis&#46; NB was a major contributor in writing the manuscript&#46; All authors read and approved the final manuscript&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:2 [
          "identificador" => "xres380893"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Introduction and Aims"
            2 => "Methods"
            3 => "Results"
            4 => "Conclusion"
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec359710"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres380892"
          "titulo" => array:5 [
            0 => "Resumo"
            1 => "Introdu&#231;&#227;o e objetivos"
            2 => "M&#233;todos"
            3 => "Resultados"
            4 => "Conclus&#245;es"
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec359711"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:10 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study population"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Patient preparation"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Assessment of pre-test probability for obstructive coronary artery disease"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Scan protocol"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Agatston calcium score quantification"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "CAD assessment"
            ]
            6 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Radiation exposure"
            ]
            7 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Image diagnostic quality"
            ]
            8 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Invasive coronary angiography and ischemia testing"
            ]
            9 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Results"
        ]
        7 => array:3 [
          "identificador" => "sec0070"
          "titulo" => "Discussion"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Study limitations"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Conclusion"
        ]
        9 => array:3 [
          "identificador" => "sec0085"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0090"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0095"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0100"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0105"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:2 [
          "identificador" => "sec0110"
          "titulo" => "Authorship"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-12-17"
    "fechaAceptado" => "2014-02-11"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec359710"
          "palabras" => array:6 [
            0 => "Heart failure"
            1 => "Coronary heart disease"
            2 => "Ischemic cardiomyopathy"
            3 => "Multidetector computed tomography"
            4 => "Computed tomography angiography"
            5 => "Agatston calcium score"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec359711"
          "palabras" => array:6 [
            0 => "Insufici&#234;ncia card&#237;aca"
            1 => "Doen&#231;a arterial coron&#225;ria"
            2 => "Cardiomiopatia isqu&#233;mica"
            3 => "Tomografia computorizada multicortes"
            4 => "Angio-TC Coron&#225;ria"
            5 => "<span class="elsevierStyleItalic">Score</span> c&#225;lcio Agatston"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Aims</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Differentiation of ischemic from non-ischemic etiology in heart failure &#40;HF&#41; patients has both therapeutic and prognostic implications&#46; One possible approach to this differentiation is direct visualization of the coronary tree&#46; Multidetector computed tomography &#40;MDCT&#41; has emerged as an alternative to invasive coronary angiography &#40;ICA&#41;&#44; but its performance and additional clinical value are still not well validated in patients with left ventricular &#40;LV&#41; dysfunction&#46; We aimed to assess the value of coronary MDCT angiography &#40;CTA&#41; in the exclusion of ischemic etiology in HF patients and to determine whether the Agatston calcium score could be used as a gatekeeper for CTA in this context&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We retrospectively selected symptomatic HF patients with LV ejection fraction &#40;LVEF&#41; &#60;50&#37;&#44; as assessed by echocardiography&#44; referred for CTA between April 2006 and May 2013&#46; Patients with previously known CAD or valvular disease were excluded&#46; The performance of MDCT in the detection of coronary artery disease &#40;CAD&#41; and&#47;or exclusion of an ischemic etiology for HF was studied&#46; Obstructive CAD was defined as the presence of &#8805;50&#37; luminal stenosis in at least one epicardial coronary artery as assessed by CTA and was assumed in patients with an Agatston coronary artery calcium &#40;CAC&#41; score &#62;400&#46; In patients referred for ICA&#44; an ischemic etiology was assumed in the presence of &#8805;75&#37; stenosis in two or more epicardial vessels or &#8805;75&#37; stenosis in the left main or proximal left anterior descending artery&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">During this period 100 patients &#40;mean age 57&#46;3&#177;10&#46;5 years&#44; 64&#37; men&#41; with HF and systolic dysfunction were referred for MDCT to exclude CAD&#46; Median effective radiation dose was 4&#46;8 mSv &#40;interquartile range 5&#46;8 mSv&#41;&#46; Mean LVEF was 35&#177;7&#46;7&#37; &#40;range 20-48&#37;&#41; and median CAC score was 13 &#40;interquartile range 212&#41;&#46; Seven patients were in atrial fibrillation&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Almost half of the patients &#40;40&#37;&#41; had no CAC and none of these had significant stenosis on CTA&#46; In an additional group of 33 patients CTA was able to confidently exclude obstructive CAD&#46; Twenty-seven patients were classified as positive for CAD &#40;16 due to CAC &#62;400 and 11 with &#8805;50&#37; stenosis&#41; and were associated with lower LVEF &#40;p&#61;0&#46;004&#41;&#46; Of these&#44; 21 patients subsequently underwent ICA&#58; obstructive CAD was confirmed in nine and only six had criteria for ischemic cardiomyopathy&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In our HF population&#44; MDCT was able to exclude an ischemic etiology in 73&#37; of cases in a single test&#46; According to our results the Agatston calcium score may serve as a gatekeeper for CTA in patients with HF&#44; with a calcium score of zero confidently excluding an ischemic etiology&#46;</p>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A diferencia&#231;&#227;o entre etiologia isqu&#233;mica de etiologia n&#227;o-isqu&#233;mica em pacientes com insufici&#234;ncia card&#237;aca &#40;IC&#41; tem implica&#231;&#245;es terap&#234;uticas e progn&#243;sticas&#46; Uma abordagem poss&#237;vel para esta diferencia&#231;&#227;o &#233; a visualiza&#231;&#227;o direta da &#225;rvore coron&#225;ria&#46; A tomografia computorizada &#40;TC&#41; surgiu como uma alternativa &#224; angiografia coron&#225;ria&#44; mas o seu desempenho e valor cl&#237;nico adicional ainda n&#227;o se encontram validados em pacientes com disfun&#231;&#227;o do ventr&#237;culo esquerdo&#46; O nosso objetivo foi avaliar o papel da angio-TC coron&#225;ria na exclus&#227;o de etiologia isqu&#233;mica em pacientes com IC e avaliar se o <span class="elsevierStyleItalic">score</span> e c&#225;lcio Agatston pode ser usado como <span class="elsevierStyleItalic">gatekeeper</span> para a angio-TC coron&#225;ria neste contexto&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram selecionados retrospetivamente pacientes com IC sintom&#225;tica com fra&#231;&#227;o de eje&#231;&#227;o do ventr&#237;culo esquerdo &#40;FEVE&#41;&#60;50&#37;&#44; avaliada por ecocardiografia&#44; referenciados para realiza&#231;&#227;o de angio-TC coron&#225;ria entre abril de 2006 a maio de 2013&#46; Pacientes com doen&#231;a arterial coron&#225;ria &#40;DAC&#41; ou doen&#231;a valvular foram exclu&#237;dos&#46; Foi avaliado o desempenho da TC na dete&#231;&#227;o de DAC e&#47;ou exclus&#227;o de etiologia isqu&#233;mica&#46; A DAC obstrutiva foi definida pela presen&#231;a de estenoses luminais &#8805;50&#37; em pelo menos uma art&#233;ria coron&#225;ria epic&#225;rdica&#44; avaliada por angio-TC coron&#225;ria e foi assumida em pacientes com o <span class="elsevierStyleItalic">score</span> de c&#225;lcio Agatston &#62;400&#46; Nos pacientes referenciados para angiografia coronaria&#44; a etiologia isqu&#233;mica foi assumida na presen&#231;a de estenoses &#8805;75&#37; em duas ou mais art&#233;rias epic&#225;rdicas ou &#8805;75&#37; no tronco comum ou no segmento proximal da art&#233;ria descendente anterior&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Durante este per&#237;odo&#44; 100 pacientes &#40;idade m&#233;dia&#58; 57&#44;3&#177;10&#44;5 anos&#44; 64&#37; homens&#41; com IC e disfun&#231;&#227;o sist&#243;lica foram referenciados para TC para exclus&#227;o de DAC&#46; A dose mediana de radia&#231;&#227;o efetiva foi de 4&#44;8 mSv &#40;intervalo interquartil 5&#44;8 mSv&#41;&#46; A FEVE m&#233;dia foi de 35&#177;7&#44;7&#37; &#40;intervalo 20-48&#37;&#41; e a mediana de <span class="elsevierStyleItalic">score</span> de c&#225;lcio Agatston foi de 13 &#40;intervalo interquartil 212&#41;&#46; Sete pacientes apresentavam fibrilha&#231;&#227;o auricular&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Quase metade dos pacientes &#40;40&#37;&#41; n&#227;o apresentava score de c&#225;lcio e nenhum deles apresentava uma estenose significativa na angio-TAC coron&#225;ria&#46; A angio-TC coron&#225;ria foi capaz de excluir DAC obstrutiva num outro grupo de 33 doentes&#46; Vinte e sete pacientes foram classificados como positivos para a presen&#231;a de DAC &#40;16 atrav&#233;s do <span class="elsevierStyleItalic">score</span> de c&#225;lcio Agatston&#62;400 e 11 apresentavam estenoses&#8805;50&#37;&#41; e foram associados a uma menor FEVE &#40;p&#61;0&#44;004&#41;&#46; Destes&#44; 21 pacientes realizaram angiografia coron&#225;ria&#58; em 9 foi confirmada a presen&#231;a de DAC obstrutiva e apenas seis apresentavam crit&#233;rios para cardiomiopatia isqu&#233;mica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Na nossa popula&#231;&#227;o com IC&#44; a TC foi capaz de excluir uma etiologia isqu&#233;mia em 73&#37; dos casos com um &#250;nico teste&#46; De acordo com os nossos resultados&#44; o <span class="elsevierStyleItalic">score</span> de c&#225;lcio Agatston pode servir como <span class="elsevierStyleItalic">gatekeeper</span> para a angio-TAC coron&#225;ria em pacientes com IC&#44; com um <span class="elsevierStyleItalic">score</span> de c&#225;lcio de 0 a excluir confiadamente uma etiologia isqu&#233;mica em pacientes com IC&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1965
            "Ancho" => 2672
            "Tamanyo" => 165147
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cardiomyopathy etiology of the 100 HF patients who underwent CTA&#46; CAD&#58; coronary artery disease&#59; CTA&#58; multidetector computed tomography coronary angiography&#59; ICA&#58; invasive coronary angiography&#59; MDCT&#58; multidetector computed tomography&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; CACS&#58; coronary artery calcium score&#59; CAD&#58; coronary artery disease&#59; IQR&#58; interquartile range&#59; LVEF&#58; left ventricular ejection fraction&#59; SBP&#58; systolic blood pressure&#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"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">General population &#40;n&#61;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Without obstructive CAD &#40;n&#61;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Obstructive CAD or CACS &#62;400 &#40;n&#61;27&#44; 11 CAD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age&#44; years &#40;mean &#177; SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;3&#177;10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;0&#177;11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;3&#177;8&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Male&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">BMI&#44; kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#40;mean &#177; SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;0&#177;4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;7&#177;4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;1&#177;3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hypertension&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Diabetes&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Obesity&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hyperlipidemia&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Smoking&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Family history&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Modified Morise risk score</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Morise risk score&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;2&#177;2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;1&#177;2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;4&#177;2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intermediate&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Maximum SBP&#44; mmHg &#40;mean &#177; SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">132&#46;3&#177;18&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133&#46;5&#177;18&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127&#46;7&#177;17&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Minimum SBP&#44; mmHg &#40;mean &#177; SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;2&#177;11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;8&#177;12&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#46;7&#177;10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Heart rate&#44; bpm &#40;median&#44; IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;0 &#40;11&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;0 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;5 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Atrial fibrillation&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Beta-blockers&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Effective radiation dose&#44; mSv &#40;median&#44; IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;8 &#40;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9 &#40;9&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">LVEF&#44; &#37; &#40;mean &#177; SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#177;7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#177;7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#177;8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Agatston calcium score&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;212&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">229 &#40;1359&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab580164.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics&#44; pre-test risk score&#44; scan protocol data&#44; left ventricular ejection fraction and Agatston calcium score of the general population and patients with or without obstructive coronary artery disease as assessed by multidetector computed tomography&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CAD&#58; coronary artery disease&#59; CTA&#58; multidetector computed tomography coronary angiography&#59; ICA&#58; invasive coronary angiography&#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"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients with obstructive CAD on ICA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">CAD on CTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Agatston calcium score &#62;400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Ischemic cardiomyopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Calcium score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">312&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">305&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1227&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1221&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">868&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab580163.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Results of multidetector computed tomography coronary angiography and Agatston calcium score in patients with obstructive coronary artery disease on invasive coronary angiography&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical epidemiology of heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Mosterd"
                            1 => "A&#46;W&#46; Hoes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/hrt.2003.025270"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart"
                        "fecha" => "2007"
                        "volumen" => "93"
                        "paginaInicial" => "1137"
                        "paginaFinal" => "1146"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17699180"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results of coronary artery surgery in patients with poor left ventricular function &#40;CASS&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;L&#46; Alderman"
                            1 => "L&#46;D&#46; Fisher"
                            2 => "P&#46; Litwin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1983"
                        "volumen" => "68"
                        "paginaInicial" => "785"
                        "paginaFinal" => "795"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6352078"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642008006064"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2009 Focused update incorporated into the ACC&#47;AHA 2005 guidelines for the diagnosis and management of heart failure in adults&#58; a report of the American College of Cardiology Foundation&#47;American Heart Association Task Force on Practice Guidelines developed in collaboration with the International Society for Heart and Lung Transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;A&#46; Hunt"
                            1 => "W&#46;T&#46; Abraham"
                            2 => "M&#46;H&#46; Chin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.11.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2009"
                        "volumen" => "53"
                        "paginaInicial" => "e1"
                        "paginaFinal" => "e90"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19358937"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary CT angiography can be used as a substitute for coronary angiography in patients with significant LV dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Nakanishi"
                            1 => "H&#46;B&#46; Park"
                            2 => "R&#46; Arsanjani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pcad.2013.01.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Prog Cardiovasc Dis"
                        "fecha" => "2013"
                        "volumen" => "55"
                        "paginaInicial" => "498"
                        "paginaFinal" => "503"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23518379"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with dilated cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Andreini"
                            1 => "G&#46; Pontone"
                            2 => "M&#46; Pepi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2007.01.086"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2007"
                        "volumen" => "49"
                        "paginaInicial" => "2044"
                        "paginaFinal" => "2050"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17512361"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy of 16-detector multislice spiral computed tomography in the initial evaluation of dilated cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;C&#46; Cornily"
                            1 => "M&#46; Gilard"
                            2 => "G&#46; Le Gal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejrad.2006.08.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Radiol"
                        "fecha" => "2007"
                        "volumen" => "61"
                        "paginaInicial" => "84"
                        "paginaFinal" => "90"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16987628"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-invasive diagnosis of ischaemic heart failure using 64-slice computed tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Ghostine"
                            1 => "C&#46; Caussin"
                            2 => "M&#46; Habis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehn072"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2008"
                        "volumen" => "29"
                        "paginaInicial" => "2133"
                        "paginaFinal" => "2140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18385120"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642010010407"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sixty-four-slice multidetector computed tomography&#58; an accurate imaging modality for the evaluation of coronary arteries in dilated cardiomyopathy of unknown etiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Andreini"
                            1 => "G&#46; Pontone"
                            2 => "A&#46;L&#46; Bartorelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCIMAGING.108.822809"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Imaging"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "199"
                        "paginaFinal" => "205"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19808593"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACCF&#47;SCCT&#47;ACR&#47;AHA&#47;ASE&#47;ASNC&#47;NASCI&#47;SCAI&#47;SCMR 2010 Appropriate use criteria for cardiac computed tomography&#58; a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force&#44; the Society of Cardiovascular Computed Tomography&#44; the American College of Radiology&#44; the American Heart Association&#44; the American Society of Echocardiography&#44; the American Society of Nuclear Cardiology&#44; the North American Society for Cardiovascular Imaging&#44; the Society for Cardiovascular Angiography and Interventions&#44; and the Society for Cardiovascular Magnetic Resonance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;J&#46; Taylor"
                            1 => "M&#46; Cerqueira"
                            2 => "J&#46; Hodgson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2010.07.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "JACC"
                        "fecha" => "2010"
                        "volumen" => "56"
                        "paginaInicial" => "1864"
                        "paginaFinal" => "1894"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21087721"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012&#46; The Task Force for the Diagnosis and Treatment of Acute Chronic Heart Failure 2012 of the European Society of Cardiology&#46; Developed in collabo ration with the Heart Failure Association &#40;HFA&#41; of the ESC"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;J&#46; McMurray"
                            1 => "S&#46; Adamopoulos"
                            2 => "S&#46;D&#46; Anker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs104"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development and validation of a clinical score to estimate the probability of coronary artery disease in men and women presenting with suspected coronary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;P&#46; Morise"
                            1 => "W&#46;J&#46; Haddad"
                            2 => "D&#46; Beckner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "1997"
                        "volumen" => "102"
                        "paginaInicial" => "350"
                        "paginaFinal" => "356"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9217616"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multidetector computed tomography in the exclusion of coronary artery disease in patients with presurgical valve disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Bettencourt"
                            1 => "J&#46; Rocha"
                            2 => "M&#46; Carvalho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCIMAGING.108.827717"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Imaging"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "306"
                        "paginaFinal" => "313"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19808611"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A reporting system on patients evaluated for coronary artery disease&#46; Report of the Ad Hoc Committee for Grading of Coronary Artery Disease&#44; Council on Cardiovascular Surgery&#44; American Heart Association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W&#46;G&#46; Austen"
                            1 => "J&#46;E&#46; Edwards"
                            2 => "R&#46;L&#46; Fyre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1975"
                        "volumen" => "51"
                        "paginaInicial" => "5"
                        "paginaFinal" => "40"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1116248"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Electron beam computed tomographic coronary calcium scanning&#58; a review and guidelines for use in asymptomatic persons"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; Rumberger"
                            1 => "B&#46;H&#46; Brundage"
                            2 => "D&#46;J&#46; Rader"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4065/74.3.243"
                      "Revista" => array:7 [
                        "tituloSerie" => "Mayo Clin Proc"
                        "fecha" => "1999"
                        "volumen" => "74"
                        "paginaInicial" => "243"
                        "paginaFinal" => "252"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10089993"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642012004022"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;L&#46; Raff"
                            1 => "M&#46;J&#46; Gallagher"
                            2 => "W&#46;W&#46; O&#8217;Neill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2005.05.056"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2005"
                        "volumen" => "46"
                        "paginaInicial" => "552"
                        "paginaFinal" => "557"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16053973"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European guidelines for multislice computed tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Bongartz"
                            1 => "S&#46;J&#46; Golding"
                            2 => "A&#46;G&#46; Jurik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2004"
                        "editorial" => "Funded by the European Commission&#46; Contract number FIGM-CT2000-20078-CT-TIP"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A standardized definition of ischemic cardiomyopathy for use in clinical research"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;M&#46; Felker"
                            1 => "L&#46;K&#46; Shaw"
                            2 => "C&#46;M&#46; O&#8217;Connor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2002"
                        "volumen" => "39"
                        "paginaInicial" => "210"
                        "paginaFinal" => "218"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Usefulness of the Agatston score &#61; 0 to exclude ischemic cardiomyopathy in patients with heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;G&#46; Abunassar"
                            1 => "Y&#46; Yam"
                            2 => "L&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2010.09.040"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2011"
                        "volumen" => "107"
                        "paginaInicial" => "428"
                        "paginaFinal" => "432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21257010"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic heart failure in the United States&#58; a manifestation of coronary artery disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Gheorghiade"
                            1 => "R&#46;O&#46; Bonow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1998"
                        "volumen" => "97"
                        "paginaInicial" => "282"
                        "paginaFinal" => "289"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9462531"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Navigating the crossroads of coronary artery disease and heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Gheorghiade"
                            1 => "G&#46; Sopko"
                            2 => "L&#46; De Luca"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2006"
                        "volumen" => "114"
                        "paginaInicial" => "1202"
                        "paginaFinal" => "1213"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;A&#46; Bart"
                            1 => "L&#46;K&#46; Shaw"
                            2 => "C&#46;B&#46; McCants"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1997"
                        "volumen" => "30"
                        "paginaInicial" => "1002"
                        "paginaFinal" => "1008"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9316531"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Segmental wall motion abnormalities in dilated cardiomyopathy&#58; a common finding and good prognostic sign"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;E&#46; Wallis"
                            1 => "J&#46;B&#46; O&#8217;Connel"
                            2 => "R&#46;E&#46; Henkin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1984"
                        "volumen" => "4"
                        "paginaInicial" => "674"
                        "paginaFinal" => "679"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6481009"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642011000649"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low diagnostic yield of elective coronary angiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;R&#46; Patel"
                            1 => "E&#46;D&#46; Peterson"
                            2 => "D&#46; Dai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0907272"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2010"
                        "volumen" => "362"
                        "paginaInicial" => "886"
                        "paginaFinal" => "895"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20220183"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642008010038"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease&#58; results from the prospective multicenter ACCURACY &#40;Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography&#41; trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Budoff"
                            1 => "D&#46; Dowe"
                            2 => "J&#46;G&#46; Jollis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.07.031"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "1724"
                        "paginaFinal" => "1732"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19007693"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACCF&#47;ACR&#47;AHA&#47;NASCI&#47;SAIP&#47;SCAI&#47;SCCT 2010 expert consensus document on coronary computed tomographic angiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;B&#46; Mark"
                            1 => "D&#46;S&#46; Berman"
                            2 => "M&#46;J&#46; Budoff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2009.11.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "JACC"
                        "fecha" => "2010"
                        "volumen" => "55"
                        "paginaInicial" => "2663"
                        "paginaFinal" => "2668"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20513611"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic accuracy of 64-slice computed tomographic coronary angiography&#58; a prospective&#44; multicenter&#44; multivendor study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W&#46;B&#46; Meijboo"
                            1 => "M&#46;F&#46;L&#46; Meijs"
                            2 => "J&#46;D&#46; Schuijf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.08.058"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "2135"
                        "paginaFinal" => "2144"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19095130"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atrial fibrillation and heart failure&#58; treatment considerations for a dual epidemic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Anter"
                            1 => "M&#46; Jessup"
                            2 => "D&#46;J&#46; Callans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.108.821306"
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2009"
                        "volumen" => "119"
                        "paginaInicial" => "2516"
                        "paginaFinal" => "2525"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19433768"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642010002435"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of dual-source CT coronary angiography for the evaluation of coronary artery disease in patients with atrial fibrillation&#58; initial experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Oncel"
                            1 => "G&#46; Oncel"
                            2 => "A&#46; Tastan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2007"
                        "volumen" => "245"
                        "paginaInicial" => "703"
                        "paginaFinal" => "711"
                        "itemHostRev" => array:3 [
                          "pii" => "S0002939408006983"
                          "estado" => "S300"
                          "issn" => "00029394"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive coronary angiography using dual-source computed tomography in patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Rist"
                            1 => "T&#46;R&#46; Johnson"
                            2 => "J&#46; Muller-Starck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RLI.0b013e3181948b05"
                      "Revista" => array:6 [
                        "tituloSerie" => "Invest Radiol"
                        "fecha" => "2009"
                        "volumen" => "44"
                        "paginaInicial" => "159"
                        "paginaFinal" => "167"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19151607"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy of dual-source computed tomography to identify significant coronary artery disease in patients with atrial fibrillation&#58; comparison with coronary angiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Marwan"
                            1 => "T&#46; Pflederer"
                            2 => "T&#46; Schepis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehq223"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2010"
                        "volumen" => "31"
                        "paginaInicial" => "2230"
                        "paginaFinal" => "2237"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20624768"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; McCrohon"
                            1 => "J&#46;C&#46; Moon"
                            2 => "S&#46;K&#46; Prassad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000078641.19365.4C"
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2003"
                        "volumen" => "108"
                        "paginaInicial" => "54"
                        "paginaFinal" => "59"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12821550"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0039625708001811"
                          "estado" => "S300"
                          "issn" => "00396257"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003300000010/v1_201411060106/S2174204914002281/v1_201411060106/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9917"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003300000010/v1_201411060106/S2174204914002281/v1_201411060106/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002281?idApp=UINPBA00004E"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Original Article
Role of cardiac multidetector computed tomography in the exclusion of ischemic etiology in heart failure patients
Papel da tomografia computorizada cardíaca na exclusão de etiologia isquémica em pacientes com insuficiência cardíaca
Pedro A. Sousaa,
Corresponding author
Peter_senado2002@yahoo.com

Corresponding author.
, Nuno Bettencourtb, Nuno Dias Ferreirab, Mónica Carvalhob, Daniel Leiteb, Wilson Ferreirab, Ilídio de Jesusa, Vasco Gamab
a Cardiology Department, Faro Hospital, Faro, Portugal
b Cardiology Department, Vila Nova de Gaia Hospital, Vila Nova de Gaia, Portugal
Read
6706
Times
was read the article
1856
Total PDF
4850
Total HTML
Share statistics
 array:24 [
  "pii" => "S2174204914002281"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2014.02.025"
  "estado" => "S300"
  "fechaPublicacion" => "2014-10-01"
  "aid" => "519"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2013"
  "documento" => "article"
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Cardiol. 2014;33:629-36"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4080
    "formatos" => array:3 [
      "EPUB" => 168
      "HTML" => 3286
      "PDF" => 626
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S0870255114002017"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2014.02.028"
      "estado" => "S300"
      "fechaPublicacion" => "2014-10-01"
      "aid" => "519"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 0
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Cardiol. 2014;33:629-36"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4125
        "formatos" => array:3 [
          "EPUB" => 168
          "HTML" => 3282
          "PDF" => 675
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
        "titulo" => "Role of cardiac multidetector computed tomography in the exclusion of ischemic etiology in heart failure patients"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "629"
            "paginaFinal" => "636"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Papel da tomografia computorizada card&#237;aca na exclus&#227;o de etiologia isqu&#233;mica em pacientes com insufici&#234;ncia card&#237;aca"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figure 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1965
                "Ancho" => 2672
                "Tamanyo" => 165147
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cardiomyopathy etiology of the 100 HF patients who underwent CTA&#46; CAD&#58; coronary artery disease&#59; CTA&#58; multidetector computed tomography coronary angiography&#59; ICA&#58; invasive coronary angiography&#59; MDCT&#58; multidetector computed tomography&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Pedro A&#46; Sousa, Nuno Bettencourt, Nuno Dias Ferreira, M&#243;nica Carvalho, Daniel Leite, Wilson Ferreira, Il&#237;dio de Jesus, Vasco Gama"
            "autores" => array:8 [
              0 => array:2 [
                "nombre" => "Pedro A&#46;"
                "apellidos" => "Sousa"
              ]
              1 => array:2 [
                "nombre" => "Nuno"
                "apellidos" => "Bettencourt"
              ]
              2 => array:2 [
                "nombre" => "Nuno"
                "apellidos" => "Dias Ferreira"
              ]
              3 => array:2 [
                "nombre" => "M&#243;nica"
                "apellidos" => "Carvalho"
              ]
              4 => array:2 [
                "nombre" => "Daniel"
                "apellidos" => "Leite"
              ]
              5 => array:2 [
                "nombre" => "Wilson"
                "apellidos" => "Ferreira"
              ]
              6 => array:2 [
                "nombre" => "Il&#237;dio"
                "apellidos" => "de Jesus"
              ]
              7 => array:2 [
                "nombre" => "Vasco"
                "apellidos" => "Gama"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204914002281"
          "doi" => "10.1016/j.repce.2014.02.025"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002281?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002017?idApp=UINPBA00004E"
      "url" => "/08702551/0000003300000010/v1_201410290045/S0870255114002017/v1_201410290045/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2174204914002293"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2014.03.011"
    "estado" => "S300"
    "fechaPublicacion" => "2014-10-01"
    "aid" => "524"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2014;33:637-40"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3090
      "formatos" => array:3 [
        "EPUB" => 162
        "HTML" => 2371
        "PDF" => 557
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Ventricular septal defect in children and adolescents in Angola&#58; Experience of a tertiary center"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "637"
          "paginaFinal" => "640"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Comunica&#231;&#227;o interventricular em crian&#231;as e adolescentes em Angola&#58; Experi&#234;ncia de um centro terci&#225;rio"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1074
              "Ancho" => 1253
              "Tamanyo" => 58947
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of the sample according to whether ventricular septal defect was associated with other congenital heart defects&#46; CHD&#58; congenital heart defect&#59; VSD&#58; ventricular septal defect&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Valdano Manuel, Humberto Morais, Ana Manuel, Bruna David, Sebastiana Gamboa"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Valdano"
              "apellidos" => "Manuel"
            ]
            1 => array:2 [
              "nombre" => "Humberto"
              "apellidos" => "Morais"
            ]
            2 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Manuel"
            ]
            3 => array:2 [
              "nombre" => "Bruna"
              "apellidos" => "David"
            ]
            4 => array:2 [
              "nombre" => "Sebastiana"
              "apellidos" => "Gamboa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0870255114002066"
        "doi" => "10.1016/j.repc.2014.03.012"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002066?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002293?idApp=UINPBA00004E"
    "url" => "/21742049/0000003300000010/v1_201411060106/S2174204914002293/v1_201411060106/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2174204914002001"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2014.01.022"
    "estado" => "S300"
    "fechaPublicacion" => "2014-10-01"
    "aid" => "509"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2014;33:617-27"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4308
      "formatos" => array:3 [
        "EPUB" => 175
        "HTML" => 3349
        "PDF" => 784
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Non-ST-elevation acute coronary syndromes in octogenarians&#58; Applicability of the GRACE and CRUSADE scores"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "617"
          "paginaFinal" => "627"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "S&#237;ndromes coron&#225;rias agudas sem supradesnivelamento-ST nos octogen&#225;rios&#58; aplicabilidade dos scores GRACE e CRUSADE"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 2063
              "Ancho" => 1667
              "Tamanyo" => 195320
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ROC curve analysis of the CRUSADE score and MB-PM for assessment of major bleeding&#46; AUC&#58; area under the curve&#59; CI&#58; confidence interval&#59; MB-PM&#58; major bleeding prediction model&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ana Faustino, Paula Mota, Joana Silva"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Faustino"
            ]
            1 => array:2 [
              "nombre" => "Paula"
              "apellidos" => "Mota"
            ]
            2 => array:2 [
              "nombre" => "Joana"
              "apellidos" => "Silva"
            ]
            3 => array:1 [
              "colaborador" => "Em nome dos Investigadores do Registo Nacional de S&#237;ndromes Coron&#225;rias Agudas da Sociedade Portuguesa de Cardiologia"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255114001917"
        "doi" => "10.1016/j.repc.2014.01.025"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114001917?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002001?idApp=UINPBA00004E"
    "url" => "/21742049/0000003300000010/v1_201411060106/S2174204914002001/v1_201411060106/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Role of cardiac multidetector computed tomography in the exclusion of ischemic etiology in heart failure patients"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "629"
        "paginaFinal" => "636"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Pedro A&#46; Sousa, Nuno Bettencourt, Nuno Dias Ferreira, M&#243;nica Carvalho, Daniel Leite, Wilson Ferreira, Il&#237;dio de Jesus, Vasco Gama"
        "autores" => array:8 [
          0 => array:4 [
            "nombre" => "Pedro A&#46;"
            "apellidos" => "Sousa"
            "email" => array:1 [
              0 => "Peter&#95;senado2002&#64;yahoo&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Nuno"
            "apellidos" => "Bettencourt"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Nuno"
            "apellidos" => "Dias Ferreira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "M&#243;nica"
            "apellidos" => "Carvalho"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Daniel"
            "apellidos" => "Leite"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Wilson"
            "apellidos" => "Ferreira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Il&#237;dio"
            "apellidos" => "de Jesus"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Vasco"
            "apellidos" => "Gama"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Cardiology Department&#44; Faro Hospital&#44; Faro&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Cardiology Department&#44; Vila Nova de Gaia Hospital&#44; Vila Nova de Gaia&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Papel da tomografia computorizada card&#237;aca na exclus&#227;o de etiologia isqu&#233;mica em pacientes com insufici&#234;ncia card&#237;aca"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1965
            "Ancho" => 2672
            "Tamanyo" => 165147
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cardiomyopathy etiology of the 100 HF patients who underwent CTA&#46; CAD&#58; coronary artery disease&#59; CTA&#58; multidetector computed tomography coronary angiography&#59; ICA&#58; invasive coronary angiography&#59; MDCT&#58; multidetector computed tomography&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Heart failure &#40;HF&#41; is a complex and progressive disease that leads to significant morbidity and mortality&#46; Approximately 1-2&#37; of the adult population in developed countries has HF&#44; the prevalence rising to &#8805;10&#37; among persons aged 70 years or older&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> There are many causes of HF&#44; and these vary in different parts of the world&#46; However&#44; the etiology is routinely categorized as ischemic or non-ischemic&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Patients with ischemic HF may benefit from revascularization<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and so the presence&#44; anatomic characteristics&#44; and functional significance of coronary artery disease &#40;CAD&#41; should be assessed in patients with new-onset HF&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The gold standard diagnostic method for CAD detection has been invasive coronary angiography &#40;ICA&#41;&#46; Multidetector computed tomography &#40;MDCT&#41; has emerged as a robust alternative&#44; demonstrating high diagnostic performance for identifying coronary stenosis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Several recent studies<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a> have shown that it is extremely accurate even in subjects with left ventricular &#40;LV&#41; dysfunction&#46; Therefore&#44; new-onset HF is currently considered an appropriate indication for MDCT&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> However&#44; the performance of coronary MDCT angiography &#40;CTA&#41; for the differentiation of HF etiology in clinical practice has not been fully validated&#44; and few studies have set out to evaluate the role of coronary artery calcium &#40;CAC&#41; score and CTA in patients with LV dysfunction&#46; We sought to assess the value of MDCT in the exclusion of ischemic etiology in HF patients and to test the potential application of the Agatston score as a gatekeeper for CTA in this context&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0020" class="elsevierStylePara elsevierViewall">Between April 2006 and May 2013&#44; 4424 patients underwent cardiac computed tomography &#40;CT&#41; for detection of CAD&#46; Of these we retrospectively selected patients with symptoms and&#47;or signs of HF and systolic dysfunction &#40;defined as left ventricular ejection fraction &#91;LVEF&#93; &#60;50&#37;&#41; who were referred for CTA aiming to exclude an ischemic etiology&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Subjects with previously known CAD or severe valvular disease were excluded from the analysis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patient preparation</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients received oral metoprolol one hour before the MDCT scan according to baseline heart rate &#40;50 mg if &#62;55 and &#60;65 bpm or 100 mg if &#8805;65 bpm&#41;&#46; An additional dose of intravenous metoprolol &#40;2&#46;5&#8211;15 mg&#41; was administered 10 minutes before the scan if heart rate remained &#62;65 bpm&#46; All patients received 0&#46;5 mg of sublingual nitroglycerin five minutes before CTA&#46; Beta-blockers were not given in patients with class III&#47;IV heart failure symptoms&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Assessment of pre-test probability for obstructive coronary artery disease</span><p id="par0030" class="elsevierStylePara elsevierViewall">A modified Morise risk score<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> with exclusion of estrogen status was used to stratify the pre-test risk&#46; Patients were classified as low &#40;score &#60;10&#41;&#44; intermediate &#40;10-16&#41; or high &#40;&#62;16&#41; pre-test probability&#44; according to this risk score&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Scan protocol</span><p id="par0035" class="elsevierStylePara elsevierViewall">All scans were performed using a 64-slice CT scanner &#40;SOMATOM Sensation 64&#44; Siemens Medical Solutions&#44; Forchheim&#44; Germany&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Agatston calcium score quantification</span><p id="par0040" class="elsevierStylePara elsevierViewall">All patients underwent a low-dose scan to assess CAC&#46; The scan parameters for this acquisition were collimation 24&#215;1&#46;2 mm&#44; gantry rotation time 330 ms&#44; pitch 0&#46;2&#44; tube voltage 120 kV and tube current 190 mAs&#46; Image reconstruction of the calcium score acquisition was performed using an effective slice thickness of 3 mm&#46; CAC was reported as the mean Agatston score and was calculated using a detection of 130 HU with semi-automated software &#40;syngo Calcium Scoring&#44; Siemens Medical Solutions&#41; as described previously&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">CAD assessment</span><p id="par0045" class="elsevierStylePara elsevierViewall">In patients with CAC &#8804;400&#44; a CTA acquisition was performed &#40;collimation 64&#215;0&#46;6 mm&#59; tube current 850 mAs&#59; all other parameters as in the CAC acquisition scan&#44; with the exception of tube voltage&#44; which was reduced to 100 kV in lower weight patients&#44; according to the radiographer&#39;s judgment&#41;&#46; Tube current modulation with electrocardiographic pulsing was used to decrease the radiation dose&#44; with full tube current applied at 60&#8211;65&#37; of the RR interval&#46; Depending on the scan time&#44; a bolus of 50&#8211;90 ml of contrast &#40;Ultravist<span class="elsevierStyleSup">&#174;</span>&#44; iopromide 370 mg&#47;ml&#44; Bayer Schering Pharma AG&#44; Berlin&#44; Germany&#41; was injected &#40;4&#46;5&#8211;7 ml&#47;min&#41; via a power injector &#40;Stellant<span class="elsevierStyleSup">&#174;</span> D&#44; Medrad Inc&#46;&#44; Warrendale&#44; PA&#44; USA&#41; followed by a 40-ml saline chaser&#44; using a dedicated antecubital vein 18-gauge access catheter&#46; A bolus-tracking technique was used&#44; with a region of interest placed in the ascending aorta&#44; set to detect a predefined threshold of 150 HU&#46; For assessment of CAD&#44; multiphase sets of the reconstructed CTA images were processed on a dedicated workstation and analyzed for detection of at least one luminal diameter narrowing of &#62;50&#37; in any coronary artery segment&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Severely calcified segments &#40;concentric vessel wall calcification precluding lumen assessment&#41; were classified as positive for CAD&#46; Following the center&#39;s protocol and international consensus&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> CTA was not performed in patients with an Agatston calcium score higher than 400&#46; These patients were considered positive for the presence of CAD&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;12&#44;14&#44;15</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Radiation exposure</span><p id="par0050" class="elsevierStylePara elsevierViewall">Mean radiation exposure was estimated by the method proposed by the European Working Group for guidelines on quality criteria in CT&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The effective radiation doses for the CAC and CTA acquisitions were calculated by the product of the conversion coefficient for cardiac CT &#40;0&#46;014 mSv&#47;mGy cm averaged between male and female models&#41; and the dose-length product obtained during each scan&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Image diagnostic quality</span><p id="par0055" class="elsevierStylePara elsevierViewall">Image quality was subjectively classified by the readers into three groups&#58; good&#44; average and poor&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">All tests were taken into consideration assuming an intention to diagnose and no patients were excluded from analysis based on image quality&#46; Non-diagnostic segments due to poor image quality were assumed positive for CAD for the purposes of the study&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Invasive coronary angiography and ischemia testing</span><p id="par0065" class="elsevierStylePara elsevierViewall">Patients were referred for ICA and non-invasive ischemia testing at the referring physician&#39;s discretion&#46; Data from tests performed in the 12 months after the exam were described&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">For ICA&#44; the same cut-off values described for CTA were used&#58; coronary artery obstruction was defined as &#8805;50&#37; luminal stenosis in at least one major coronary artery&#46; An anatomically-based definition for ischemic cardiomyopathy on ICA was taken as &#8805;75&#37; stenosis in the left main or proximal left anterior descending artery or in &#8805;2 epicardial vessels&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Statistical analyses were performed using SPSS 17&#46;0 &#40;IBM&#44; Chicago&#44; IL&#41; and statistical significance was defined as p&#60;0&#46;05&#46; Categorical variables were presented as frequencies with percentages&#46; Continuous variables were presented as means &#177; standard deviations &#40;SD&#41; if normally distributed or as medians &#40;interquartile range &#91;IQR&#93;&#41; if non-normally distributed&#46; For patient characteristics and imaging parameters&#44; Fisher&#39;s exact test was used to compare categorical variables&#44; and the Student&#39;s t test or the Mann-Whitney test were used for continuous variables&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">Of the 4424 patients who underwent CTA between April 2006 and May 2013&#44; 100 fulfilled the study&#39;s inclusion criteria&#46; Patient data are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Diagnostic quality of CTA was classified as good in 67&#37; of patients&#44; average in 25&#37; and poor in 8&#37;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">According to the MDCT findings&#44; 27 patients presented obstructive CAD&#58; 11 with &#8805;50&#37; luminal stenosis and 16 with CAC &#62;400 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Patients with obstructive CAD presented lower body mass index &#40;25&#46;1 vs&#46; 27&#46;7 kg&#47;m<span class="elsevierStyleSup">2</span>&#44; p&#61;0&#46;01&#41;&#44; less radiation exposure &#40;following the study protocol&#41; &#40;0&#46;9 vs&#46; 5&#46;5 mSv&#44; p&#61;0&#46;005&#41; and lower LVEF &#40;31 vs&#46; 37&#37;&#44; p&#61;0&#46;004&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">All patients with obstructive CAD as assessed by CTA had some degree of calcification &#40;CAC &#62;0&#41; and the patient with the lowest calcium score in this group had a value of 3&#46;3&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Of the 27 patients with CAD as assessed by MDCT&#44; 21 underwent ICA &#40;nine with CAD according to CTA and 12 with Agatston calcium score &#62;400&#41;&#46; Six patients with CAD detected on MDCT did not undergo ICA&#46; Of these&#44; two were referred for non-invasive stress perfusion imaging and ischemia was excluded&#46; In the other four patients the physician&#39;s decision was to correct cardiovascular risk factors and to optimize therapy without further testing&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Of the 21 patients who underwent ICA&#44; 12 had non-obstructive CAD and nine &#40;43&#37;&#41; had obstructive CAD&#46; Of these only six &#40;29&#37;&#41; had criteria for ischemic cardiomyopathy &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Of the seven patients in atrial fibrillation &#40;AF&#41;&#44; one had tachycardia precluding CTA acquisition and only underwent CAC testing&#46; Of the remaining six&#44; three had no CAD&#44; one had &#8805;50&#37; stenosis on CTA and two had CAC &#62;400&#46; Average image quality was reported in all of these CTA cases&#46; The patient with rapid heart rate and the patients with obstructive CAD and CAC &#62;400 underwent ICA&#44; which revealed no obstructive CAD&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">The main finding of our study is that in symptomatic heart failure patients with depressed LV function of unknown etiology&#44; MDCT was able to exclude CAD in the majority of cases &#40;73&#37;&#41;&#46; Furthermore&#44; in our intermediate to low pre-test probability HF population&#44; the absence of coronary calcification was an effective predictor of the absence of CAD and was thus able to confidently exclude an ischemic etiology&#46; According to these findings&#44; a calcium score threshold of zero can be safely used as a gatekeeper for CTA acquisition in these patients &#8211; thus avoiding the small&#44; but non-negligible&#44; risk of complications related to contrast administration and radiation exposure&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Our results are in line with the published literature&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Abunassar et al&#46; reported that in a population of 153 patients with a history of HF and low LVEF &#40;&#60;50&#37;&#41; all the 13 subjects with ischemic etiology had some degree of coronary calcification as assessed by the calcium score&#44; whereas 30&#37; of the subjects with non-ischemic cardiomyopathy had a Agatston score of zero&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">CAD is believed to be the underlying cause in approximately two-thirds of patients with HF and low LVEF&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> The distinction between ischemic and non-ischemic cardiomyopathy and assessment of CAD extent have major clinical implications in patients with dilated cardiomyopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Clinical data and assessment of pre-test probability based on cardiovascular risk factors have been shown to be unreliable in this differentiation&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> Therefore&#44; auxiliary exams are usually necessary&#46; One approach would be the use of functional tests to detect ischemia scar&#44; using nuclear&#44; magnetic resonance or stress echocardiography&#46; Cardiac magnetic resonance &#40;CMR&#41; may be particularly suited for this indication&#44; given its accurate assessment of volumes and biventricular function and its high-resolution ability to detect scarring and to distinguish different patterns of fibrosis according to the underlying etiology&#46; However&#44; the availability of CMR is still limited in some centers and a significant proportion of HF patients are still referred for ICA to assess the coronary tree and to infer the etiology&#46; A recent study demonstrated that nearly two-thirds of patients referred for ICA do not have obstructive CAD &#40;defined as &#8805;50&#37; stenosis in the left main or &#8805;70&#37; in any other coronary artery&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> According to this study&#44; ICA may be unnecessary in many patients &#8211; and MDCT might be used as an effective non-invasive alternative for the exclusion of CAD&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;26</span></a> However&#44; HF patients have distinctive characteristics that may limit the image quality and diagnostic performance of MDCT&#44; particularly reduced apnea capability&#44; higher prevalence of atrial fibrillation and lower cardiac output &#40;which tends to slow the first passage of contrast&#44; leading to contrast dilution and suboptimal vessel opacification&#41;&#46; In our study&#44; MDCT image quality was considered diagnostic in the majority of patients and overall performance appears to support its use for exclusion of CAD in this context&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Only a third of patients presented obstructive CAD on CTA&#44; and only 6&#37; had criteria for ICM&#46; This low prevalence of CAD may be explained by the study design&#44; since patients referred for MDCT are usually those with a relatively low probability of CAD&#46; In our study the majority of patients had a low to intermediate pre-test probability&#44; probably reflecting a good clinical selection of candidates for this test&#44; especially suited for the exclusion of CAD&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">One particular subgroup of HF patients requiring a focused analysis is the population with AF&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> The reported prevalence of AF in modern heart failure series ranges from 13&#37; to 27&#37;&#46; Moreover&#44; the prevalence of AF in patients with HF increases in parallel with disease severity&#44; ranging from 5&#37; in patients with mild HF to 10&#37;&#8211;26&#37; among patients with moderate HF and up to 50&#37; in patients with severe HF&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> In our HF population&#44; with a mean LVEF of 35&#177;7&#46;7&#37;&#44; only 7&#37; of patients presented AF&#46; This low prevalence may be explained&#44; once again&#44; by patient selection&#46; Although AF poses a challenge to MDCT due to typically higher rates and an irregular R-R interval&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> recent studies<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> have demonstrated that MDCT can still be an option in this context&#46; Also&#44; Marwan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> reported that in 60 patients &#40;15&#37; with unexplained LV dysfunction&#41; with controlled AF &#40;range 32-107 bpm&#41; referred for MDCT for exclusion of CAD the sensitivity&#44; specificity&#44; positive predictive value and negative predictive value were 100&#37;&#44; 85&#37;&#44; 67&#37; and 100&#37;&#44; respectively&#46; Our data&#44; although on only seven AF patients&#44; are consistent with these findings&#46;</p><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Study limitations</span><p id="par0145" class="elsevierStylePara elsevierViewall">We acknowledge that our study has various limitations&#46; This is a retrospective study&#44; reflecting a single-center experience of patients referred for CTA during diagnostic workup of heart failure&#46; As such&#44; a clear selection bias has to be reported since only patients without known CAD clinically referred for MDCT were included&#46; This resulted in a relatively small population sample with an intermediate to low pre-test probability of CAD and low prevalence of AF and CAD&#46; Therefore&#44; our results cannot be generalized to other populations&#46; Nevertheless&#44; they may be indicative of the value of MDCT in clinically selected patients&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Additionally&#44; the observational and retrospective nature of the study does not allow determination of the sensitivity and specificity of CAC or CTA for the exclusion of an ischemic etiology&#44; since patients did not systematically undergo CTA or ICA&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Another important limitation is the standard for defining CAD and ischemic cardiomyopathy&#46; The use of CTA and ICA&#44; rather than functional assessment&#44; particularly CMR&#44; may limit the actual discrimination of etiologies&#46; Moreover&#44; obstructive CAD as assessed by angiography may be a concomitant disease rather than the etiology of cardiomyopathy&#46; Conversely&#44; myocardial infarction can complicate non-significant coronary stenosis due to spasm or plaque rupture&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conclusion</span><p id="par0160" class="elsevierStylePara elsevierViewall">In our intermediate to low pre-test probability HF population&#44; MCDT was able to exclude an ischemic etiology in 73&#37; of cases in a single test&#46; According to our results the Agatston calcium score can serve as a gatekeeper for CTA in patients with HF&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Ethical disclosures</span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Protection of human and animal subjects</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Confidentiality of data</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Right to privacy and informed consent</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Authorship</span><p id="par0185" class="elsevierStylePara elsevierViewall">PAS&#44; NB&#44; NDF&#44; MC&#44; DL and WF performed the CTA&#46; NDF performed the statistical analysis&#46; NB was a major contributor in writing the manuscript&#46; All authors read and approved the final manuscript&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:2 [
          "identificador" => "xres380893"
          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Introduction and Aims"
            2 => "Methods"
            3 => "Results"
            4 => "Conclusion"
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec359710"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres380892"
          "titulo" => array:5 [
            0 => "Resumo"
            1 => "Introdu&#231;&#227;o e objetivos"
            2 => "M&#233;todos"
            3 => "Resultados"
            4 => "Conclus&#245;es"
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec359711"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:10 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study population"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Patient preparation"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Assessment of pre-test probability for obstructive coronary artery disease"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Scan protocol"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Agatston calcium score quantification"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "CAD assessment"
            ]
            6 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Radiation exposure"
            ]
            7 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Image diagnostic quality"
            ]
            8 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Invasive coronary angiography and ischemia testing"
            ]
            9 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Results"
        ]
        7 => array:3 [
          "identificador" => "sec0070"
          "titulo" => "Discussion"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Study limitations"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Conclusion"
        ]
        9 => array:3 [
          "identificador" => "sec0085"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0090"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0095"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0100"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0105"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:2 [
          "identificador" => "sec0110"
          "titulo" => "Authorship"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-12-17"
    "fechaAceptado" => "2014-02-11"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec359710"
          "palabras" => array:6 [
            0 => "Heart failure"
            1 => "Coronary heart disease"
            2 => "Ischemic cardiomyopathy"
            3 => "Multidetector computed tomography"
            4 => "Computed tomography angiography"
            5 => "Agatston calcium score"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec359711"
          "palabras" => array:6 [
            0 => "Insufici&#234;ncia card&#237;aca"
            1 => "Doen&#231;a arterial coron&#225;ria"
            2 => "Cardiomiopatia isqu&#233;mica"
            3 => "Tomografia computorizada multicortes"
            4 => "Angio-TC Coron&#225;ria"
            5 => "<span class="elsevierStyleItalic">Score</span> c&#225;lcio Agatston"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction and Aims</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Differentiation of ischemic from non-ischemic etiology in heart failure &#40;HF&#41; patients has both therapeutic and prognostic implications&#46; One possible approach to this differentiation is direct visualization of the coronary tree&#46; Multidetector computed tomography &#40;MDCT&#41; has emerged as an alternative to invasive coronary angiography &#40;ICA&#41;&#44; but its performance and additional clinical value are still not well validated in patients with left ventricular &#40;LV&#41; dysfunction&#46; We aimed to assess the value of coronary MDCT angiography &#40;CTA&#41; in the exclusion of ischemic etiology in HF patients and to determine whether the Agatston calcium score could be used as a gatekeeper for CTA in this context&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We retrospectively selected symptomatic HF patients with LV ejection fraction &#40;LVEF&#41; &#60;50&#37;&#44; as assessed by echocardiography&#44; referred for CTA between April 2006 and May 2013&#46; Patients with previously known CAD or valvular disease were excluded&#46; The performance of MDCT in the detection of coronary artery disease &#40;CAD&#41; and&#47;or exclusion of an ischemic etiology for HF was studied&#46; Obstructive CAD was defined as the presence of &#8805;50&#37; luminal stenosis in at least one epicardial coronary artery as assessed by CTA and was assumed in patients with an Agatston coronary artery calcium &#40;CAC&#41; score &#62;400&#46; In patients referred for ICA&#44; an ischemic etiology was assumed in the presence of &#8805;75&#37; stenosis in two or more epicardial vessels or &#8805;75&#37; stenosis in the left main or proximal left anterior descending artery&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">During this period 100 patients &#40;mean age 57&#46;3&#177;10&#46;5 years&#44; 64&#37; men&#41; with HF and systolic dysfunction were referred for MDCT to exclude CAD&#46; Median effective radiation dose was 4&#46;8 mSv &#40;interquartile range 5&#46;8 mSv&#41;&#46; Mean LVEF was 35&#177;7&#46;7&#37; &#40;range 20-48&#37;&#41; and median CAC score was 13 &#40;interquartile range 212&#41;&#46; Seven patients were in atrial fibrillation&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Almost half of the patients &#40;40&#37;&#41; had no CAC and none of these had significant stenosis on CTA&#46; In an additional group of 33 patients CTA was able to confidently exclude obstructive CAD&#46; Twenty-seven patients were classified as positive for CAD &#40;16 due to CAC &#62;400 and 11 with &#8805;50&#37; stenosis&#41; and were associated with lower LVEF &#40;p&#61;0&#46;004&#41;&#46; Of these&#44; 21 patients subsequently underwent ICA&#58; obstructive CAD was confirmed in nine and only six had criteria for ischemic cardiomyopathy&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In our HF population&#44; MDCT was able to exclude an ischemic etiology in 73&#37; of cases in a single test&#46; According to our results the Agatston calcium score may serve as a gatekeeper for CTA in patients with HF&#44; with a calcium score of zero confidently excluding an ischemic etiology&#46;</p>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o e objetivos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A diferencia&#231;&#227;o entre etiologia isqu&#233;mica de etiologia n&#227;o-isqu&#233;mica em pacientes com insufici&#234;ncia card&#237;aca &#40;IC&#41; tem implica&#231;&#245;es terap&#234;uticas e progn&#243;sticas&#46; Uma abordagem poss&#237;vel para esta diferencia&#231;&#227;o &#233; a visualiza&#231;&#227;o direta da &#225;rvore coron&#225;ria&#46; A tomografia computorizada &#40;TC&#41; surgiu como uma alternativa &#224; angiografia coron&#225;ria&#44; mas o seu desempenho e valor cl&#237;nico adicional ainda n&#227;o se encontram validados em pacientes com disfun&#231;&#227;o do ventr&#237;culo esquerdo&#46; O nosso objetivo foi avaliar o papel da angio-TC coron&#225;ria na exclus&#227;o de etiologia isqu&#233;mica em pacientes com IC e avaliar se o <span class="elsevierStyleItalic">score</span> e c&#225;lcio Agatston pode ser usado como <span class="elsevierStyleItalic">gatekeeper</span> para a angio-TC coron&#225;ria neste contexto&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram selecionados retrospetivamente pacientes com IC sintom&#225;tica com fra&#231;&#227;o de eje&#231;&#227;o do ventr&#237;culo esquerdo &#40;FEVE&#41;&#60;50&#37;&#44; avaliada por ecocardiografia&#44; referenciados para realiza&#231;&#227;o de angio-TC coron&#225;ria entre abril de 2006 a maio de 2013&#46; Pacientes com doen&#231;a arterial coron&#225;ria &#40;DAC&#41; ou doen&#231;a valvular foram exclu&#237;dos&#46; Foi avaliado o desempenho da TC na dete&#231;&#227;o de DAC e&#47;ou exclus&#227;o de etiologia isqu&#233;mica&#46; A DAC obstrutiva foi definida pela presen&#231;a de estenoses luminais &#8805;50&#37; em pelo menos uma art&#233;ria coron&#225;ria epic&#225;rdica&#44; avaliada por angio-TC coron&#225;ria e foi assumida em pacientes com o <span class="elsevierStyleItalic">score</span> de c&#225;lcio Agatston &#62;400&#46; Nos pacientes referenciados para angiografia coronaria&#44; a etiologia isqu&#233;mica foi assumida na presen&#231;a de estenoses &#8805;75&#37; em duas ou mais art&#233;rias epic&#225;rdicas ou &#8805;75&#37; no tronco comum ou no segmento proximal da art&#233;ria descendente anterior&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Durante este per&#237;odo&#44; 100 pacientes &#40;idade m&#233;dia&#58; 57&#44;3&#177;10&#44;5 anos&#44; 64&#37; homens&#41; com IC e disfun&#231;&#227;o sist&#243;lica foram referenciados para TC para exclus&#227;o de DAC&#46; A dose mediana de radia&#231;&#227;o efetiva foi de 4&#44;8 mSv &#40;intervalo interquartil 5&#44;8 mSv&#41;&#46; A FEVE m&#233;dia foi de 35&#177;7&#44;7&#37; &#40;intervalo 20-48&#37;&#41; e a mediana de <span class="elsevierStyleItalic">score</span> de c&#225;lcio Agatston foi de 13 &#40;intervalo interquartil 212&#41;&#46; Sete pacientes apresentavam fibrilha&#231;&#227;o auricular&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Quase metade dos pacientes &#40;40&#37;&#41; n&#227;o apresentava score de c&#225;lcio e nenhum deles apresentava uma estenose significativa na angio-TAC coron&#225;ria&#46; A angio-TC coron&#225;ria foi capaz de excluir DAC obstrutiva num outro grupo de 33 doentes&#46; Vinte e sete pacientes foram classificados como positivos para a presen&#231;a de DAC &#40;16 atrav&#233;s do <span class="elsevierStyleItalic">score</span> de c&#225;lcio Agatston&#62;400 e 11 apresentavam estenoses&#8805;50&#37;&#41; e foram associados a uma menor FEVE &#40;p&#61;0&#44;004&#41;&#46; Destes&#44; 21 pacientes realizaram angiografia coron&#225;ria&#58; em 9 foi confirmada a presen&#231;a de DAC obstrutiva e apenas seis apresentavam crit&#233;rios para cardiomiopatia isqu&#233;mica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Na nossa popula&#231;&#227;o com IC&#44; a TC foi capaz de excluir uma etiologia isqu&#233;mia em 73&#37; dos casos com um &#250;nico teste&#46; De acordo com os nossos resultados&#44; o <span class="elsevierStyleItalic">score</span> de c&#225;lcio Agatston pode servir como <span class="elsevierStyleItalic">gatekeeper</span> para a angio-TAC coron&#225;ria em pacientes com IC&#44; com um <span class="elsevierStyleItalic">score</span> de c&#225;lcio de 0 a excluir confiadamente uma etiologia isqu&#233;mica em pacientes com IC&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1965
            "Ancho" => 2672
            "Tamanyo" => 165147
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cardiomyopathy etiology of the 100 HF patients who underwent CTA&#46; CAD&#58; coronary artery disease&#59; CTA&#58; multidetector computed tomography coronary angiography&#59; ICA&#58; invasive coronary angiography&#59; MDCT&#58; multidetector computed tomography&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; CACS&#58; coronary artery calcium score&#59; CAD&#58; coronary artery disease&#59; IQR&#58; interquartile range&#59; LVEF&#58; left ventricular ejection fraction&#59; SBP&#58; systolic blood pressure&#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"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">General population &#40;n&#61;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Without obstructive CAD &#40;n&#61;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Obstructive CAD or CACS &#62;400 &#40;n&#61;27&#44; 11 CAD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age&#44; years &#40;mean &#177; SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;3&#177;10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;0&#177;11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;3&#177;8&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Male&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">BMI&#44; kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#40;mean &#177; SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;0&#177;4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;7&#177;4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;1&#177;3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hypertension&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Diabetes&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Obesity&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hyperlipidemia&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Smoking&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Family history&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Modified Morise risk score</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Morise risk score&#44; mean &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;2&#177;2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;1&#177;2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;4&#177;2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intermediate&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>High&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Maximum SBP&#44; mmHg &#40;mean &#177; SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">132&#46;3&#177;18&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133&#46;5&#177;18&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127&#46;7&#177;17&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Minimum SBP&#44; mmHg &#40;mean &#177; SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;2&#177;11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;8&#177;12&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#46;7&#177;10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Heart rate&#44; bpm &#40;median&#44; IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;0 &#40;11&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;0 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;5 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Atrial fibrillation&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Beta-blockers&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Effective radiation dose&#44; mSv &#40;median&#44; IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;8 &#40;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9 &#40;9&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">LVEF&#44; &#37; &#40;mean &#177; SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#177;7&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#177;7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#177;8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Agatston calcium score&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;212&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">229 &#40;1359&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab580164.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics&#44; pre-test risk score&#44; scan protocol data&#44; left ventricular ejection fraction and Agatston calcium score of the general population and patients with or without obstructive coronary artery disease as assessed by multidetector computed tomography&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CAD&#58; coronary artery disease&#59; CTA&#58; multidetector computed tomography coronary angiography&#59; ICA&#58; invasive coronary angiography&#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"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients with obstructive CAD on ICA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">CAD on CTA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Agatston calcium score &#62;400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Ischemic cardiomyopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Calcium score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">312&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">305&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1227&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1221&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">868&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab580163.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Results of multidetector computed tomography coronary angiography and Agatston calcium score in patients with obstructive coronary artery disease on invasive coronary angiography&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical epidemiology of heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Mosterd"
                            1 => "A&#46;W&#46; Hoes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/hrt.2003.025270"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart"
                        "fecha" => "2007"
                        "volumen" => "93"
                        "paginaInicial" => "1137"
                        "paginaFinal" => "1146"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17699180"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results of coronary artery surgery in patients with poor left ventricular function &#40;CASS&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;L&#46; Alderman"
                            1 => "L&#46;D&#46; Fisher"
                            2 => "P&#46; Litwin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1983"
                        "volumen" => "68"
                        "paginaInicial" => "785"
                        "paginaFinal" => "795"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6352078"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642008006064"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2009 Focused update incorporated into the ACC&#47;AHA 2005 guidelines for the diagnosis and management of heart failure in adults&#58; a report of the American College of Cardiology Foundation&#47;American Heart Association Task Force on Practice Guidelines developed in collaboration with the International Society for Heart and Lung Transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;A&#46; Hunt"
                            1 => "W&#46;T&#46; Abraham"
                            2 => "M&#46;H&#46; Chin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.11.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2009"
                        "volumen" => "53"
                        "paginaInicial" => "e1"
                        "paginaFinal" => "e90"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19358937"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary CT angiography can be used as a substitute for coronary angiography in patients with significant LV dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Nakanishi"
                            1 => "H&#46;B&#46; Park"
                            2 => "R&#46; Arsanjani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pcad.2013.01.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Prog Cardiovasc Dis"
                        "fecha" => "2013"
                        "volumen" => "55"
                        "paginaInicial" => "498"
                        "paginaFinal" => "503"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23518379"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with dilated cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Andreini"
                            1 => "G&#46; Pontone"
                            2 => "M&#46; Pepi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2007.01.086"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2007"
                        "volumen" => "49"
                        "paginaInicial" => "2044"
                        "paginaFinal" => "2050"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17512361"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy of 16-detector multislice spiral computed tomography in the initial evaluation of dilated cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;C&#46; Cornily"
                            1 => "M&#46; Gilard"
                            2 => "G&#46; Le Gal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejrad.2006.08.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Radiol"
                        "fecha" => "2007"
                        "volumen" => "61"
                        "paginaInicial" => "84"
                        "paginaFinal" => "90"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16987628"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-invasive diagnosis of ischaemic heart failure using 64-slice computed tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Ghostine"
                            1 => "C&#46; Caussin"
                            2 => "M&#46; Habis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehn072"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2008"
                        "volumen" => "29"
                        "paginaInicial" => "2133"
                        "paginaFinal" => "2140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18385120"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642010010407"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sixty-four-slice multidetector computed tomography&#58; an accurate imaging modality for the evaluation of coronary arteries in dilated cardiomyopathy of unknown etiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Andreini"
                            1 => "G&#46; Pontone"
                            2 => "A&#46;L&#46; Bartorelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCIMAGING.108.822809"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Imaging"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "199"
                        "paginaFinal" => "205"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19808593"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACCF&#47;SCCT&#47;ACR&#47;AHA&#47;ASE&#47;ASNC&#47;NASCI&#47;SCAI&#47;SCMR 2010 Appropriate use criteria for cardiac computed tomography&#58; a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force&#44; the Society of Cardiovascular Computed Tomography&#44; the American College of Radiology&#44; the American Heart Association&#44; the American Society of Echocardiography&#44; the American Society of Nuclear Cardiology&#44; the North American Society for Cardiovascular Imaging&#44; the Society for Cardiovascular Angiography and Interventions&#44; and the Society for Cardiovascular Magnetic Resonance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;J&#46; Taylor"
                            1 => "M&#46; Cerqueira"
                            2 => "J&#46; Hodgson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2010.07.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "JACC"
                        "fecha" => "2010"
                        "volumen" => "56"
                        "paginaInicial" => "1864"
                        "paginaFinal" => "1894"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21087721"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012&#46; The Task Force for the Diagnosis and Treatment of Acute Chronic Heart Failure 2012 of the European Society of Cardiology&#46; Developed in collabo ration with the Heart Failure Association &#40;HFA&#41; of the ESC"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;J&#46; McMurray"
                            1 => "S&#46; Adamopoulos"
                            2 => "S&#46;D&#46; Anker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs104"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development and validation of a clinical score to estimate the probability of coronary artery disease in men and women presenting with suspected coronary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;P&#46; Morise"
                            1 => "W&#46;J&#46; Haddad"
                            2 => "D&#46; Beckner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med"
                        "fecha" => "1997"
                        "volumen" => "102"
                        "paginaInicial" => "350"
                        "paginaFinal" => "356"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9217616"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multidetector computed tomography in the exclusion of coronary artery disease in patients with presurgical valve disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Bettencourt"
                            1 => "J&#46; Rocha"
                            2 => "M&#46; Carvalho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCIMAGING.108.827717"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Imaging"
                        "fecha" => "2009"
                        "volumen" => "2"
                        "paginaInicial" => "306"
                        "paginaFinal" => "313"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19808611"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A reporting system on patients evaluated for coronary artery disease&#46; Report of the Ad Hoc Committee for Grading of Coronary Artery Disease&#44; Council on Cardiovascular Surgery&#44; American Heart Association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W&#46;G&#46; Austen"
                            1 => "J&#46;E&#46; Edwards"
                            2 => "R&#46;L&#46; Fyre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1975"
                        "volumen" => "51"
                        "paginaInicial" => "5"
                        "paginaFinal" => "40"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1116248"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Electron beam computed tomographic coronary calcium scanning&#58; a review and guidelines for use in asymptomatic persons"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; Rumberger"
                            1 => "B&#46;H&#46; Brundage"
                            2 => "D&#46;J&#46; Rader"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4065/74.3.243"
                      "Revista" => array:7 [
                        "tituloSerie" => "Mayo Clin Proc"
                        "fecha" => "1999"
                        "volumen" => "74"
                        "paginaInicial" => "243"
                        "paginaFinal" => "252"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10089993"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642012004022"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;L&#46; Raff"
                            1 => "M&#46;J&#46; Gallagher"
                            2 => "W&#46;W&#46; O&#8217;Neill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2005.05.056"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2005"
                        "volumen" => "46"
                        "paginaInicial" => "552"
                        "paginaFinal" => "557"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16053973"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European guidelines for multislice computed tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Bongartz"
                            1 => "S&#46;J&#46; Golding"
                            2 => "A&#46;G&#46; Jurik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2004"
                        "editorial" => "Funded by the European Commission&#46; Contract number FIGM-CT2000-20078-CT-TIP"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A standardized definition of ischemic cardiomyopathy for use in clinical research"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;M&#46; Felker"
                            1 => "L&#46;K&#46; Shaw"
                            2 => "C&#46;M&#46; O&#8217;Connor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2002"
                        "volumen" => "39"
                        "paginaInicial" => "210"
                        "paginaFinal" => "218"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Usefulness of the Agatston score &#61; 0 to exclude ischemic cardiomyopathy in patients with heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;G&#46; Abunassar"
                            1 => "Y&#46; Yam"
                            2 => "L&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2010.09.040"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2011"
                        "volumen" => "107"
                        "paginaInicial" => "428"
                        "paginaFinal" => "432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21257010"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic heart failure in the United States&#58; a manifestation of coronary artery disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Gheorghiade"
                            1 => "R&#46;O&#46; Bonow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1998"
                        "volumen" => "97"
                        "paginaInicial" => "282"
                        "paginaFinal" => "289"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9462531"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Navigating the crossroads of coronary artery disease and heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Gheorghiade"
                            1 => "G&#46; Sopko"
                            2 => "L&#46; De Luca"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2006"
                        "volumen" => "114"
                        "paginaInicial" => "1202"
                        "paginaFinal" => "1213"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;A&#46; Bart"
                            1 => "L&#46;K&#46; Shaw"
                            2 => "C&#46;B&#46; McCants"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1997"
                        "volumen" => "30"
                        "paginaInicial" => "1002"
                        "paginaFinal" => "1008"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9316531"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Segmental wall motion abnormalities in dilated cardiomyopathy&#58; a common finding and good prognostic sign"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;E&#46; Wallis"
                            1 => "J&#46;B&#46; O&#8217;Connel"
                            2 => "R&#46;E&#46; Henkin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1984"
                        "volumen" => "4"
                        "paginaInicial" => "674"
                        "paginaFinal" => "679"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6481009"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642011000649"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low diagnostic yield of elective coronary angiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;R&#46; Patel"
                            1 => "E&#46;D&#46; Peterson"
                            2 => "D&#46; Dai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0907272"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2010"
                        "volumen" => "362"
                        "paginaInicial" => "886"
                        "paginaFinal" => "895"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20220183"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642008010038"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease&#58; results from the prospective multicenter ACCURACY &#40;Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography&#41; trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Budoff"
                            1 => "D&#46; Dowe"
                            2 => "J&#46;G&#46; Jollis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.07.031"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "1724"
                        "paginaFinal" => "1732"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19007693"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACCF&#47;ACR&#47;AHA&#47;NASCI&#47;SAIP&#47;SCAI&#47;SCCT 2010 expert consensus document on coronary computed tomographic angiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;B&#46; Mark"
                            1 => "D&#46;S&#46; Berman"
                            2 => "M&#46;J&#46; Budoff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2009.11.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "JACC"
                        "fecha" => "2010"
                        "volumen" => "55"
                        "paginaInicial" => "2663"
                        "paginaFinal" => "2668"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20513611"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic accuracy of 64-slice computed tomographic coronary angiography&#58; a prospective&#44; multicenter&#44; multivendor study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W&#46;B&#46; Meijboo"
                            1 => "M&#46;F&#46;L&#46; Meijs"
                            2 => "J&#46;D&#46; Schuijf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2008.08.058"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2008"
                        "volumen" => "52"
                        "paginaInicial" => "2135"
                        "paginaFinal" => "2144"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19095130"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atrial fibrillation and heart failure&#58; treatment considerations for a dual epidemic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Anter"
                            1 => "M&#46; Jessup"
                            2 => "D&#46;J&#46; Callans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.108.821306"
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2009"
                        "volumen" => "119"
                        "paginaInicial" => "2516"
                        "paginaFinal" => "2525"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19433768"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0161642010002435"
                          "estado" => "S300"
                          "issn" => "01616420"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of dual-source CT coronary angiography for the evaluation of coronary artery disease in patients with atrial fibrillation&#58; initial experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Oncel"
                            1 => "G&#46; Oncel"
                            2 => "A&#46; Tastan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2007"
                        "volumen" => "245"
                        "paginaInicial" => "703"
                        "paginaFinal" => "711"
                        "itemHostRev" => array:3 [
                          "pii" => "S0002939408006983"
                          "estado" => "S300"
                          "issn" => "00029394"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive coronary angiography using dual-source computed tomography in patients with atrial fibrillation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Rist"
                            1 => "T&#46;R&#46; Johnson"
                            2 => "J&#46; Muller-Starck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RLI.0b013e3181948b05"
                      "Revista" => array:6 [
                        "tituloSerie" => "Invest Radiol"
                        "fecha" => "2009"
                        "volumen" => "44"
                        "paginaInicial" => "159"
                        "paginaFinal" => "167"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19151607"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accuracy of dual-source computed tomography to identify significant coronary artery disease in patients with atrial fibrillation&#58; comparison with coronary angiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Marwan"
                            1 => "T&#46; Pflederer"
                            2 => "T&#46; Schepis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehq223"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2010"
                        "volumen" => "31"
                        "paginaInicial" => "2230"
                        "paginaFinal" => "2237"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20624768"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; McCrohon"
                            1 => "J&#46;C&#46; Moon"
                            2 => "S&#46;K&#46; Prassad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000078641.19365.4C"
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2003"
                        "volumen" => "108"
                        "paginaInicial" => "54"
                        "paginaFinal" => "59"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12821550"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0039625708001811"
                          "estado" => "S300"
                          "issn" => "00396257"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003300000010/v1_201411060106/S2174204914002281/v1_201411060106/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9917"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003300000010/v1_201411060106/S2174204914002281/v1_201411060106/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002281?idApp=UINPBA00004E"
]
Article information
ISSN: 21742049
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 6 5 11
2024 October 27 31 58
2024 September 28 22 50
2024 August 44 27 71
2024 July 32 30 62
2024 June 31 19 50
2024 May 29 23 52
2024 April 38 21 59
2024 March 29 16 45
2024 February 27 21 48
2024 January 19 32 51
2023 December 23 30 53
2023 November 21 20 41
2023 October 25 26 51
2023 September 27 16 43
2023 August 19 15 34
2023 July 15 20 35
2023 June 27 9 36
2023 May 34 25 59
2023 April 12 6 18
2023 March 30 21 51
2023 February 30 20 50
2023 January 22 19 41
2022 December 27 21 48
2022 November 28 25 53
2022 October 34 19 53
2022 September 23 34 57
2022 August 20 34 54
2022 July 30 40 70
2022 June 25 26 51
2022 May 28 26 54
2022 April 30 29 59
2022 March 34 45 79
2022 February 34 36 70
2022 January 23 21 44
2021 December 21 33 54
2021 November 31 29 60
2021 October 28 42 70
2021 September 19 25 44
2021 August 20 26 46
2021 July 17 23 40
2021 June 23 16 39
2021 May 24 31 55
2021 April 29 29 58
2021 March 28 11 39
2021 February 45 18 63
2021 January 16 19 35
2020 December 23 18 41
2020 November 39 10 49
2020 October 15 15 30
2020 September 52 9 61
2020 August 18 8 26
2020 July 38 4 42
2020 June 31 8 39
2020 May 36 2 38
2020 April 33 11 44
2020 March 41 9 50
2020 February 100 16 116
2020 January 43 6 49
2019 December 40 6 46
2019 November 22 10 32
2019 October 38 3 41
2019 September 63 9 72
2019 August 28 7 35
2019 July 37 9 46
2019 June 28 9 37
2019 May 39 9 48
2019 April 27 21 48
2019 March 29 10 39
2019 February 49 12 61
2019 January 57 8 65
2018 December 57 12 69
2018 November 205 7 212
2018 October 688 30 718
2018 September 174 9 183
2018 August 165 9 174
2018 July 32 9 41
2018 June 52 8 60
2018 May 46 11 57
2018 April 109 8 117
2018 March 31 12 43
2018 February 32 3 35
2018 January 40 5 45
2017 December 54 11 65
2017 November 56 15 71
2017 October 22 10 32
2017 September 30 15 45
2017 August 32 24 56
2017 July 21 13 34
2017 June 49 11 60
2017 May 36 12 48
2017 April 25 10 35
2017 March 31 14 45
2017 February 28 3 31
2017 January 41 1 42
2016 December 33 7 40
2016 November 29 4 33
2016 October 28 1 29
2016 September 31 2 33
2016 August 7 1 8
2016 July 10 1 11
2016 June 8 4 12
2016 May 16 8 24
2016 April 16 1 17
2016 March 15 19 34
2016 February 32 25 57
2016 January 32 24 56
2015 December 36 20 56
2015 November 27 10 37
2015 October 29 14 43
2015 September 31 14 45
2015 August 29 6 35
2015 July 17 6 23
2015 June 13 2 15
2015 May 22 9 31
2015 April 23 14 37
2015 March 17 5 22
2015 February 20 4 24
2015 January 26 10 36
2014 December 48 12 60
2014 November 41 10 51
Show all

Follow this link to access the full text of the article

Idiomas
Revista Portuguesa de Cardiologia (English edition)
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.