Editorial comment
Universal response to cardiac resynchronization therapy: A challenge still to be overcome
Resposta universal à terapêutica de ressincronização cardíaca – um desafio por resolver
Read
6453
Timeswas read the article
1660
Total PDF
4793
Total HTML
Share statistics
array:25 [ "pii" => "S2174204917301320" "issn" => "21742049" "doi" => "10.1016/j.repce.2017.05.004" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1000" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2017;36:427-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3579 "formatos" => array:3 [ "EPUB" => 184 "HTML" => 3009 "PDF" => 386 ] ] "Traduccion" => array:1 [ "pt" => array:20 [ "pii" => "S0870255117303098" "issn" => "08702551" "doi" => "10.1016/j.repc.2017.04.002" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1000" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2017;36:427-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2222 "formatos" => array:3 [ "EPUB" => 175 "HTML" => 1574 "PDF" => 473 ] ] "pt" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comentário Editorial</span>" "titulo" => "Resposta universal à terapêutica de ressincronização cardíaca – um desafio por resolver" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "427" "paginaFinal" => "430" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Universal response to cardiac resynchronization therapy: A challenge still to be overcome" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "António Hipólito Reis" "autores" => array:1 [ 0 => array:2 [ "nombre" => "António Hipólito" "apellidos" => "Reis" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204917301320" "doi" => "10.1016/j.repce.2017.05.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917301320?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117303098?idApp=UINPBA00004E" "url" => "/08702551/0000003600000006/v2_201706240150/S0870255117303098/v2_201706240150/pt/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2174204917301721" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.10.021" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1001" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2017;36:431-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3214 "formatos" => array:3 [ "EPUB" => 180 "HTML" => 2650 "PDF" => 384 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Characteristics and outcomes of heart failure hospitalization before implementation of a heart failure clinic: The PRECIC study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "431" "paginaFinal" => "438" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Características e prognóstico da hospitalização por insuficiência cardíaca PRÉvios a uma Clínica de Insuficiência Cardíaca: estudo PRECIC" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1275 "Ancho" => 1003 "Tamanyo" => 70106 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of patient enrollment. The data refer to admissions to the internal medicine department in the study period. HF: heart failure; ICD-9: International Classification of Diseases, 9th Revision.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Irene Marques, Sara Abreu, Manuela V. Bertão, Betânia Ferreira, Raquel Lopes Ramos, Juliana Lopes, Sandra Nunes, Denisa Mendonça, Laetitia Teixeira" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Irene" "apellidos" => "Marques" ] 1 => array:2 [ "nombre" => "Sara" "apellidos" => "Abreu" ] 2 => array:2 [ "nombre" => "Manuela V." "apellidos" => "Bertão" ] 3 => array:2 [ "nombre" => "Betânia" "apellidos" => "Ferreira" ] 4 => array:2 [ "nombre" => "Raquel Lopes" "apellidos" => "Ramos" ] 5 => array:2 [ "nombre" => "Juliana" "apellidos" => "Lopes" ] 6 => array:2 [ "nombre" => "Sandra" "apellidos" => "Nunes" ] 7 => array:2 [ "nombre" => "Denisa" "apellidos" => "Mendonça" ] 8 => array:2 [ "nombre" => "Laetitia" "apellidos" => "Teixeira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255117303372" "doi" => "10.1016/j.repc.2016.10.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117303372?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917301721?idApp=UINPBA00004E" "url" => "/21742049/0000003600000006/v1_201707020042/S2174204917301721/v1_201707020042/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S217420491730171X" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.10.020" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "999" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2017;36:417-25" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2501 "formatos" => array:3 [ "EPUB" => 175 "HTML" => 1978 "PDF" => 348 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Predictors of response to cardiac resynchronization therapy: A prospective cohort study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "417" "paginaFinal" => "425" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Preditores de resposta à terapêutica de ressincronização cardíaca: estudo <span class="elsevierStyleItalic">cohort</span> prospetivo" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 633 "Ancho" => 975 "Tamanyo" => 120529 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Measurement of tricuspid annular plane systolic excursion by M-mode echocardiography.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Abreu, Mário Oliveira, Pedro Silva Cunha, Helena Santa Clara, Vanessa Santos, Guilherme Portugal, Pedro Rio, Rui Soares, Luísa Moura Branco, Marta Alves, Ana Luísa Papoila, Rui Ferreira, Miguel Mota Carmo" "autores" => array:14 [ 0 => array:2 [ "nombre" => "Ana" "apellidos" => "Abreu" ] 1 => array:2 [ "nombre" => "Mário" "apellidos" => "Oliveira" ] 2 => array:2 [ "nombre" => "Pedro" "apellidos" => "Silva Cunha" ] 3 => array:2 [ "nombre" => "Helena" "apellidos" => "Santa Clara" ] 4 => array:2 [ "nombre" => "Vanessa" "apellidos" => "Santos" ] 5 => array:2 [ "nombre" => "Guilherme" "apellidos" => "Portugal" ] 6 => array:2 [ "nombre" => "Pedro" "apellidos" => "Rio" ] 7 => array:2 [ "nombre" => "Rui" "apellidos" => "Soares" ] 8 => array:2 [ "nombre" => "Luísa" "apellidos" => "Moura Branco" ] 9 => array:2 [ "nombre" => "Marta" "apellidos" => "Alves" ] 10 => array:2 [ "nombre" => "Ana Luísa" "apellidos" => "Papoila" ] 11 => array:2 [ "nombre" => "Rui" "apellidos" => "Ferreira" ] 12 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mota Carmo" ] 13 => array:1 [ "colaborador" => "on behalf of the BETTER-HF investigators" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255117303086" "doi" => "10.1016/j.repc.2016.10.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117303086?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491730171X?idApp=UINPBA00004E" "url" => "/21742049/0000003600000006/v1_201707020042/S217420491730171X/v1_201707020042/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Universal response to cardiac resynchronization therapy: A challenge still to be overcome" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "427" "paginaFinal" => "430" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "António Hipólito Reis" "autores" => array:1 [ 0 => array:4 [ "nombre" => "António" "apellidos" => "Hipólito Reis" "email" => array:1 [ 0 => "a.hipolitoreis@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Serviço de Cardiologia, Centro Hospitalar do Porto E.P.E, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta universal à terapêutica de ressincronização cardíaca – um desafio por resolver" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiac resynchronization therapy (CRT) has become established in recent years as a cornerstone in the treatment of chronic heart failure (HF) in selected patients with moderate to severe left ventricular (LV) dysfunction and intraventricular conduction disturbances refractory to optimal medical therapy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Following the pioneering work of Cazeau and coworkers in 1994,<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">1</span></a> a series of clinical trials<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">2–8</span></a> including over 4000 patients validated this strategy, which in 2005 was considered a class I indication, level of evidence A.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">9</span></a> Many more trials on CRT followed, and it is now recognized as one of the most important treatment options for HF.<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Despite its acknowledged efficacy, multicenter randomized trials have reported that 20-40% of patients (depending on the criteria used) do not respond to CRT.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Precise determination of the response rate to CRT is hampered by the lack of uniformity in definitions of a CRT responder.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The effects of CRT are seen at various levels. Acute hemodynamic improvement is seen very early, in the first few days after implantation of the biventricular device, reflected in symptomatic relief (reduced fatigue, more comfortable sensation of heartbeat, and better tolerance of lying down), clinical benefit (improved quality of life, functional capacity and exercise tolerance), and structural recovery. The latter is the best measure of response to CRT, and is manifested by decreased ventricular volume, increased LV ejection fraction, and reduced functional mitral regurgitation.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This favorable anatomical and functional evolution, termed reverse remodeling,<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">13,14</span></a> is associated with a significant reduction in clinical events such as episodes of HF decompensation, hospitalizations and cardiovascular mortality, including sudden death.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Even so, the efficacy of the different stages of CRT depends on many factors, a major one of which is patient selection.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Chronic HF may have different etiologies, which can influence the quality of response to CRT. Another variable is the mechanical dysfunction underlying cardiac dyssynchrony, and the resulting functional repercussions can vary between patients even when the electrocardiographic patterns of intraventricular conduction disturbance are similar.</p><p id="par0045" class="elsevierStylePara elsevierViewall">It is thus clear that successful CRT requires the presence of mechanical dyssynchrony (as reflected by corresponding electrical manifestations), the definition of which has defied all efforts to standardize, even with the addition of echocardiographic exams to the candidate selection process.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">15</span></a> Other factors that can affect the success of the therapy are the degree of myocardial viability, the extent of scarring and fibrosis, and anatomical variations in the veins of the coronary sinus, but these factors are often not assessed before device implantation. In addition, success rates are influenced by the experience of the center, optimization of medical therapy and device programming (both of which should be adjusted according to the patient's clinical and structural evolution), and the availability of appropriate cardiac rehabilitation programs, since these can promote an earlier and better response.</p><p id="par0050" class="elsevierStylePara elsevierViewall">When instituted early in the course of the disease, the clinical benefits of CRT may not be obvious – since the patient's functional capacity is still largely preserved – but it does have a preventive function, slowing the natural history of HF as expressed by progressive structural alterations and dysfunction (cardiac remodeling) associated with increased risk of fatal cardiac events such as pulmonary edema and malignant ventricular arrhythmias, which in turn hamper reverse remodeling. Halting exacerbation of symptoms by preventing disease progression is itself a sign of a positive response, given our knowledge of the natural history of HF.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Accordingly, patients in less symptomatic stages of HF (New York Heart Association [NYHA] classes I and II) are now recommended for referral for CRT, which was originally only intended for those in NYHA classes III and IV. This recommendation, which is designed to increase the benefit of CRT and prevent patients from progressing to the advanced stages of HF, is based on evidence from three large reference studies: the REVERSE (REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction) trial,<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">16</span></a> which showed evidence of significant reverse remodeling in NYHA classes I and II; MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy),<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">17</span></a> which reported a reduction in heart failure events; and RAFT (the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial),<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">18</span></a> in which mortality was significantly lower in the CRT group.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In my opinion, and as also shown in some studies,<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">19,20</span></a> another important factor may be the site of LV pacing when there is functional mitral regurgitation, a common situation that is associated with worse prognosis.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">21</span></a> Stimulation of the most proximal segment of the posterolateral wall improves coaptation of the mitral valve leaflets, leading to earlier depolarization and hence contraction of the posterior papillary muscle, which is delayed by conduction disturbances within the left ventricle. CRT reduces functional mitral regurgitation, which together with reverse remodeling (reduction in chamber and mitral annulus size), results in better response to CRT.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The efficacy of CRT has been improved by technical advances, particularly the development of smaller leads that enable better positioning, thereby increasing procedural success. The advent of quadripolar leads has the potential to increase response rate by offering different pacing options<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">22</span></a> and, with some devices, providing multipoint pacing.<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">23</span></a> These new leads also avoid problems associated with diaphragmatic stimulation, which can cause therapy to be suspended or require surgical revision with its attendant risks.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">24</span></a> The different ventricular pacing options include pacing at more than one site in the right or left ventricle using a three-lead device; this technique appears to be associated with increased cardiac output and shortened QRS.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">25</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Another technological advance is remote monitoring, which improves safety by enabling earlier detection and solution of problems in the pacing system; reports on various parameters that enable the patient's clinical course to be monitored, particularly in terms of HF decompensation; and records the percentage of effective biventricular pacing, permitting optimization of resynchronization and hence improving response to CRT. It has been demonstrated that when pacing exceeds 97%, there is a significant fall in overall and HF mortality and an increase in reverse remodeling.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">26</span></a> Remote monitoring is especially useful in patients with atrial fibrillation or frequent premature ventricular contractions.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">27</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Various studies and meta-analyses have set out to identify factors that can help or hinder a positive response to CRT. It is now known that non-ischemic cardiomyopathy,<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">28</span></a> female gender,<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">29</span></a> and left bundle branch block, especially with QRS >150 ms and sinus rhythm, are the characteristics most likely to result in a positive CRT response. The type of LV lead and its position, device programming, and operator experience are also important. CRT is definitely recommended in cases of atrial fibrillation,<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">30,31</span></a> if treated by atrioventricular node ablation or effective pharmacological heart rate control that can ensure nearly 100% biventricular pacing. By contrast, the presence of ischemic cardiomyopathy, particularly when there is extensive scarring<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">32</span></a> in the target area for pacing (the posterolateral wall) or of comorbidities such as chronic kidney disease or significant valve disease, have been shown to reduce response rates, while right bundle branch block<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">33</span></a> and narrow QRS (<120 ms)<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">34</span></a> should be considered exclusion criteria for CTR.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Another important factor in candidate assessment is right ventricular (RV) dysfunction, the role of which in selection for CRT has recently been the subject of considerable research and debate, with different studies showing conflicting results. The main cause of RV dysfunction, which is often an indication of advanced disease, is chronic LV dysfunction. RV dysfunction is also a strong independent predictor of mortality in patients with chronic HF secondary to LV dysfunction.<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">35,36</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Some authors consider that the presence of RV dysfunction is not an impediment to referral for CRT,<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">37</span></a> an attitude that is supported by the results of studies that show significant gains in RV size and function following CRT<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">38,39</span></a> and even recovery of RV function following resynchronization therapy.<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">40</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In contrast to these positive findings, other authors have argued that impaired RV function in itself significantly limits the ability of CRT to bring about reverse LV remodeling and is a strong prognostic factor identifying patients who have already undergone extensive cardiac remodeling and who will therefore not benefit from CRT.<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">41–44</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The above background highlights the importance of the article by Abreu et al.<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">45</span></a> published in this issue of the <span class="elsevierStyleItalic">Journal</span>, on a prospective cohort study that addresses the question of CRT response and helps clarify the role of RV function. The authors found that of the different baseline characteristics that can influence response to CRT, only preserved RV function as reflected by tricuspid annular plane systolic excursion (TAPSE) >15 mm was an independent predictor of echocardiographic response, defined in this study as improvement in LV ejection fraction of 5% or more. They also showed that patients with TAPSE <15 mm at initial assessment did not respond to CRT, which may help to identify patients who should not be referred for this therapy.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The study emphasizes once again the importance of referral for CRT at an early stage of the disease, in order to prevent progression to RV dysfunction, which will compromise the degree of response.</p><p id="par0105" class="elsevierStylePara elsevierViewall">It is likely that in the near future patients will be selected for CRT on the basis of scores that use a range of variables, and some such tools have already been proposed.<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">46,47</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In conclusion, research should continue into the characteristics that determine CRT response, in order to ensure appropriate selection of candidates who will benefit from this therapy and to identify factors that hamper response, in order not to expose those unsuitable for CRT to unnecessary risks and to avoid wastage of resources.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Reis AH. Resposta universal à terapêutica de ressincronização cardíaca – um desafio por resolver. Rev Port Cardiol. 2017;36:427–430.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:47 [ 0 => array:3 [ "identificador" => "bib0240" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Four chamber pacing in dilated cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Cazeau" 1 => "P. Ritter" 2 => "S. Bakdach" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pacing Clin Electrophysiol" "fecha" => "1994" "volumen" => "17" "paginaInicial" => "1974" "paginaFinal" => "1979" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7845801" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0245" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Pacing Therapies for Congestive Heart Failure (PATH-CHF) study: rationale, design, and endpoints of a prospective randomized multicenter study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Auricchio" 1 => "C. Stellbrink" 2 => "S. Sack" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Cardiol" "fecha" => "1999" "volumen" => "83" "numero" => "Suppl." "paginaInicial" => "130D" "paginaFinal" => "135D" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10089855" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0250" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators" "etal" => true "autores" => array:3 [ 0 => "S. Cazeau" 1 => "C. Leclercq" 2 => "T. Lavergne" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200103223441202" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2001" "volumen" => "344" "paginaInicial" => "873" "paginaFinal" => "880" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11259720" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0255" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac resynchronization in chronic heart failure" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "MIRACLE Study Group. Multicenter InSync Randomized Clinical Evaluation" "etal" => true "autores" => array:3 [ 0 => "W.T. Abraham" 1 => "W.G. Fisher" 2 => "A.L. Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa013168" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2002" "volumen" => "346" "paginaInicial" => "1845" "paginaFinal" => "1853" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12063368" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0260" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.B. Young" 1 => "W.T. Abraham" 2 => "A.L. Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.289.20.2685" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2003" "volumen" => "289" "paginaInicial" => "2685" "paginaFinal" => "2964" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12771115" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0265" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Pacing and Defibrillation in Heart Failure (COMPANION) Investigators" "etal" => true "autores" => array:3 [ 0 => "M.R. Bristow" 1 => "L.A. Saxon" 2 => "J. Boehmer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa032423" "Revista" => array:7 [ "tituloSerie" => "N Engl J Med" "fecha" => "2004" "volumen" => "350" "paginaInicial" => "2140" "paginaFinal" => "2150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15152059" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283814008446" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0270" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of cardiac resynchronization therapy on morbidity and mortality in heart failure" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators" "etal" => true "autores" => array:3 [ 0 => "J.G.F. Cleland" 1 => "J.C. Daubert" 2 => "E. Erdmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa050496" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2005" "volumen" => "352" "paginaInicial" => "1539" "paginaFinal" => "1549" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15753115" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0275" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac resynchronization therapy for the treatment of heart failure in patients with intraventricular conduction delay and malignant ventricular tachyarrhythmias" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.L. Higgins" 1 => "J.D. Hummel" 2 => "I.K. Niazi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2003" "volumen" => "42" "paginaInicial" => "1454" "paginaFinal" => "1459" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14563591" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002934315000807" "estado" => "S300" "issn" => "00029343" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0280" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ACC/AHA 2005 guidelines update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.A. Hunt" 1 => "W.T. Abraham" 2 => "M.H. Chin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.105.167586" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2005" "volumen" => "112" "paginaInicial" => "e154" "paginaFinal" => "e235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16160202" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0285" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.W. Yancy" 1 => "M. Jessup" 2 => "B. Bozkurt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIR.0b013e3.18298807" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2013" "volumen" => "128" "paginaInicial" => "1810" "paginaFinal" => "1852" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23741057" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0290" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Ponikowski" 1 => "A.A. Voors" 2 => "S.D. Anker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehw128" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2016" "volumen" => "37" "paginaInicial" => "2129" "paginaFinal" => "2200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27206819" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0295" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.C. Daubert" 1 => "L. Saxon" 2 => "P.B. Adamson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/eus222" "Revista" => array:6 [ "tituloSerie" => "Europace" "fecha" => "2012" "volumen" => "14" "paginaInicial" => "1236" "paginaFinal" => "1286" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22930717" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0300" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Multicenter InSync Randomized Clinical Evaluation (MIRACLE) Study Group" "etal" => true "autores" => array:3 [ 0 => "M.G. St John Sutton" 1 => "T. Plappert" 2 => "W.T. Abraham" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000065226.24159.E9" "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "2003" "volumen" => "107" "paginaInicial" => "1985" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12668512" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0305" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of long-term biventricular stimulation for resynchronization on echocardiographic measures of remodeling" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Congestive Heart Failure Investigators" "etal" => true "autores" => array:3 [ 0 => "L.A. Saxon" 1 => "T. De Marco" 2 => "J. Schafer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "2002" "volumen" => "105" "paginaInicial" => "1304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11901040" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0310" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Results of the Predictors of Response to CRT (PROSPECT) trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.S. Chung" 1 => "A.R. Leon" 2 => "L. Tavazzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.107.743120" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2008" "volumen" => "117" "paginaInicial" => "2608" "paginaFinal" => "2616" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18458170" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0315" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "REVERSE (Resynchronization reVErses Remodeling in Systolic left vEntricular dysfunction) Study Group" "etal" => true "autores" => array:3 [ 0 => "C. Linde" 1 => "W.T. Abraham" 2 => "M.R. Gold" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2008.08.027" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2008" "volumen" => "52" "paginaInicial" => "1834" "paginaFinal" => "1843" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19038680" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0320" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac-resynchronization therapy for the prevention of heart-failure events" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "MADIT-CRT Trial Investigators" "etal" => true "autores" => array:3 [ 0 => "A.J. Moss" 1 => "W.J. Hall" 2 => "D.S. Cannom" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0906431" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2009" "volumen" => "361" "paginaInicial" => "1329" "paginaFinal" => "1338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19723701" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0325" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac-resynchronization therapy for mild-to-moderate heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.S.L. Tang" 1 => "G.A. Wells" 2 => "M. Taljic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1009540" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2010" "volumen" => "363" "paginaInicial" => "2385" "paginaFinal" => "2395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21073365" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0330" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "O.A. Breithardt" 1 => "A.M. Sinha" 2 => "E. Schwammenthal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2003" "volumen" => "41" "paginaInicial" => "765" "paginaFinal" => "770" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12628720" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0335" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy: insights from mechanical activation strain mapping" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Kanzaki" 1 => "R. Bazaz" 2 => "D. Schwartzman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2004.07.036" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2004" "volumen" => "44" "paginaInicial" => "1619" "paginaFinal" => "1625" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15489094" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0340" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic implications of functional mitral regurgitation according to the severity of the underlying chronic heart failure: a long-term outcome study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Bursi" 1 => "A. Barbieri" 2 => "F. Grigioni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurjhf/hfq014" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2010" "volumen" => "12" "paginaInicial" => "382" "paginaFinal" => "388" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20197266" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0345" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome of patients treated by cardiac resynchronization therapy using a quadripolar left ventricular lead" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Bencardino" 1 => "A. Di Monaco" 2 => "E. Russo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1253/circj.CJ-15-0932" "Revista" => array:6 [ "tituloSerie" => "Circ J" "fecha" => "2016" "volumen" => "80" "paginaInicial" => "613" "paginaFinal" => "618" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26821688" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0350" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of multisite left ventricular pacing via quadripolar lead improves acute haemodynamics and mechanical dyssynchrony assessed by radial strain speckle tracking: initial results" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Osca" 1 => "P. Alonso" 2 => "O. Cano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/euv211" "Revista" => array:6 [ "tituloSerie" => "Europace" "fecha" => "2016" "volumen" => "18" "paginaInicial" => "560" "paginaFinal" => "567" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26333378" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0355" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complication rates associated with pacemaker or implantable cardioverter-defibrillator generator replacements and upgrade procedures: results from the REPLACE registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.E. Poole" 1 => "M.J. Gleva" 2 => "T. Mela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.110.976076" "Revista" => array:7 [ "tituloSerie" => "Circulation" "fecha" => "2010" "volumen" => "122" "paginaInicial" => "1553" "paginaFinal" => "1561" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20921437" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283812012213" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0360" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Triple-site pacing for cardiac resynchronization in permanent atrial fibrillation – acute phase results from a prospective observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Marques" 1 => "M. Nobre Menezes" 2 => "G. Lima da Silva" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2015.12.006" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "331" "paginaFinal" => "388" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27255170" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0365" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association between biventricular pacing and cardiac resynchronization therapy-defibrillator efficacy when compared with implantable cardioverter defibrillator on outcomes and reverse remodelling" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.C. Ruwald" 1 => "V. Kutyifa" 2 => "M.H. Ruwald" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehu294" "Revista" => array:7 [ "tituloSerie" => "Eur Heart J" "fecha" => "2015" "volumen" => "36" "paginaInicial" => "440" "paginaFinal" => "448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25112662" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022534714041512" "estado" => "S300" "issn" => "00225347" ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0370" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of paroxysmal atrial tachycardias in patients treated with cardiac resynchronization therapy and continuously monitored by device diagnostics" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "CHAMP Study Investigators" "etal" => true "autores" => array:3 [ 0 => "C. Leclercq" 1 => "L. Padeletti" 2 => "R. Cihák" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/eup318" "Revista" => array:6 [ "tituloSerie" => "Europace" "fecha" => "2010" "volumen" => "12" "paginaInicial" => "71" "paginaFinal" => "77" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19864311" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0375" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Response to preventive cardiac resynchronization therapy in patients with ischaemic and non ischaemic cardiomyopathy in MADIT-CRT" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Barsheshet" 1 => "I. Goldenberg" 2 => "A.J. Moss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehq407" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2011" "volumen" => "32" "paginaInicial" => "1622" "paginaFinal" => "1630" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21075774" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0380" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac resynchronization therapy is more effective in women than in men: the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy) trial" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "MADIT-CRT Executive Committee" "etal" => true "autores" => array:3 [ 0 => "A. Arshad" 1 => "A.J. Moss" 2 => "E. Foster" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2010.06.061" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2011" "volumen" => "57" "paginaInicial" => "813" "paginaFinal" => "820" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21310317" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0385" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparative assessment of right, left, and biventricular pacing in patients with permanent atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Brignole" 1 => "M. Gammage" 2 => "E. Puggioni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehi069" "Revista" => array:5 [ "tituloSerie" => "Eur Heart J" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "712" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15618036" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0390" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.N. Doshi" 1 => "E.G. Daoud" 2 => "C. Fellows" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1540-8167.2005.50062.x" "Revista" => array:5 [ "tituloSerie" => "J Cardiovasc Electrophysiol" "fecha" => "2005" "volumen" => "16" "paginaInicial" => "1160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16302897" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0395" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extent of myocardial viability predicts response to biventricular pacing in ischemic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.P. Hummell" 1 => "J.R. Lindner" 2 => "J.T. Belcik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.hrthm.2005.07.027" "Revista" => array:6 [ "tituloSerie" => "Heart Rhythm" "fecha" => "2005" "volumen" => "2" "paginaInicial" => "1211" "paginaFinal" => "1217" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16253911" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0400" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT)" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "MADIT-CRT Investigators" "etal" => true "autores" => array:3 [ 0 => "W. Zareba" 1 => "H. Klein" 2 => "I. Cygankiewicz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.110.960898" "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "2011" "volumen" => "123" "paginaInicial" => "1061" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21357819" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0405" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac-resynchronization therapy in heart failure with narrow QRS complexes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.F. Beshai" 1 => "R.A. Grimm" 2 => "S.F. Nagueh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0706695" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2007" "volumen" => "357" "paginaInicial" => "2461" "paginaFinal" => "2471" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17986493" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0410" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. de Groote" 1 => "A. Millaire" 2 => "C. Foucher-Hossein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "1998" "volumen" => "32" "paginaInicial" => "948" "paginaFinal" => "954" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9768716" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0415" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Ghio" 1 => "A. Gavazzi" 2 => "C. Campana" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2001" "volumen" => "37" "paginaInicial" => "183" "paginaFinal" => "188" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11153735" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0420" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interplay between right ventricular function and cardiac resynchronization therapy: an analysis of the CARE-HF trial (Cardiac Resynchronization-Heart Failure)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Damy" 1 => "S. Ghio" 2 => "A.S. Rigby" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2013.02.049" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2013" "volumen" => "61" "paginaInicial" => "2153" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23541971" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283814000967" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0425" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left ventricular dyssynchrony predicts right ventricular remodeling after cardiac resynchronization therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.B. Bleeker" 1 => "M.J. Schalij" 2 => "P. Nihoyannopoulos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2005.04.069" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2005" "volumen" => "46" "paginaInicial" => "2264" "paginaFinal" => "2269" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16360056" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0430" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Right ventricular function following cardiac resynchronization therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Rajagopalan" 1 => "M.S. Suffoletto" 2 => "M. Tanabe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2007.06.037" "Revista" => array:7 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2007" "volumen" => "100" "paginaInicial" => "1434" "paginaFinal" => "1436" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17950803" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283815002304" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0435" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Haddad" 1 => "R. Doyle" 2 => "D.J. Murphy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.107.653584" "Revista" => array:7 [ "tituloSerie" => "Circulation" "fecha" => "2008" "volumen" => "117" "paginaInicial" => "1717" "paginaFinal" => "1731" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18378625" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0302283814008161" "estado" => "S300" "issn" => "03022838" ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0440" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Right ventricular dysfunction and adverse outcome in patients with advanced heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.E. Field" 1 => "S.D. Solomon" 2 => "E.F. Lewis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cardfail.2006.06.472" "Revista" => array:7 [ "tituloSerie" => "J Card Fail" "fecha" => "2006" "volumen" => "12" "paginaInicial" => "616" "paginaFinal" => "620" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17045180" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1473309913703189" "estado" => "S300" "issn" => "14733099" ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0445" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relevance of echocardiographic evaluation of right ventricular function in patients undergoing cardiac resynchronization therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Scuteri" 1 => "R. Rordorf" 2 => "N.A. Marsan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1540-8159.2009.02436.x" "Revista" => array:6 [ "tituloSerie" => "Pacing Clin Electrophysiol" "fecha" => "2009" "volumen" => "32" "paginaInicial" => "1040" "paginaFinal" => "1049" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19659624" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0450" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[in press]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Limited response to cardiac resynchronization therapy in patients with concomitant right ventricular dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.B. Tabereaux" 1 => "H. Doppalapudi" 2 => "G.N. Kay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1540-8167.2009.01634.x" "Revista" => array:2 [ "tituloSerie" => "J Cardiovasc Electrophysiol" "fecha" => "2010" ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0455" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Right ventricular dysfunction is a predictor of non-response and clinical outcome following cardiac resynchronization therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Alpendurada" 1 => "K. Guha" 2 => "R. Sharma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1532-429X-13-68" "Revista" => array:5 [ "tituloSerie" => "J Cardiovasc Magn Reson" "fecha" => "2011" "volumen" => "13" "paginaInicial" => "68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22040270" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0460" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictores de resposta à terapêutica de ressincronização cardíaca: estudo cohort prospectivo" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "on behalf of BETTER-HF Investigators" "etal" => false "autores" => array:3 [ 0 => "A. Abreu" 1 => "M. Oliveira" 2 => "P.S. Cunha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2016.10.010" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2017" "volumen" => "36" "paginaInicial" => "417" "paginaFinal" => "425" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28554585" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0465" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validation of a simple risk stratification tool for patients implanted with cardiac resynchronization therapy: the VALID-CRT risk score" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Gasparini" 1 => "C. Klersy" 2 => "C. Leclercq" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ejhf.269" "Revista" => array:7 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "717" "paginaFinal" => "724" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25903349" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673613612155" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0470" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EAARN score, a predictive score for mortality in patients receiving cardiac resynchronization therapy based on pre-implantation risk factors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Khatib" 1 => "J.M. Tolosana" 2 => "E. Trucco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ejhf.102" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2014" "volumen" => "16" "paginaInicial" => "802" "paginaFinal" => "809" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24863467" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003600000006/v1_201707020042/S2174204917301320/v1_201707020042/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/21742049/0000003600000006/v1_201707020042/S2174204917301320/v1_201707020042/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917301320?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 9 | 15 |
| 2024 October | 31 | 48 | 79 |
| 2024 September | 38 | 24 | 62 |
| 2024 August | 25 | 22 | 47 |
| 2024 July | 38 | 27 | 65 |
| 2024 June | 39 | 20 | 59 |
| 2024 May | 18 | 19 | 37 |
| 2024 April | 24 | 21 | 45 |
| 2024 March | 26 | 18 | 44 |
| 2024 February | 27 | 29 | 56 |
| 2024 January | 19 | 28 | 47 |
| 2023 December | 22 | 26 | 48 |
| 2023 November | 32 | 22 | 54 |
| 2023 October | 17 | 20 | 37 |
| 2023 September | 16 | 15 | 31 |
| 2023 August | 20 | 14 | 34 |
| 2023 July | 16 | 18 | 34 |
| 2023 June | 19 | 15 | 34 |
| 2023 May | 63 | 26 | 89 |
| 2023 April | 47 | 5 | 52 |
| 2023 March | 66 | 15 | 81 |
| 2023 February | 50 | 22 | 72 |
| 2023 January | 12 | 13 | 25 |
| 2022 December | 44 | 29 | 73 |
| 2022 November | 60 | 26 | 86 |
| 2022 October | 22 | 9 | 31 |
| 2022 September | 18 | 27 | 45 |
| 2022 August | 21 | 27 | 48 |
| 2022 July | 27 | 27 | 54 |
| 2022 June | 19 | 25 | 44 |
| 2022 May | 23 | 24 | 47 |
| 2022 April | 32 | 36 | 68 |
| 2022 March | 25 | 43 | 68 |
| 2022 February | 42 | 36 | 78 |
| 2022 January | 20 | 33 | 53 |
| 2021 December | 21 | 31 | 52 |
| 2021 November | 33 | 36 | 69 |
| 2021 October | 33 | 53 | 86 |
| 2021 September | 15 | 22 | 37 |
| 2021 August | 28 | 25 | 53 |
| 2021 July | 12 | 19 | 31 |
| 2021 June | 26 | 18 | 44 |
| 2021 May | 23 | 42 | 65 |
| 2021 April | 37 | 33 | 70 |
| 2021 March | 50 | 21 | 71 |
| 2021 February | 57 | 15 | 72 |
| 2021 January | 33 | 21 | 54 |
| 2020 December | 34 | 11 | 45 |
| 2020 November | 40 | 12 | 52 |
| 2020 October | 20 | 19 | 39 |
| 2020 September | 73 | 9 | 82 |
| 2020 August | 17 | 10 | 27 |
| 2020 July | 46 | 9 | 55 |
| 2020 June | 41 | 9 | 50 |
| 2020 May | 39 | 11 | 50 |
| 2020 April | 22 | 7 | 29 |
| 2020 March | 41 | 14 | 55 |
| 2020 February | 46 | 36 | 82 |
| 2020 January | 39 | 11 | 50 |
| 2019 December | 25 | 5 | 30 |
| 2019 November | 26 | 7 | 33 |
| 2019 October | 34 | 5 | 39 |
| 2019 September | 50 | 10 | 60 |
| 2019 August | 36 | 8 | 44 |
| 2019 July | 35 | 7 | 42 |
| 2019 June | 26 | 21 | 47 |
| 2019 May | 31 | 12 | 43 |
| 2019 April | 14 | 20 | 34 |
| 2019 March | 73 | 8 | 81 |
| 2019 February | 62 | 12 | 74 |
| 2019 January | 81 | 6 | 87 |
| 2018 December | 75 | 9 | 84 |
| 2018 November | 198 | 10 | 208 |
| 2018 October | 542 | 12 | 554 |
| 2018 September | 188 | 15 | 203 |
| 2018 August | 105 | 7 | 112 |
| 2018 July | 55 | 3 | 58 |
| 2018 June | 92 | 6 | 98 |
| 2018 May | 133 | 7 | 140 |
| 2018 April | 147 | 10 | 157 |
| 2018 March | 246 | 9 | 255 |
| 2018 February | 80 | 4 | 84 |
| 2018 January | 108 | 10 | 118 |
| 2017 December | 180 | 15 | 195 |
| 2017 November | 63 | 17 | 80 |
| 2017 October | 40 | 16 | 56 |
| 2017 September | 39 | 19 | 58 |
| 2017 August | 56 | 16 | 72 |
| 2017 July | 86 | 37 | 123 |
| 2017 June | 17 | 5 | 22 |
Show all
