Editorial comment
Renal failure in decompensated heart failure patients: Double trouble
Insuficiência renal em doentes com insuficiência cardíaca descompensada: um problema duplo
Daniel Ferreira
Cardiovascular Centre, Hospital da Luz Lisboa, Lisbon, Portugal
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"S2174204918300606" "issn" => "21742049" "doi" => "10.1016/j.repce.2018.03.009" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "1162" "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. 2018;37:159-65" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1524 "formatos" => array:3 [ "EPUB" => 116 "HTML" => 1187 "PDF" => 221 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Clinical characteristics and one-year mortality according to admission renal function in patients with a first acute heart failure hospitalization" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "159" "paginaFinal" => "165" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Características clínicas e mortalidade a um ano de acordo com a função renal à admissão, em doentes com a primeira hospitalização por insuficiência cardíaca aguda" ] ] "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" => 1034 "Ancho" => 1585 "Tamanyo" => 92329 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier analysis of one-year mortality according to estimated glomerular filtration rate. Log-rank test 23.559; p<0.0001.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francesc Formiga, Rafael Moreno-Gonzalez, David Chivite, Jesús Casado, Francesc Escrihuela-Vidal, Xavier Corbella" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Francesc" "apellidos" => "Formiga" ] 1 => array:2 [ "nombre" => "Rafael" "apellidos" => "Moreno-Gonzalez" ] 2 => array:2 [ "nombre" => "David" "apellidos" => "Chivite" ] 3 => array:2 [ "nombre" => "Jesús" "apellidos" => "Casado" ] 4 => array:2 [ "nombre" => "Francesc" "apellidos" => "Escrihuela-Vidal" ] 5 => array:2 [ "nombre" => "Xavier" "apellidos" => "Corbella" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300606?idApp=UINPBA00004E" "url" => "/21742049/0000003700000002/v1_201803200458/S2174204918300606/v1_201803200458/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Renal failure in decompensated heart failure patients: Double trouble" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "167" "paginaFinal" => "168" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Daniel Ferreira" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Daniel" "apellidos" => "Ferreira" "email" => array:1 [ 0 => "dferreira@hospitaldaluz.pt" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cardiovascular Centre, Hospital da Luz Lisboa, Lisbon, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Insuficiência renal em doentes com insuficiência cardíaca descompensada: um problema duplo" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The association between cardiac and renal disease has been an area of growing interest in recent years. The interactions between these organs play an important role in control of blood pressure, renal sodium and water excretion, arterial perfusion and tissue oxygenation, and, most importantly, extracellular fluid balance, including intravascular volume. It is therefore not surprising that, when one organ becomes dysfunctional, the other may be affected as well.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Heart failure (HF) interacts with renal disease via several pathophysiological pathways in both acute and chronic settings. The expression ‘cardiorenal syndrome
tm) has often been used in the last decade to define this interdependency of the kidneys and the heart, and as an umbrella term for worse outcome when the two organs fail simultaneously. A recent review of the pathophysiological pathways of this syndrome was recently published by Schefold et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although the concept of the cardiorenal syndrome is helpful when describing these heart-kidney interactions, it should be emphasized that the current definition of cardiorenal syndrome includes all forms of two-way connections and is not specific to HF.</p><p id="par0020" class="elsevierStylePara elsevierViewall">That being said, it is widely documented that renal dysfunction occurs frequently in all phenotypes of HF, and when present, is associated with higher mortality and morbidity.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Over 50 studies have been published describing the association between renal dysfunction and mortality in HF.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> The majority of these studies were observational, since most randomized clinical trials on HF exclude patients with moderate to severe chronic kidney disease (CKD). However, two landmark retrospective analyses of randomized controlled trials showed that reductions in estimated glomerular filtration rate (eGFR) were associated with higher mortality.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3,4</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Worsening renal function</span><p id="par0030" class="elsevierStylePara elsevierViewall">Several meta-analyses have also demonstrated that worsening renal function (WRF) is associated with increased mortality in both inpatients and outpatients, with larger increases in serum creatinine predicting worse outcomes.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2,5,6</span></a> It has been observed that even a small increase in serum creatinine during hospitalization, as low as 0.2 mg/dl, is associated with poor outcomes.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">However, at least in acute decompensated heart failure (ADHF), some increase in serum creatinine may be acceptable, as long as the patient's overall clinical status does not deteriorate.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> Patients with WRF and some degree of hemoconcentration, decongestion, or reduction in blood pressure resulting from acute HF treatment, especially with diuretics, have a much better outcome than those who have WRF that appears to be unprovoked.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">9•11</span></a> In other words, as suggested by Damman et al., if a patient's clinical status improves or remains the same and their serum creatinine increases, this ‘pseudo-WRF
tm) may not necessarily mean a poor prognosis.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">On the other hand, Gottlieb et al. found that 47% of patients admitted for ADHF had WRF during the first three days of hospitalization, when they were still hypervolemic.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> This finding challenges the common conception that worsening renal function in ADHF is due to decreased intravascular volume and/or low cardiac output. Clearly overdiuresis and lowering filling pressure can potentially worsen renal function, but this is not the case in almost half of ADHF admissions.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Renal function on admission for decompensated heart failure</span><p id="par0045" class="elsevierStylePara elsevierViewall">According to Damman et al., around 4.5% of the general population have eGFR <60 ml/min/1.73 m<span class="elsevierStyleSup">2</span>, normally classified as chronic kidney disease (CKD), while over 50% of patients with acute and chronic HF (both preserved and reduced ejection fraction) have a similar reduction in eGFR.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">It is therefore not surprising that a large percentage of patients admitted to hospital with ADHF present with some degree of renal dysfunction. The exact proportion varies according to the definition of renal failure and the methods used to determine renal function.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Determination of the prognostic significance of low eGFR in ADHF patients on admission in the real world could provide valuable information, considering the increased risk of these patients and the potential implications for therapeutic choices.</p><p id="par0060" class="elsevierStylePara elsevierViewall">It is well known that patients with renal dysfunction are less likely to be treated with drugs like angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, spironolactone or sacubitril, that can improve HF prognosis, for fear of causing renal dysfunction and electrolyte imbalance.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The study by Formiga et al. published in this issue of the <span class="elsevierStyleItalic">Journal</span><a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> sheds more light on this important subject. This observational study included nearly 1000 patients with a first episode of ADHF (52.3% of whom had eGFR <60 ml/min), and assessed the one-year prognostic significance of renal dysfunction on admission.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The study's strengths and limitations are well described in the discussion of the paper and should be taken into account when analyzing its results and conclusions.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In our view, the major limitation of this paper (which is also acknowledged by the authors) lies in the fact that data on changes in patients
tm) eGFR during and after hospitalization were not collected, and so the role of worsening or improving renal function (beyond the spot admission data) in the prognosis of the study population could not be assessed.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Despite this limitation, the study's results support the authors
tm) conclusions that assessment of renal failure by the determination of admission eGFR has significant short- and medium-term prognostic value.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In conclusion, careful reading of Formiga et al. is recommended and physicians should understand that patients with combined renal and heart failure have problems that are more than the sum of these diseases alone.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The management of these patients cannot be based on treating both diseases as separate entities. Many pathophysiological and therapeutic factors must be taken into account and a balance sought between hemodynamic and renal factors for each individual. Getting this balance right can favorably modify the patient's prognosis.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">Daniel Ferreira has received honoraria (advisory board member and/or invited speaker) from Astellas, Astra-Zeneca, Bayer, BMS/Pfizer, Boehringer-Ingelheim, Novartis, and Sanofi-Aventis.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Worsening renal function" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Renal function on admission for decompensated heart failure" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart failure and kidney dysfunction: epidemiology, mechanisms and management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.C. Schefold" 1 => "G. Filippatos" 2 => "G. Hasenfuss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrneph.2016.113" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Nephrol" "fecha" => "2016" "volumen" => "12" "paginaInicial" => "610" "paginaFinal" => "623" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27573728" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0070" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The kidney in heart failure: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Damman" 1 => "J.M. Testani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehv010" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2015" "volumen" => "36" "paginaInicial" => "1437" "paginaFinal" => "1444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25838436" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0075" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.L. Dries" 1 => "D.V. Exner" 2 => "M.J. Domanski" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2000" "volumen" => "35" "paginaInicial" => "681" "paginaFinal" => "689" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10716471" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0080" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal function, neurohormonal activation, and survival in patients with chronic heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H.L. Hillege" 1 => "A.R. Girbes" 2 => "P.J. de Kam" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2000" "volumen" => "102" "paginaInicial" => "203" "paginaFinal" => "210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10889132" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0085" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal impairment and outcomes in heart failure: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.L. Smith" 1 => "J.H. Lichtman" 2 => "M.B. Bracken" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2005.11.084" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2006" "volumen" => "47" "paginaInicial" => "1987" "paginaFinal" => "1996" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16697315" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0090" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Worsening renal function and prognosis in heart failure: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Damman" 1 => "G. Navis" 2 => "A.A. Voors" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cardfail.2007.04.008" "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2007" "volumen" => "13" "paginaInicial" => "599" "paginaFinal" => "608" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17923350" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0095" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prognostic importance of different definitions of worsening renal function in congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.S. Gottlieb" 1 => "W. Abraham" 2 => "J. Butler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2002" "volumen" => "8" "paginaInicial" => "136" "paginaFinal" => "141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12140805" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0100" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Terminology and definition of changes renal function in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Damman" 1 => "W.H. Tang" 2 => "J.M. Testani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehu320" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2014" "volumen" => "35" "paginaInicial" => "3413" "paginaFinal" => "3416" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25157110" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0105" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Timing of hemoconcentration during treatment of acute decompensated heart failure and subsequent survival: importance of sustained decongestion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.M. Testani" 1 => "M.A. Brisco" 2 => "J. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2013.05.027" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2013" "volumen" => "62" "paginaInicial" => "516" "paginaFinal" => "524" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23747773" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0110" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Metra" 1 => "B. Davison" 2 => "L. Bettari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCHEARTFAILURE.111.963413" "Revista" => array:6 [ "tituloSerie" => "Circ Heart Fail" "fecha" => "2012" "volumen" => "5" "paginaInicial" => "54" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22167320" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0115" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of changes in blood pressure during the treatment of acute decompensated heart failure on renal and clinical outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.M. Testani" 1 => "S.G. Coca" 2 => "B.D. McCauley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurjhf/hfr070" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2011" "volumen" => "13" "paginaInicial" => "877" "paginaFinal" => "884" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21693504" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0120" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics and one-year mortality according to admission renal function in patients with a first acute heart failure hospitalization" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Formiga" 1 => "R. Moreno-Gonzalez" 2 => "D. Chivite" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2018" "volumen" => "37" "paginaInicial" => "159" "paginaFinal" => "165" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003700000002/v1_201803200458/S2174204918300618/v1_201803200458/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/21742049/0000003700000002/v1_201803200458/S2174204918300618/v1_201803200458/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300618?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 4 | 12 |
| 2024 October | 17 | 15 | 32 |
| 2024 September | 42 | 22 | 64 |
| 2024 August | 49 | 20 | 69 |
| 2024 July | 35 | 29 | 64 |
| 2024 June | 35 | 25 | 60 |
| 2024 May | 30 | 30 | 60 |
| 2024 April | 38 | 22 | 60 |
| 2024 March | 34 | 25 | 59 |
| 2024 February | 30 | 31 | 61 |
| 2024 January | 20 | 31 | 51 |
| 2023 December | 25 | 19 | 44 |
| 2023 November | 27 | 25 | 52 |
| 2023 October | 21 | 15 | 36 |
| 2023 September | 29 | 17 | 46 |
| 2023 August | 25 | 14 | 39 |
| 2023 July | 39 | 8 | 47 |
| 2023 June | 19 | 9 | 28 |
| 2023 May | 33 | 20 | 53 |
| 2023 April | 20 | 4 | 24 |
| 2023 March | 49 | 22 | 71 |
| 2023 February | 36 | 17 | 53 |
| 2023 January | 23 | 14 | 37 |
| 2022 December | 35 | 21 | 56 |
| 2022 November | 42 | 26 | 68 |
| 2022 October | 35 | 22 | 57 |
| 2022 September | 22 | 22 | 44 |
| 2022 August | 22 | 48 | 70 |
| 2022 July | 25 | 33 | 58 |
| 2022 June | 23 | 27 | 50 |
| 2022 May | 18 | 37 | 55 |
| 2022 April | 28 | 32 | 60 |
| 2022 March | 23 | 37 | 60 |
| 2022 February | 21 | 29 | 50 |
| 2022 January | 26 | 21 | 47 |
| 2021 December | 22 | 36 | 58 |
| 2021 November | 27 | 35 | 62 |
| 2021 October | 29 | 35 | 64 |
| 2021 September | 16 | 26 | 42 |
| 2021 August | 21 | 23 | 44 |
| 2021 July | 14 | 25 | 39 |
| 2021 June | 14 | 21 | 35 |
| 2021 May | 21 | 38 | 59 |
| 2021 April | 47 | 32 | 79 |
| 2021 March | 49 | 24 | 73 |
| 2021 February | 46 | 17 | 63 |
| 2021 January | 29 | 18 | 47 |
| 2020 December | 39 | 9 | 48 |
| 2020 November | 17 | 16 | 33 |
| 2020 October | 18 | 15 | 33 |
| 2020 September | 40 | 8 | 48 |
| 2020 August | 12 | 14 | 26 |
| 2020 July | 38 | 7 | 45 |
| 2020 June | 35 | 4 | 39 |
| 2020 May | 31 | 16 | 47 |
| 2020 April | 27 | 14 | 41 |
| 2020 March | 42 | 11 | 53 |
| 2020 February | 65 | 22 | 87 |
| 2020 January | 24 | 9 | 33 |
| 2019 December | 23 | 31 | 54 |
| 2019 November | 19 | 96 | 115 |
| 2019 October | 34 | 101 | 135 |
| 2019 September | 18 | 72 | 90 |
| 2019 August | 23 | 78 | 101 |
| 2019 July | 32 | 55 | 87 |
| 2019 June | 23 | 18 | 41 |
| 2019 May | 38 | 11 | 49 |
| 2019 April | 20 | 23 | 43 |
| 2019 March | 80 | 9 | 89 |
| 2019 February | 78 | 9 | 87 |
| 2019 January | 22 | 7 | 29 |
| 2018 December | 82 | 9 | 91 |
| 2018 November | 54 | 12 | 66 |
| 2018 October | 48 | 16 | 64 |
| 2018 September | 21 | 9 | 30 |
| 2018 August | 27 | 6 | 33 |
| 2018 July | 20 | 2 | 22 |
| 2018 June | 22 | 6 | 28 |
| 2018 May | 20 | 10 | 30 |
| 2018 April | 77 | 14 | 91 |
| 2018 March | 47 | 10 | 57 |
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