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Cardiac rehabilitation after acute coronary syndrome: Do all patients derive the same benefit?
Reabilitação cardíaca após síndrome coronária aguda – terão todos os doentes o mesmo benefício?
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It is a coordinated multidisciplinary intervention that aims to improve the cardiac patient's physical, psychological and social functioning. CR programs include exercise training and strategies to reduce modifiable cardiovascular risk factors such as hypertension, dyslipidemia, diabetes and smoking, and to improve adherence to pharmacologic and non-pharmacologic therapy.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">CR has been shown to reduce reinfarction, cardiovascular and non-cardiovascular readmission and death<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3,4,2,5</span></a> and to improve health-related quality of life, and to be cost-effective.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1,6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Exercise training programs increase patients’ cardiorespiratory fitness, reducing symptoms and improving physiologic responses to physical effort.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> As a consequence, heart rate and blood pressure decrease during physical activity, reducing myocardial oxygen demand.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The positive effects of CR in cardiovascular disease include stabilization of the progression of atherosclerosis and improvement in endothelial function, resulting in increased coronary compliance, elasticity and flow.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1,8–11</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Exercise testing is essential before CR to assess exercise capacity, to prescribe exercise training programs, to stratify cardiovascular risk and to estimate prognosis. After CR, it provides an objective measure of the program's effect on functional capacity.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Achievement of higher functional capacity is clinically significant because it not only impacts on health-related quality of life but it also is prognostically valuable, strongly predicting the risk of death. Assessing fitness at baseline and after CR is important since an improvement in functional capacity lowers the risk of death.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Cardiopulmonary exercise testing (CPET) is the best tool for this purpose, providing a detailed assessment of functional capacity through the analysis of respiratory gas exchange during exercise. Among important CPET parameters is peak oxygen uptake (pVO<span class="elsevierStyleInf">2</span>), which is an accurate measure of exercise capacity and an important predictor of outcome in patients with coronary artery disease (CAD).<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">13–15</span></a> Peak VO<span class="elsevierStyleInf">2</span> reflects tissue oxygen uptake in exercise, and depends on cardiac output, arterial oxygen content and oxygen extraction ability of muscle tissue. A supervised exercise training program can increase pVO<span class="elsevierStyleInf">2</span> by 11-36%, with the greatest improvement in the most deconditioned individuals.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a> Peak VO<span class="elsevierStyleInf">2</span> varies according to age and gender, so it is also adjusted in relation to the predicted value for age and gender (%pVO<span class="elsevierStyleInf">2</span>).<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Another useful parameter, considered by some authors to be a better prognostic parameter than pVO<span class="elsevierStyleInf">2</span>, is the slope of the ventilation/CO<span class="elsevierStyleInf">2</span> ratio (VE/VCO<span class="elsevierStyleInf">2</span> slope), which expresses ventilatory efficiency and has been shown to be an independent predictor of outcome.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">14,16,17</span></a> The ratio (VE/VCO<span class="elsevierStyleInf">2</span> slope)/pVO<span class="elsevierStyleInf">2</span> integrates the two above parameters and also has prognostic value.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Another form of assessment is calculation of peak circulatory power (PCP), defined as pVO<span class="elsevierStyleInf">2</span> times systolic pressure at peak exercise.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Despite its advantages, CPET is not routinely used after ACS.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The aim of the present study was, using CPET parameters, to identify which patients would benefit most in terms of functional capacity after a CR program. Patients were divided according to pVO<span class="elsevierStyleInf">2</span> and left ventricular ejection fraction (LVEF) at baseline, and the benefit of CR was evaluated by comparing CPET performance before and after the program.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study design</span><p id="par0110" class="elsevierStylePara elsevierViewall">This was a retrospective observational study of consecutive patients who suffered an ACS and participated in CR after hospital discharge, in whom CPET was performed before and after the program. All patients admitted with ACS were invited to take part in a CR program.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The data were collected between January 2004 and December 2013, in a single center.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The study population was divided into two groups according to baseline functional capacity based on the Weber-Janicki classification<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a>: group 1 (G1), pVO<span class="elsevierStyleInf">2</span> <20 ml/kg/min; and group 2 (G2), pVO<span class="elsevierStyleInf">2</span> ≥20 ml/kg/min. A second analysis was performed, dividing patients according to left ventricular (LV) systolic function before CR, using the cut-point of 50% LVEF: group A (GA), LVEF <50%; and group B (GB), LVEF ≥50%.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Cardiac rehabilitation</span><p id="par0125" class="elsevierStylePara elsevierViewall">Early ambulatory phase (phase 2) of CR program was performed by a multidisciplinary team, led by a cardiologist.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Before starting the program, patients were stratified according to CAD risk, exercise capacity and safety concerns. All underwent clinical and echocardiographic assessment and exercise testing.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The exercise program was prescribed on the basis of CPET results and was individualized for each patient based on pVO<span class="elsevierStyleInf">2</span>, in accordance with current guidelines.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Continuous moderate-intensity exercise training was performed in 36 twice-weekly sessions of 60 min each. Each session included warm-up (10 min), aerobic activity (30 min), muscle-strengthening activity and flexibility exercises (10 min) and cool-down (10 min).</p><p id="par0145" class="elsevierStylePara elsevierViewall">The program was begun at lower intensity (65-70% of maximum training heart rate), and was progressively elevated to a target of 85-95% of maximum training heart rate, without reaching the anaerobic threshold.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Besides the exercise training component, the phase 2 CR program also included:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">–</span><p id="par0155" class="elsevierStylePara elsevierViewall">identification and control of cardiovascular risk factors, including diabetes, hypertension, dyslipidemia, obesity, smoking, and sedentary lifestyle;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">–</span><p id="par0160" class="elsevierStylePara elsevierViewall">lifestyle modification with individualized dietary counseling by a dietician, psychologic counseling for selected patients, smoking cessation sessions for some patients, social support in selected cases and promotion of adherence to drug therapy;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">–</span><p id="par0165" class="elsevierStylePara elsevierViewall">group educational sessions by the multidisciplinary CR team, with the participation of family members, to explain atherosclerotic disease and its consequences and the importance of risk factors and secondary prevention measures.</p></li></ul></p><p id="par0170" class="elsevierStylePara elsevierViewall">Immediately after the end of the program, clinical and echocardiographic assessment and exercise testing were repeated, and patients were scheduled for consultations to quantify the benefits obtained the program. Follow-up by telephone was performed to check adherence to healthy behaviors, particularly exercise and medication, control of cardiovascular risk factors and the occurrence of cardiac events.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Cardiopulmonary exercise testing</span><p id="par0175" class="elsevierStylePara elsevierViewall">All patients underwent CPET at baseline and after 36 exercise training sessions.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Maximal symptom-limited treadmill CPET was performed using the modified Bruce protocol. CPET was monitored with continuous 12-lead electrocardiogram, blood pressure cuff, saturation probe and face mask to measure respiratory gases. Blood pressure was measured at rest, at each stage, at peak exercise and at the first, third and sixth minute of the recovery phase. Respiratory gases were analyzed using an Innocor<span class="elsevierStyleSup">®</span> gas analyzer and VO<span class="elsevierStyleInf">2</span>, CO<span class="elsevierStyleInf">2</span> production (VCO<span class="elsevierStyleInf">2</span>) and ventilation (VE) were measured on a breath-by-breath basis.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Patients were encouraged to continue exercising until the VCO<span class="elsevierStyleInf">2</span>/VO<span class="elsevierStyleInf">2</span> ratio was ≥1.15.</p><p id="par0190" class="elsevierStylePara elsevierViewall">Peak VO<span class="elsevierStyleInf">2</span> adjusted for body mass, or for fat-free mass in obese patients (body mass index >30 kg/m<span class="elsevierStyleSup">2</span>), was analyzed as %pVO<span class="elsevierStyleInf">2</span> according to age and gender. The VE/VCO<span class="elsevierStyleInf">2</span> slope was calculated by automatic linear regression with values obtained during the exercise test. The VE/VCO<span class="elsevierStyleInf">2</span> slope/pVO<span class="elsevierStyleInf">2</span> ratio was calculated using the obtained VE/VCO<span class="elsevierStyleInf">2</span> slope and pVO<span class="elsevierStyleInf">2</span>. PCP was calculated as pVO<span class="elsevierStyleInf">2</span> times peak systolic blood pressure. The differences in pVO<span class="elsevierStyleInf">2</span>, %pVO<span class="elsevierStyleInf">2</span>, PCP and exercise test duration before and after CR were also calculated.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Echocardiography</span><p id="par0195" class="elsevierStylePara elsevierViewall">All patients underwent a comprehensive Doppler echocardiographic study using commercially available ultrasound systems (Vivid 9<span class="elsevierStyleSup">®</span>, General Electric) before and after the CR program.</p><p id="par0200" class="elsevierStylePara elsevierViewall">Echocardiographic parameters of LV systolic and diastolic function were assessed, as well as right ventricular function parameters, pulmonary artery systolic pressure and the presence of cardiac valve disease. LV end-diastolic and end-systolic volume and LVEF were determined by Simpson's biplane method.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0205" class="elsevierStylePara elsevierViewall">The statistical analysis was performed using SPSS Statistics (version 22; IBM SPSS, Chicago, IL). Continuous variables were expressed as mean ± standard deviation. CPET parameters at baseline and after CR were compared using the two-tailed Student's t test or the non-parametric Wilcoxon test, as appropriate. Characteristics of the study groups were compared using the Student's t test or the Wilcoxon-Mann-Whitney test for continuous variables and Pearson's chi-square or Fisher's exact test for categorical variables.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0210" class="elsevierStylePara elsevierViewall">During the study period 4724 patients were admitted with ACS diagnosis. Of these, around 50% were transferred from non-tertiary centers without a catheterization laboratory and were followed in those hospitals after discharge. Of the 2363 (50%) followed in our center, only 12% agreed to be included in the hospital's CR program and completed the program.</p><p id="par0215" class="elsevierStylePara elsevierViewall">The study included the 129 patients who underwent CPET before and after CR, 111 (86.0%) male, mean age 56.3±9.8 years, 88.1% of whom had suffered STEMI. The clinical characteristics of the overall population are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0220" class="elsevierStylePara elsevierViewall">Compared to G1, G2 patients (with lower baseline functional capacity) were older, included fewer males and had a higher prevalence of diabetes and dyslipidemia (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0225" class="elsevierStylePara elsevierViewall">CR improved functional capacity in both groups. In G1, pVO<span class="elsevierStyleInf">2</span> increased from 17.7±1.8 to 22.1±7.2 ml/kg/min (p<0.001). PCP and exercise test duration also increased significantly (p<0.001 for both). VE/VCO<span class="elsevierStyleInf">2</span> slope/pVO<span class="elsevierStyleInf">2</span> decreased from 1.7±0.4 to 1.4±0.6 (p<0.001). There was no significant change in VE/VCO<span class="elsevierStyleInf">2</span> slope in this group (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0230" class="elsevierStylePara elsevierViewall">In G2 all CPET parameters improved after CR, pVO<span class="elsevierStyleInf">2</span> rising from 28.1±5.6 to 29.7±6.2 ml/kg/min (p<0.001) and %pVO<span class="elsevierStyleInf">2</span> from 96.3% to 100.3% (p=0.001). PCP and exercise test duration also increased significantly. VE/VCO<span class="elsevierStyleInf">2</span> slope and VE/VCO<span class="elsevierStyleInf">2</span> slope/pVO<span class="elsevierStyleInf">2</span> decreased significantly (p=0.032 and p<0.001, respectively) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><p id="par0235" class="elsevierStylePara elsevierViewall">As expected, CPET parameters were substantially different between groups before and after CR, with a better performance in G2. However, when range of improvement is compared, G1 achieved a greater benefit after CR. The improvement in pVO<span class="elsevierStyleInf">2</span> was greater in G1, in absolute value (ΔpVO<span class="elsevierStyleInf">2</span> 4.4±7.3 vs. 1.6±5.4; p=0.018) and in percentage of predicted value (Δ%pVO<span class="elsevierStyleInf">2</span> 17.9±35.4% vs. 4.0±19.9%; p=0.009). In G1 improvement in pVO<span class="elsevierStyleInf">2</span> was more than 10% in 71% of patients, contrasting with only 40.8% in G2. The increase in PCP was also significantly greater in G1 (883.3±1217.3 vs. 238.5±1250.5 mmHg.ml/kg/min; p=0.015). Exercise test duration increased more in G1, although not significantly (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0240" class="elsevierStylePara elsevierViewall">When patients were grouped according to LV systolic function, both groups presented improved functional capacity after exercise training. In GA, pVO<span class="elsevierStyleInf">2</span> increased from 24.7±6.1 to 27.7±6.9 ml/kg/min (p=0.002), %pVO<span class="elsevierStyleInf">2</span> from 84.9±19.4 to 95.4±24.0% (p=0.001) and exercise test duration from 13.4±2.6 to 15.0±3.3 min (p<0.001) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). GB patients also achieved a significant improvement, as demonstrated by increased pVO<span class="elsevierStyleInf">2</span>, %pVO<span class="elsevierStyleInf">2</span>, PCP and exercise test duration and decreased VE/VCO<span class="elsevierStyleInf">2</span> slope and (VE/VCO<span class="elsevierStyleInf">2</span> slope)/pVO<span class="elsevierStyleInf">2</span> ratio (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><p id="par0245" class="elsevierStylePara elsevierViewall">There were no significant differences in CPET parameters between these two groups before or after CR. GA presented greater increases in pVO<span class="elsevierStyleInf">2</span> (3.1±5.6 vs. 2.0±6.1 ml/kg/min; p=0.382), %pVO<span class="elsevierStyleInf">2</span> (10.6±19.0 vs. 6.2±26.9%; p=0.291) and exercise test duration (1.6±2.5 vs. 2.0±2.6; p=0.920), although they were not significant.</p><p id="par0250" class="elsevierStylePara elsevierViewall">In patients with initial VE/VCO<span class="elsevierStyleInf">2</span> slope >30, a significant improvement in this parameter was achieved after CR (34.4±5.8 vs. 31.1±5.1; p=0.02).</p><p id="par0255" class="elsevierStylePara elsevierViewall">In a follow-up of 5.17±2.04 years, there were no significant differences in death, cardiac events, lifestyle or adherence to therapy between the study groups (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). The lower mortality and ACS recurrence in all groups is noteworthy. Regarding lifestyle, more than 90% of the overall population maintained therapeutic adherence and more than half of patients performed regular physical exercise and kept to a healthy diet.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0260" class="elsevierStylePara elsevierViewall">The main result of our study was that the CPET parameter pVO<span class="elsevierStyleInf">2</span> is useful in the selection of ACS patients who will have a better functional response to exercise training.</p><p id="par0265" class="elsevierStylePara elsevierViewall">Our data indicate that the inclusion of ACS patients in a supervised 36-session exercise training program improved functional capacity independently of baseline performance, and that patients with pVO<span class="elsevierStyleInf">2</span> <20 ml/kg/min before CR derived greater benefit. The improvement in pVO<span class="elsevierStyleInf">2</span> was seen in absolute terms, as well as adjusted to predicted value for age and gender. As demonstrated in previous papers,<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1,21</span></a> our data showed that the most deconditioned individuals had the greatest improvement in functional capacity after the program, with 71% of patients in G1 achieving an improvement of >10% in pVO<span class="elsevierStyleInf">2</span> compared to 40.8% in G2.</p><p id="par0270" class="elsevierStylePara elsevierViewall">This greater benefit was also reflected in VE/VCO<span class="elsevierStyleInf">2</span> slope/pVO<span class="elsevierStyleInf">2</span>, PCP and exercise test duration, which have important prognostic implications. Kavanagh et al. demonstrated that the main predictor of outcome in CAD patients is exercise tolerance, as objectively measured by pVO<span class="elsevierStyleInf">2</span>. A 10% decrease in mortality was observed for each increase of 1 ml/kg/min in pVO<span class="elsevierStyleInf">2</span>.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">Comparing patients according to baseline LVEF, our research demonstrates that CR is beneficial regardless of LV systolic function. More than half of the patients (55.9%) in GA saw an increase in pVO<span class="elsevierStyleInf">2</span> of >10%, compared to 45.3% in GB. This finding, although not statistically significant, suggests that patients with LV dysfunction may derive more benefit from an exercise training program. Previous studies have shown that patients with LV systolic dysfunction benefit more from CR.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a></p><p id="par0280" class="elsevierStylePara elsevierViewall">The number of ACS patients undergoing CR was low for various reasons, as analyzed in previous studies, including financial constraints, difficulties in transportation, conflicts with work, low motivation and geographic distance. There are multiple barriers to CR, three of which have been identified as patient-related, physician-related and health system-related factors.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a></p><p id="par0285" class="elsevierStylePara elsevierViewall">Cardiac rehabilitation, though widely recommended in ACS guidelines, is poorly implemented in several countries, including Portugal, where previous studies have shown that only 3% of ACS patients discharged from hospital are admitted to a CR program.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">24–26</span></a> Although an increasing number of ACS patients have been included in CR programs in Portugal in recent years, recruitment in the country remains far below the European average of 30%.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a></p><p id="par0290" class="elsevierStylePara elsevierViewall">Including more patients in CR programs will require modifications in the health system, including increases in the number of CR centers and improvements in specialized training of health professionals. Failure by cardiologists and surgeons to refer patients for CR is particularly evident in some cases, including the elderly, women, obese patients, smokers and those of low socioeconomic status or suffering from depression.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a> Only with a more suitable health structure and better trained professionals will be possible to recruit and motivate more ACS patients for CR.</p><p id="par0295" class="elsevierStylePara elsevierViewall">Although in our center there is presently no limitation on the number of ACS patients who can be referred for CR, it should be borne in mind that many hospitals do not have facilities available to provide CR for all patients. Knowing who will derive the greatest benefit will help in the selection of the best responders to CR.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Study limitations</span><p id="par0300" class="elsevierStylePara elsevierViewall">This is a single-center retrospective study and thus suffers from inherent limitations, including the small number of patients. The size of our sample was due to the fact that of the patients followed after discharge in our center, only a minority agreed to be included in CR at the hospital and completed the program, for the reasons described.</p><p id="par0305" class="elsevierStylePara elsevierViewall">Furthermore, the present study only included patients who performed CPET before and after CR, and since CPET is not a routine procedure, this excluded patients who underwent standard exercise testing, which does not include gas exchange analysis.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusion</span><p id="par0310" class="elsevierStylePara elsevierViewall">In conclusion, of the heterogeneous group of patients with ACS, those with the worst functional capacity identified by CPET, and those with lower LVEF, obtained the greatest benefit from CR. These individuals should be the main target for referral for comprehensive CR, and CPET may be in fact a valuable tool for their identification.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Ethical disclosures</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Protection of human and animal subjects</span><p id="par0315" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Confidentiality of data</span><p id="par0320" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Right to privacy and informed consent</span><p id="par0325" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflicts of interest</span><p id="par0330" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres819550" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec816612" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres819549" "titulo" => "Resumo" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec816611" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Cardiac rehabilitation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Cardiopulmonary exercise testing" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Echocardiography" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Study limitations" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusion" ] 10 => array:3 [ "identificador" => "sec0060" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0070" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0075" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-02-09" "fechaAceptado" => "2016-09-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec816612" "palabras" => array:3 [ 0 => "Acute coronary syndrome" 1 => "Cardiac rehabilitation" 2 => "Cardiopulmonary exercise testing" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec816611" "palabras" => array:3 [ 0 => "Síndrome coronária aguda" 1 => "Reabilitação cardíaca" 2 => "Prova de esforço cardiorrespiratória" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cardiac rehabilitation (CR) has been demonstrated to improve exercise capacity in acute coronary syndrome (ACS), but not all patients derive the same benefit. Careful patient selection is crucial to maximize resources.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To identify in a heterogeneous ACS population which patients would benefit the most with CR, in terms of functional capacity (FC), by using cardiopulmonary exercise testing (CPET).</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A retrospective analysis of consecutive ACS patients who underwent CR and CPET was undertaken. CPET was performed at baseline and after 36 sessions of exercise. Peak oxygen uptake (pVO<span class="elsevierStyleInf">2</span>), percentage of predicted pVO<span class="elsevierStyleInf">2</span>, minute ventilation/CO<span class="elsevierStyleInf">2</span> production (VE/VCO<span class="elsevierStyleInf">2</span>) slope, VE/VCO<span class="elsevierStyleInf">2</span> slope/pVO<span class="elsevierStyleInf">2</span> and peak circulatory power (PCP) (pVO<span class="elsevierStyleInf">2</span> times peak systolic blood pressure) were assessed in two moments. The differences in pVO<span class="elsevierStyleInf">2</span> (ΔpVO<span class="elsevierStyleInf">2</span>), %pVO<span class="elsevierStyleInf">2</span>, PCP and exercise test duration were calculated. Patients were classified according to baseline pVO<span class="elsevierStyleInf">2</span> (group 1, <20 ml/kg/min vs. group 2, ≥20 ml/kg/min) and left ventricular ejection fraction (group A, <50% vs. group B, ≥50%).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We analyzed 129 patients, 86% male, mean age 56.3±9.8 years. Both group 1 (n=31) and group 2 (n=98) showed significant improvement in FC after CR, with a more significant increase in pVO<span class="elsevierStyleInf">2</span>, in group 1 (ΔpVO<span class="elsevierStyleInf">2</span> 4.4±7.3 vs. 1.6±5.4; p=0.018). Significant improvement was observed in CPET parameters in group A (n=34) and group B (n=95), particularly in pVO<span class="elsevierStyleInf">2</span> and test duration.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Patients with lower baseline pVO<span class="elsevierStyleInf">2</span> (<20 ml/kg/min) presented more significant improvement in FC after CR. CPET which is not routinely used in assessement before CR in context of ACS, could be a valuable tool to identify patients who will benefit the most.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introdução</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A reabilitação cardíaca (RC) melhora a capacidade funcional (CF) de exercício na síndrome coronária aguda (SCA), contudo nem todos os doentes apresentam benefício idêntico. A criteriosa seleção de doentes é crucial para a rentabilização de recursos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Identificar na população heterogénea de SCA quais os doentes que mais poderiam beneficiar em termos de capacidade funcional (CF) após programa de RC, através de prova de esforço cardiorrespiratória (PECR).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Realizámos uma análise retrospetiva de doentes consecutivos com SCA que foram submetidos a RC e PECR. A PECR foi realizada previamente e após 36 sessões de treino de exercício. Parâmetros avaliados: consumo de oxigénio no pico (pVO2), percentagem do pVO2 previsto (%pVO2), declive ventilação minuto/CO2 produzido (VE/VCO2), declive VE/VCO2/pVO2, potência circulatória no pico (PCP) (pVO2 x pressão arterial sistólica no pico). Foram calculadas as variações de pVO2 (ΔpVO2). Os doentes foram analisados de acordo com o pVO2 basal (G1<20 <span class="elsevierStyleItalic">versus</span> G2≥20 ml/kg/min) e fração de ejeção do ventrículo esquerdo (FEVE) (GA<50% <span class="elsevierStyleItalic">versus</span> GB≥50%).</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Analisámos 129 doentes, 86% homens, idade média 56,3±9,8 anos. Ambos, G1 (n=31) e G2 (n=98) apresentaram melhoria significativa na CF após RC, com maior aumento significativo de pVO2 no G1 (ΔpVO2 4,4±7,3 <span class="elsevierStyleItalic">versus</span> 1,6±5,4; p=0,018). Verificou-se melhoria dos parâmetros da PECR em GA (n=34) e GB (n=95), particularmente no pVO2 e duração da PECR.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusão</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Doentes com menores pVO2 (<20 ml/kg/min) apresentaram, após programa de RC, melhoria mais significativa da CF. A PECR, que não é rotina na avaliação de SCA pré RC, poderá constituir um instrumento valioso na identificação dos doentes que mais beneficiam de RC.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusão" ] ] ] ] "nomenclatura" => array:1 [ 0 => array:2 [ "identificador" => "nom0005" "listaDefinicion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0075">List of abbreviations</span>" "definicion" => array:10 [ 0 => array:2 [ "termino" => "%pVO<span class="elsevierStyleInf">2</span>" "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">percentage of predicted pVO<span class="elsevierStyleInf">2</span></p>" ] 1 => array:2 [ "termino" => "ACS" "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">acute coronary syndrome</p>" ] 2 => array:2 [ "termino" => "CPET" "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">cardiopulmonary exercise testing</p>" ] 3 => array:2 [ "termino" => "CR" "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">cardiac rehabilitation</p>" ] 4 => array:2 [ "termino" => "ET" "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">exercise training</p>" ] 5 => array:2 [ "termino" => "LV" "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">left ventricular</p>" ] 6 => array:2 [ "termino" => "LVEF" "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">left ventricular ejection fraction</p>" ] 7 => array:2 [ "termino" => "PCP" "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">peak circulatory power</p>" ] 8 => array:2 [ "termino" => "pVO<span class="elsevierStyleInf">2</span>" "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">peak oxygen uptake</p>" ] 9 => array:2 [ "termino" => "VE/VCO<span class="elsevierStyleInf">2</span>" "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">minute ventilation/CO<span class="elsevierStyleInf">2</span> production</p>" ] ] ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">BMI: body mass index; CAD: coronary artery disease; G1: group 1 (pVO<span class="elsevierStyleInf">2</span> <20 ml/kg/min); G2: group 2 (pVO<span class="elsevierStyleInf">2</span> ≥20 ml/kg/min); GA: group A (LVEF <50%); GB: group B (LVEF ≥50%); LVEF: left ventricular ejection fraction; STEMI: ST-segment myocardial infarction.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall (n=129) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">G1 (n=31) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">G2 (n=98) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GA (n=34) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GB (n=95) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.3±9.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.3±7.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.8±9.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.3±10.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.0±9.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.497 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.00% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.039 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.153 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.00% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.864 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.90% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.894 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.042 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.00% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.90% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.769 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.00% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.8±5.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.5±6.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.9±5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.837 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.9±79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.2±4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.898 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family history of CAD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.562 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.00% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.556 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">STEMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.00% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.864 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.00% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.497 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No. of vessels with CAD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5±0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.626 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.578 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Untreated CAD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.991 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LVEF (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.1±9.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.4±11.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.3±9.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.662 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.9±7.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.5±6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sinus rhythm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.729 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1377578.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of the overall population and comparison between study groups.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CPET: cardiopulmonary exercise testing; G1: group 1 (pVO<span class="elsevierStyleInf">2</span> <20 ml/kg/min); G2: group 2 (pVO<span class="elsevierStyleInf">2</span> ≥20 ml/kg/min); GA: group A (LVEF <50%); GB: group B (LVEF ≥50%); PCP: peak circulatory power.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">CPET parameters \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G1 (n=31)</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">G2 (n=98)</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GA (n=34)</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GB (n=95)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Before CR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">After CR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Before CR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">After CR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Before CR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">After CR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Before CR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">After CR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peak VO<span class="elsevierStyleInf">2</span> (ml/kg/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.7±1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.1±7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.1±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.7±6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.7±6.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.7±6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.0±6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.0±7.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">% predicted peak VO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.6±12.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.5±33.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.3±21.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100.3±21.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.9±19.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95.4±24.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.4±24.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.6±26.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VE/VCO<span class="elsevierStyleInf">2</span> slope \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.2±6.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.6±5.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.213 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.7±5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.9±4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.031 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.9±5.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.5±4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.241 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.8±5.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.0±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.028 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PCP (mmHg.ml/kg/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2863.7±581.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4866.4±1213.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4866.4±1213.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5104.9±1196.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4206.7±1372.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4583.8±1417.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.034 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4449.0±1398.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4848.3±1367.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(VE/VCO<span class="elsevierStyleInf">2</span> slope)/pVO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.031 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.8±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.2±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.2±2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.9±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.4±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.0±3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.4±3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.4±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1377580.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparison of cardiopulmonary exercise testing parameters before and after cardiac rehabilitation in the study groups.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Δ: difference; CPET: cardiopulmonary exercise test; CR: cardiac rehabilitation; G1: group 1 (pVO<span class="elsevierStyleInf">2</span> <20 ml/kg/min); G2: group 2 (pVO<span class="elsevierStyleInf">2</span> ≥20 ml/kg/min); PCP: peak circulatory power.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CPET parameters \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">G1 (n=31) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">G2 (n=98) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peak VO<span class="elsevierStyleInf">2</span> (ml/kg/min) before CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.7±1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.1±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peak VO<span class="elsevierStyleInf">2</span> (ml/kg/min) after CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.1±7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.7±6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">% predicted peak VO<span class="elsevierStyleInf">2</span> before CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.6±12.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.3±21.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">% predicted peak VO<span class="elsevierStyleInf">2</span> after CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.5±33.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100.3±21.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VE/VCO<span class="elsevierStyleInf">2</span> slope before CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.2±6.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.7±5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VE/VCO<span class="elsevierStyleInf">2</span> slope after CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.6±5.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.9±4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PCP (mmHg.ml/kg/min) before CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2863.7±581.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4866.4±1213.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PCP (mmHg.ml/kg/min) after CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3746.9±1432.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5104.9±1196.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(VE/VCO<span class="elsevierStyleInf">2</span> slope)/pVO<span class="elsevierStyleInf">2</span> before CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(VE/VCO<span class="elsevierStyleInf">2</span> slope)/pVO<span class="elsevierStyleInf">2</span> after CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9±0.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration (min) before CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.8±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.2±2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration (min) after CR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.2±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.9±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ΔpVO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4±7.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±5.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Δ%pVO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.9±35.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.0±19.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Increase in pVO<span class="elsevierStyleInf">2</span> >10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Δ CPET duration (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5±2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.101 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Δ PCP (mmHg.ml/kg/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">883.3±1217.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">238.5±1250.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1377581.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Comparison between cardiopulmonary exercise testing parameters before and after cardiac rehabilitation in groups 1 and 2.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">ACS: acute coronary syndrome; CABG: coronary artery bypass grafting; G1: group 1 (pVO<span class="elsevierStyleInf">2</span> <20 ml/kg/min); G2: group 2 (pVO<span class="elsevierStyleInf">2</span> ≥20 ml/kg/min); GA: group A (LVEF <50%); GB: group B (LVEF ≥50%); PCI: percutaneous coronary intervention.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall (n=129) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">G1 (n=31) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">G2 (n=98) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GA (n=34) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GB (n=95) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Death (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.555 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.329 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">All-cause hospitalization (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.876 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.994 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiac hospitalization (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.412 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.979 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ACS (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.197 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.999 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PCI (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.359 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.192 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CABG (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.351 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Adherence to therapy (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.595 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.581 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Regular exercise (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.170 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.090 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Healthy diet (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.608 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.699 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Risk factor control (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.354 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1377579.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Comparison of follow-up parameters in the study groups.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0145" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "CD011273" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Anderson" 1 => "R.S. Taylor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD003091.pub4" "Revista" => array:4 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2014" "volumen" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27996083" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0150" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "CD001800" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise-based cardiac rehabilitation for coronary heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.S. Heran" 1 => "J.M. Chen" 2 => "S. Ebrahim" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2011" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0155" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American Association of Cardiovascular and Pulmonary Rehabilitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.S. Leon" 1 => "B.A. Franklin" 2 => "F. Costa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000151788.08740.5C" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2005" "volumen" => "111" "paginaInicial" => "369" "paginaFinal" => "376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15668354" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0160" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Participation in cardiac rehabilitation, readmissions, and death after acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.M. Dunlay" 1 => "Q.R. Pack" 2 => "R.J. Thomas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjmed.2014.02.008" "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2014" "volumen" => "127" "paginaInicial" => "538" "paginaFinal" => "546" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24556195" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0165" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.S. Taylor" 1 => "A. Brown" 2 => "S. Ebrahim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjmed.2004.01.009" "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2004" "volumen" => "116" "paginaInicial" => "682" "paginaFinal" => "692" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15121495" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0170" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meta-analysis: secondary prevention programs for patients with coronary artery disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.M. Clark" 1 => "L. Hartling" 2 => "B. Vandermeer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2005" "volumen" => "143" "paginaInicial" => "659" "paginaFinal" => "672" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16263889" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0175" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Nursing; American Heart Association Council on Epidemiology and Prevention; American Heart Association Council on Nutrition, Physical Activity, and Metabolism; American Association of Cardiovascular and Pulmonary Rehabilitation" "etal" => true "autores" => array:3 [ 0 => "G.J. Balady" 1 => "M.A. Williams" 2 => "P.A. Ades" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.106.180945" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2007" "volumen" => "115" "paginaInicial" => "2675" "paginaFinal" => "2682" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17513578" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0180" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of exercise training on arterial stiffness in coronary artery disease patients: a state-of-the-art review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N.L. Oliveira" 1 => "F. Ribeiro" 2 => "A.J. Alves" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cpf.12093" "Revista" => array:6 [ "tituloSerie" => "Clin Physiol Funct Imaging" "fecha" => "2014" "volumen" => "34" "paginaInicial" => "254" "paginaFinal" => "262" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24138480" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0185" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Niebauer" 1 => "R. Hambrecht" 2 => "T. Velich" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1997" "volumen" => "96" "paginaInicial" => "2534" "paginaFinal" => "2541" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9355890" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0190" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Hambrecht" 1 => "V. Adams" 2 => "S. Erbs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000074229.93804.5C" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2003" "volumen" => "107" "paginaInicial" => "3152" "paginaFinal" => "3158" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12810615" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0195" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aging, habitual exercise, and dynamic arterial compliance" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Tanaka" 1 => "F.A. Dinenno" 2 => "K.D. Monahan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2000" "volumen" => "102" "paginaInicial" => "1270" "paginaFinal" => "1275" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10982542" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0200" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise capacity and mortality among men referred for exercise testing" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Myers" 1 => "M. Prakash" 2 => "V. Froelicher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa011858" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2002" "volumen" => "346" "paginaInicial" => "793" "paginaFinal" => "801" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11893790" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0205" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of long-term prognosis in 12 169 men referred for cardiac rehabilitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Kavanagh" 1 => "D.J. Mertens" 2 => "L.F. Hamm" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2002" "volumen" => "106" "paginaInicial" => "666" "paginaFinal" => "671" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12163425" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0210" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Kavanagh" 1 => "D.J. Mertens" 2 => "L.F. Hamm" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2003" "volumen" => "42" "paginaInicial" => "2139" "paginaFinal" => "2143" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14680741" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0215" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Principles of exercise testing and interpretation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Wasserman" 1 => "J.E. Hansen" 2 => "D.Y. Sue" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "3rd ed." "fecha" => "1999" "editorial" => "Lippincott Williams & Wilkins" "editorialLocalizacion" => "Baltimore" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0220" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilatory efficiency and the selection of patients for heart transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.M. Ferreira" 1 => "J.Y. Tabet" 2 => "L. Frankenstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCHEARTFAILURE.108.847392" "Revista" => array:6 [ "tituloSerie" => "Circ Heart Fail" "fecha" => "2010" "volumen" => "3" "paginaInicial" => "378" "paginaFinal" => "386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20176714" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0225" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peak VO<span class="elsevierStyleInf">2</span> and VE/VCO<span class="elsevierStyleInf">2</span> slope in patients with heart failure: a prognostic comparison" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Arena" 1 => "J. Myers" 2 => "S.S. Aslam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ahj.2003.07.014" "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "2004" "volumen" => "147" "paginaInicial" => "354" "paginaFinal" => "360" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14760336" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0230" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normalization for peak oxygen uptake increases the prognostic power of the ventilatory response to exercise in patients with chronic heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Guazzi" 1 => "S. De Vita" 2 => "P. Cardano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0002-8703(03)00321-1" "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "2003" "volumen" => "146" "paginaInicial" => "542" "paginaFinal" => "548" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12947376" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0235" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K.T. Weber" 1 => "G.T. Kinasewitz" 2 => "J.S. Janicki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1982" "volumen" => "65" "paginaInicial" => "1213" "paginaFinal" => "1223" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6804111" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0240" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise prescription for patients with cardiovascular and cerebrovascular disease. American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.S. Pescatello" 1 => "R. Arena" 2 => "D. Riebe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:6 [ "edicion" => "9th ed." "fecha" => "2014" "paginaInicial" => "240" "paginaFinal" => "252" "editorial" => "Lippincott Williams & Wilkins" "editorialLocalizacion" => "Philadelphia" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0245" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[review]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac rehabilitation and secondary prevention of coronary heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.A. Ades" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra001529" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2001" "volumen" => "345" "paginaInicial" => "892" "paginaFinal" => "902" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11565523" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0250" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of different initiation time of exercise training on left ventricular remodeling and cardiopulmonary rehabilitation in patients with left ventricular dysfunction after myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y.M. Zhang" 1 => "Y. Lu" 2 => "Y. Tang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/09638288.2015.1036174" "Revista" => array:6 [ "tituloSerie" => "Disabil Rehabil" "fecha" => "2016" "volumen" => "38" "paginaInicial" => "268" "paginaFinal" => "276" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25885667" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0255" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adherence of heart failure patients to exercise: barriers and possible solutions: a position statement of the Study Group on Exercise Training in Heart Failure of the Heart Failure Association of the European Society of Cardiology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V.M. Conraads" 1 => "C. Deaton" 2 => "E. Piotrowicz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurjhf/hfs048" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2012" "volumen" => "14" "paginaInicial" => "451" "paginaFinal" => "458" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22499542" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0260" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Overview of cardiac rehabilitation in Portugal 2007-2009" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Abreu" 1 => "N. Bettencourt" 2 => "P. Fontes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2010" "volumen" => "29" "paginaInicial" => "545" "paginaFinal" => "558" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20734575" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0265" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reabilitação cardíaca em Portugal: a intervenção que falta!" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Mendes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Saúde Tecnol" "fecha" => "2009" "volumen" => "3" "paginaInicial" => "5" "paginaFinal" => "9" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0270" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Reabilitação Cardíaca: Realidade Nacional e Recomendações Clínicas" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2009" "editorial" => "Coordenação Nacional para as Doenças Cardiovasculares, Ministério da Saúde" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0275" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Results from the European Cardiac Rehabilitation Inventory Survey (ECRIS)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B. Bjarnason-Wehrens" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "Europrevent 2008" "serieFecha" => "2008" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0280" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Barriers to participation in cardiac rehabilitation programs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Mendes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2011" "volumen" => "30" "paginaInicial" => "509" "paginaFinal" => "514" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21800479" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003600000003/v1_201703240113/S2174204917300582/v1_201703240113/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/21742049/0000003600000003/v1_201703240113/S2174204917300582/v1_201703240113/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917300582?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 4 | 15 |
| 2024 October | 49 | 16 | 65 |
| 2024 September | 34 | 24 | 58 |
| 2024 August | 38 | 31 | 69 |
| 2024 July | 32 | 27 | 59 |
| 2024 June | 35 | 33 | 68 |
| 2024 May | 29 | 27 | 56 |
| 2024 April | 28 | 19 | 47 |
| 2024 March | 26 | 27 | 53 |
| 2024 February | 25 | 27 | 52 |
| 2024 January | 30 | 34 | 64 |
| 2023 December | 20 | 31 | 51 |
| 2023 November | 29 | 13 | 42 |
| 2023 October | 16 | 14 | 30 |
| 2023 September | 20 | 23 | 43 |
| 2023 August | 18 | 15 | 33 |
| 2023 July | 26 | 12 | 38 |
| 2023 June | 24 | 5 | 29 |
| 2023 May | 41 | 18 | 59 |
| 2023 April | 20 | 7 | 27 |
| 2023 March | 49 | 16 | 65 |
| 2023 February | 32 | 19 | 51 |
| 2023 January | 17 | 6 | 23 |
| 2022 December | 49 | 34 | 83 |
| 2022 November | 50 | 23 | 73 |
| 2022 October | 45 | 22 | 67 |
| 2022 September | 20 | 22 | 42 |
| 2022 August | 32 | 23 | 55 |
| 2022 July | 24 | 27 | 51 |
| 2022 June | 24 | 22 | 46 |
| 2022 May | 20 | 26 | 46 |
| 2022 April | 31 | 23 | 54 |
| 2022 March | 16 | 29 | 45 |
| 2022 February | 38 | 41 | 79 |
| 2022 January | 32 | 30 | 62 |
| 2021 December | 33 | 33 | 66 |
| 2021 November | 60 | 28 | 88 |
| 2021 October | 32 | 40 | 72 |
| 2021 September | 51 | 25 | 76 |
| 2021 August | 45 | 31 | 76 |
| 2021 July | 38 | 23 | 61 |
| 2021 June | 28 | 24 | 52 |
| 2021 May | 34 | 39 | 73 |
| 2021 April | 87 | 39 | 126 |
| 2021 March | 60 | 13 | 73 |
| 2021 February | 80 | 27 | 107 |
| 2021 January | 47 | 20 | 67 |
| 2020 December | 61 | 9 | 70 |
| 2020 November | 45 | 14 | 59 |
| 2020 October | 24 | 15 | 39 |
| 2020 September | 69 | 12 | 81 |
| 2020 August | 21 | 7 | 28 |
| 2020 July | 56 | 10 | 66 |
| 2020 June | 42 | 7 | 49 |
| 2020 May | 43 | 8 | 51 |
| 2020 April | 42 | 6 | 48 |
| 2020 March | 49 | 9 | 58 |
| 2020 February | 52 | 36 | 88 |
| 2020 January | 43 | 7 | 50 |
| 2019 December | 30 | 7 | 37 |
| 2019 November | 41 | 13 | 54 |
| 2019 October | 38 | 6 | 44 |
| 2019 September | 22 | 14 | 36 |
| 2019 August | 32 | 3 | 35 |
| 2019 July | 48 | 7 | 55 |
| 2019 June | 26 | 20 | 46 |
| 2019 May | 50 | 5 | 55 |
| 2019 April | 14 | 19 | 33 |
| 2019 March | 68 | 17 | 85 |
| 2019 February | 80 | 10 | 90 |
| 2019 January | 56 | 8 | 64 |
| 2018 December | 30 | 15 | 45 |
| 2018 November | 139 | 14 | 153 |
| 2018 October | 287 | 13 | 300 |
| 2018 September | 82 | 19 | 101 |
| 2018 August | 28 | 5 | 33 |
| 2018 July | 19 | 4 | 23 |
| 2018 June | 27 | 5 | 32 |
| 2018 May | 27 | 10 | 37 |
| 2018 April | 42 | 13 | 55 |
| 2018 March | 85 | 15 | 100 |
| 2018 February | 16 | 8 | 24 |
| 2018 January | 22 | 7 | 29 |
| 2017 December | 36 | 9 | 45 |
| 2017 November | 35 | 11 | 46 |
| 2017 October | 37 | 13 | 50 |
| 2017 September | 38 | 19 | 57 |
| 2017 August | 37 | 21 | 58 |
| 2017 July | 25 | 15 | 40 |
| 2017 June | 44 | 16 | 60 |
| 2017 May | 47 | 33 | 80 |
| 2017 April | 41 | 27 | 68 |
| 2017 March | 16 | 21 | 37 |
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