Myocardial dysfunction in Takotsubo syndrome: More than meets the eye? | Revista Portuguesa de Cardiologia (English edition)

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Júlia" "apellidos" => "Maciel" ] 8 => array:2 [ "nombre" => "Filipe" "apellidos" => "Macedo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Disfunção miocárdica na síndrome de Takotsubo – Primeira impressão enganadora?" ] ] "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" => 1013 "Ancho" => 2083 "Tamanyo" => 167430 ] ] "descripcion" => array:1 [ "en" => "Examples of polar maps of peak systolic longitudinal strain obtained from a Takotsubo syndrome patient (left) and an anterior ST-segment elevation myocardial infarction patient (right)." ] ] ] "textoCompleto" => "IntroductionTakotsubo syndrome (TTS) typically presents with symptoms, electrocardiographic changes and mild elevation of cardiac enzymes that mimic myocardial infarction. It is characterized by transient left ventricular (LV) dysfunction extending beyond a single coronary territory, in the absence of obstructive coronary artery disease.<a class="elsevierStyleCrossRefs" href="#bib0120">1–3</a> The classic echocardiographic description is of apical akinesia, with or without mid-ventricular involvement, associated with basal hypercontractility; alternative patterns of regional dysfunction have been described, although less frequently.<a class="elsevierStyleCrossRefs" href="#bib0135">4,5</a> These features, which most frequently follow an emotional or physical trigger, were first described by Sato and colleagues in the 1990s.<a class="elsevierStyleCrossRef" href="#bib0145">6</a> Initially believed to be a benign entity, it has been shown to be associated with non-negligible complications and an estimated 4-5% mortality.<a class="elsevierStyleCrossRefs" href="#bib0135">4,7–9</a> Its etiology is still somewhat elusive, but the most widely accepted hypotheses focus on catecholamine increase owing to sympathetic stimulation, which could cause myocardial dysfunction through adrenoceptor-mediated damage, direct toxicity, and endothelial dysfunction.<a class="elsevierStyleCrossRefs" href="#bib0165">10–12</a>Myocardial deformation analysis with speckle-tracking echocardiography has been shown to be more sensitive to lesser degrees of dysfunction than parameters such as ejection fraction, and is nowadays part of standard practice for detection of subclinical dysfunction in settings such as chemotherapy.<a class="elsevierStyleCrossRefs" href="#bib0180">13,14</a> Its use in TTS patients has been described in small reports, mainly focusing on serial assessment and possible persisting subclinical dysfunction.<a class="elsevierStyleCrossRefs" href="#bib0190">15–17</a> Some groups have also described abnormalities particular to this entity,<a class="elsevierStyleCrossRefs" href="#bib0205">18,19</a> however these findings have not been reproduced in larger studies.Our goal was to characterize global and regional myocardial dysfunction in TTS using standard parameters as well as strain assessment with speckle-tracking echocardiography. A comparison with ST-segment elevation myocardial infarction (STEMI) sought to find patterns distinguishing between the two entities.MethodsStudy populationWe retrospectively included 17 patients admitted to our hospital with a diagnosis of TTS. This was defined according to the Heart Failure Association diagnostic criteria,<a class="elsevierStyleCrossRef" href="#bib0120">1</a> which include transient regional wall motion abnormalities in the absence of culprit atherosclerotic coronary artery disease on invasive angiography or other pathological conditions to explain the LV dysfunction; new and reversible electrocardiographic abnormalities, elevated serum natriuretic peptide and small elevation in cardiac troponin during the acute phase; and recovery of ventricular systolic function on cardiac imaging at follow-up. Predominantly basal and/or mid-ventricular involvement was an exclusion criterion.A control group was formed of 20 randomly selected subjects with no prior history of coronary artery disease admitted to our department for anterior wall STEMI.Besides the above criteria, inclusion in both groups required availability of transthoracic echocardiography acquisitions suitable for speckle-tracking strain assessment obtained within 48 hours of symptom onset.EchocardiogramAll patients underwent comprehensive transthoracic echocardiographic examination after admission. Standard acquisitions were obtained using a 2.5 MHz phased-array transducer and either a Vivid 6 or Vivid 7 machine (GE Ultrasound). Post-processing of apical 4-, 2- and 3-chamber images at 50-80 frames per second was performed using the 2D strain module of the EchoPAC software (GE Ultrasound). Endocardial borders were defined from end-systolic frames, with further adjustments when necessary to optimize automated speckle tracking, according to published guidelines.<a class="elsevierStyleCrossRefs" href="#bib0180">13,20</a>Peak systolic longitudinal strain was determined for each myocardial segment using an 18-segment model, and global longitudinal strain was calculated as the mean of all segments. In addition, three LV slices – apical, midventricular and basal – were analyzed, and the mean of the peak systolic longitudinal strain in the six segments in each slice was calculated, from which the basal/apical ratio was derived.Statistical analysisContinuous variables are presented as mean ± standard deviation or median [interquartile range]. Comparisons of continuous data were performed using the independent samples t test or Mann-Whitney U test, as appropriate. Categorical variables were compared using the chi-square test or Fisher's exact test, as appropriate. A p-value <0.05 was considered statistically significant.All statistical analysis was performed using IBM SPSS Statistics version 22.ResultsA total of 17 TTS patients were compared with 20 STEMI controls. Baseline demographic, clinical and laboratory features are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. All TTS patients were female, with a mean age of 64 years (ranging from 33 to 84 years), while 19 of the STEMI patients were male, with mean age 57 years (37-76 years). The overall cardiovascular risk factor profile of the two groups was similar, except for current or previous smoking, which was more prevalent in STEMI than in TTS patients.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>In the TTS group, 11 patients developed symptoms after an emotional stressor, two after a physical stressor, and four had no identifiable trigger; 16 presented with primary TTS and only one with secondary TTS. The electrocardiogram at hospital admission showed ST-segment elevation in six patients, T-wave inversion in four, ST-segment depression in one and other nonspecific changes in the remaining six patients.All STEMI patients underwent emergent coronary angiography which showed a culprit left anterior descending (LAD) artery lesion (11 in the proximal segment, eight mid and one distal), with single-vessel disease in 11 of them (55%). Primary angioplasty with stent implantation was performed in 18 patients (90%), the others being two cases of spontaneous reperfusion, one with no need for intervention and the other with three-vessel disease for deferred surgical revascularization.Laboratory tests showed that peak troponin I levels were higher in STEMI patients and peak brain natriuretic peptide (BNP) was higher in TTS patients. The BNP/troponin I ratio was also significantly higher in the latter, as previously reported.<a class="elsevierStyleCrossRef" href="#bib0220">21</a> By contrast, neutrophil count and acute-phase reactant levels were not significantly different.Transthoracic echocardiography on admission showed significant LV systolic dysfunction in TTS and STEMI patients, and ejection fraction was similar in the two groups (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Diastolic function parameters were also comparable in patients in both groups.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>As with ejection fraction, LV global longitudinal strain was impaired in both groups, although with no statistically significant difference (-10.3±2.9 in TTS vs. -10.1±3.7% in STEMI, p=0.9).Regarding regional function, longitudinal strain was worse in TTS patients in basal inferolateral and mid anterolateral segments and, conversely, worse in STEMI patients in the apical anteroseptal segment (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Concerning the three LV slices, mean mid and apical longitudinal strain did not differ significantly between the two groups (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). Basal longitudinal strain, however, was worse in TTS than in STEMI patients (-9.8±2.9 vs. -12.4±4.1%, p=0.010).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Analyzing the differences in dysfunction throughout the LV axis, the ratio between mean longitudinal strain in the basal and apical slices was significantly lower in TTS patients as well (1.51±0.86 vs. 2.94±1.88, p=0.006).A subanalysis comparing TTS and STEMI patients with non-proximal LAD culprit lesions showed similar results, with worse basal longitudinal strain (-9.8±2.9 vs. -13.9±2.7%, p=0.002) and lower basal/apical ratio in the former (1.51±0.86 vs. 3.23±2.51, p=0.016).A trend towards worse basal longitudinal strain was also seen in TTS compared to STEMI patients with proximal LAD culprit lesions, although this did not reach statistical significance (-9.8±2.9 vs. -11.3±3.0%, p=0.19). By contrast, proximal LAD patients had worse basal longitudinal strain than TTS (-8.4±5.2 vs. -4.9±2.2, p=0.046); moreover, this resulted in a still statistically significant lower basal/apical ratio in TTS patients (1.51±0.86 vs. 2.70±1.23, p=0.005).DiscussionOur study shows that, while LV dysfunction is obviously a key feature in both TTS and myocardial infarction patients, the former have worse mean longitudinal strain in basal segments. This finding challenges the eyeball appearance of basal hypercontractility, possibly related to the contrasting markedly akinetic mid and apical segments with a ballooning appearance. The basal strain impairment could be explained, first of all, by unfavorable loading effects and geometrical changes due to remote dysfunctional segments, as has been described in acute myocardial infarction.<a class="elsevierStyleCrossRef" href="#bib0225">22</a> Additionally, the trend toward worse longitudinal strain in TTS patients in inferior, inferolateral and anterolateral segments, similar to the findings of Heggemann et al.,<a class="elsevierStyleCrossRef" href="#bib0205">18</a> suggests more global myocardial dysfunction, as would be expected considering the different pathophysiological mechanisms. Still, we would be inclined to interpret these segmental results with caution, due not only to the number of patients but also to the statistical limitations of using multiple comparisons.The difference between the two groups lost significance when STEMI patients with proximal LAD culprit lesions only were analyzed, which could be due to the limited sample size, as the numerical difference persisted. Nevertheless, the resulting lower basal/apical longitudinal strain ratio in TTS remained statistically significant both in the entire sample and in each STEMI subgroup, translating into a smaller ‘dysfunction gradient’, providing further evidence of more generalized myocardial impairment in these patients (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Unlike previous studies, we did not identify worse global LV systolic function in TTS than in STEMI patients as assessed by ejection fraction or global longitudinal strain.<a class="elsevierStyleCrossRefs" href="#bib0205">18,23</a> This might help explain why we did not find the more severe midventricular and apical impairment in TTS described by the same authors; nevertheless, this could also be an indicator of better comparability between the two groups, and thus increase confidence in the differences found. Neither do our findings support the existence of the ‘evil eye’ pattern of symmetrical apical involvement in TTS described by Sosa and Banchs.<a class="elsevierStyleCrossRef" href="#bib0210">19</a> On the contrary, there was a trend towards worse longitudinal strain in all apical segments in STEMI patients.Some limitations in our work should be acknowledged, first of all those inherent to any study with a retrospective design. Additionally, owing to the inclusion criteria used, our findings are only valid for classical TTS. The lack of gender matching is self-evident, but it is closely linked to the contrasting epidemiology of these diseases. The relatively small sample is also a limitation, as previously stated, that is related not only to the relative rarity of this diagnosis but also to the need to use information on patients whose echocardiograms were obtained from only one manufacturer, as speckle-tracking strain analysis is still not fully standardized across different platforms. Nevertheless, we believe these limitations are overcome by the importance of adding to knowledge on a disease about which our understanding still has important gaps.One of the ultimate goals in TTS research is the ability to quickly and safely distinguish it from STEMI, thus enabling appropriate decisions on the appropriate timing for coronary angiography. Echocardiography is a readily accessible tool in clinical practice and, with appropriately validated specific features, would be the ideal means to this end. Right now, we believe that identifying potential parameters of interest and assessing them in different settings, as we sought to do, is essential for this objective, and will enable adequately powered prospective studies to be performed in the near future. Moreover, the identification of such distinctive characteristics is of great value in advancing our knowledge on the pathophysiology of TTS, which in turn is inextricably linked to research into new therapeutic strategies.ConclusionsOur main findings are the worse mean longitudinal strain in basal LV segments of TTS compared with STEMI patients, and the smaller basal/apical longitudinal strain ratio in the former group. This smaller ‘dysfunction gradient’ compared to the localized phenomenon that is coronary artery disease is indicative of more generalized myocardial impairment than initially realized. If confirmed by further studies, it could help identify echocardiographic patterns specific to TTS and enhance both our knowledge of this disease and the clinical approach.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1204927" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1122499" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1204926" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1122498" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Echocardiogram" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-12-05" "fechaAceptado" => "2018-07-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1122499" "palabras" => array:3 [ 0 => "Takotsubo cardiomyopathy" 1 => "Echocardiography" 2 => "Myocardial deformation" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec1122498" "palabras" => array:3 [ 0 => "Miocardiopatia de Takotsubo" 1 => "Ecocardiografia" 2 => "Deformação miocárdica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionTakotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction, typically mimicking an anterior wall myocardial infarction (MI), without obstructive coronary artery disease. In the few published reports assessing myocardial deformation in TTS and MI, no consistent differences have been described between the two entities. We sought to characterize global and regional function in TTS and to compare it with a population with MI. MethodsClinical data, including echocardiography, were gathered from 17 TTS patients and 20 anterior wall ST-segment elevation myocardial infarction (STEMI) controls. Peak systolic longitudinal strain was determined for each LV segment using speckle tracking imaging, and global and mean apical, midventricular and basal longitudinal strain were calculated from these. ResultsBoth TTS and STEMI patients presented significant LV systolic dysfunction, and there were no significant differences in ejection fraction or global longitudinal strain. Regional longitudinal strain was more severely impaired in basal inferolateral and mid anterolateral segments in the TTS group and in apical anteroseptal segments in the STEMI group. Mean longitudinal strain was worse in the basal segments of TTS patients (-9.8±2.9 vs. -12.4±4.1%, p=0.010), with no significant differences in mid and apical segments. The basal/apical ratio was significantly lower in this group as well (1.51±0.86 vs. 2.94±1.88, p=0.006). ConclusionsWhile both TTS and STEMI feature significantly impaired global systolic function, we found a regional pattern of worse basal longitudinal strain and a lower basal/apical ratio in the former. These suggest generalized myocardial impairment in TTS, providing new clues about its pathophysiology and possible specific echocardiographic changes." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "IntroduçãoA síndrome de Takotsubo (TTS) é caracterizada por disfunção ventricular esquerda transitória, habitualmente simulando um enfarte agudo do miocárdio (STEMI) anterior, sem doença coronária obstrutiva. Nos poucos trabalhos publicados avaliando deformação miocárdica não estão descritas diferenças consistentes entre as duas entidades. Procurámos caracterizar a função global e regional na TTS e compará-la com uma população com STEMI. MétodosReunimos dados clínicos, incluindo ecocardiográficos, de 17 doentes com TTS e 20 controlos com STEMI anterior. O pico sistólico de strain longitudinal foi determinado para cada segmento ventricular usando speckle tracking; a partir destes calculou-se o strain longitudinal global e a média dos segmentos apicais, médios e basais. ResultadosTanto os doentes com TTS como STEMI apresentaram disfunção sistólica ventricular esquerda importante, sem diferença significativa da fração de ejeção e strain longitudinal global. O strain regional foi pior nos segmentos basal inferolateral e médio anterolateral do grupo com TTS e no apical anteroseptal dos doentes com STEMI. O strain longitudinal médio dos segmentos basais foi pior nos doentes com TTS (-9,8±2,9 versus -12,4±4,1%, p=0,010), sem diferença significativa nos médios ou apicais. A razão basal/apical também foi mais baixa neste grupo (1,51±0,86 versus 2,94±1,88, p=0,006). ConclusõesApesar de tanto a TTS como o STEMI apresentarem disfunção sistólica global importante, encontrámos um padrão de pior strain longitudinal basal e uma razão basal/apical mais baixa nos primeiros. Isto sugere uma disfunção miocárdica generalizada na TTS e fornece novas pistas relativamente à sua fisiopatologia e possíveis alterações ecocardiográficas específicas." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1013 "Ancho" => 2083 "Tamanyo" => 167430 ] ] "descripcion" => array:1 [ "en" => "Examples of polar maps of peak systolic longitudinal strain obtained from a Takotsubo syndrome patient (left) and an anterior ST-segment elevation myocardial infarction patient (right)." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "BNP: brain natriuretic peptide; CRP: C-reactive protein; STEMI: ST-segment elevation myocardial infarction; TTS: Takotsubo syndrome." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TTS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">STEMI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, years<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.5±11.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.2±9.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.048 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (5.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (70.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (60.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (23.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (10.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyslipidemia<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (35.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (50.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ever-smokers<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (5.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (70.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peak troponin I, ng/l<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.6 [1.1-5.0] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.1 [65.7-174.6] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peak BNP, pg/ml<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">546 [164-1185] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 [20-142] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BNP/troponin I ratio<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">310.1 [90.4-704.1] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.6 [0.2-2.2] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neutrophils, ×109/l<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.9 [7.1-8.4] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.8 [6.2-11.1] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CRP, mg/l<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.2 [2.3-19.7] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.4 [1.8-13.1] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Albumin, g/l<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.0 [36.0-40.1] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.8 [36.5-40.4] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.83 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2057626.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Mean ± standard deviation." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "n (%)." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "Median [interquartile range]." ] ] ] "descripcion" => array:1 [ "en" => "Demographic, clinical and laboratory features of the study sample." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Values are mean ± standard deviation.EDVI: end-diastolic volume index; LA: left atrial; STEMI: ST-segment elevation myocardial infarction; TR: tricuspid regurgitation; TTS: Takotsubo syndrome; WMSI: wall motion score index." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TTS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">STEMI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ejection fraction, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.8±5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.9±7.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EDVI, ml/m2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.6±8.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.6±9.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WMSI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.93±0.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.92±0.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.87 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">E, cm/s \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.2±22.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.6±16.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">E/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.10±0.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00±0.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">E/e’ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.7±3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.9±2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TR velocity, m/s \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.4±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LA volume index, ml/m2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.8±4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.9±6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.062 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2057627.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Left ventricular systolic and diastolic function parameters obtained from baseline echocardiography." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Values are mean ± standard deviation.STEMI: ST-segment elevation myocardial infarction; TTS: Takotsubo syndrome." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TTS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">STEMI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Basal segments</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anterior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-9.0±5.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-10.0±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.59 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anteroseptal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-7.7±6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-6.8±7.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inferoseptal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-9.0±4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-11.4±4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inferior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-13.3±6.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-16.6±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inferolateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-11.9±9.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-17.2±6.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.053 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anterolateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-10.7±6.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-14.9±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.041 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mid-ventricular segments</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anterior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-6.6±5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-7.2±4.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.72 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anteroseptal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-8.7±5.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-6.5±5.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inferoseptal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-10.5±4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-9.0±4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inferior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-10.3±6.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-13.1±4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inferolateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-8.4±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-12.3±4.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.031 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anterolateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-8.8±4.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-11.6±4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.057 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Apical segments</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anterior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-4.5±6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-2.9±7.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anteroseptal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-8.4±6.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-5.1±6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inferoseptal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-11.0±7.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-6.3±6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.039 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inferior \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-8.0±5.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-7.6±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inferolateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-6.6±5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-6.0±6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anterolateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-9.0±5.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-6.8±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.23 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2057629.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Peak systolic regional longitudinal strain (%) by left ventricular segment." ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Values are mean ± standard deviation.STEMI: ST-segment elevation myocardial infarction; TTS: Takotsubo syndrome." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TTS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">STEMI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Basal segments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-9.8±2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-12.4±3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.010 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mid-ventricular segments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-8.9±2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-9.9±3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.328 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Apical segments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-8.4±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-6.0±4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.134 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2057628.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Mean peak systolic longitudinal strain (%) in the six basal, mid and apical left ventricular segments." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0120" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.R. Lyon" 1 => "E. Bossone" 2 => "B. Schneider" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2016" "volumen" => "18" "paginaInicial" => "8" "paginaFinal" => "27" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0125" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology and pathophysiology of Takotsubo syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y.J. Akashi" 1 => "H.M. Nef" 2 => "A.R. Lyon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrcardio.2015.39" "Revista" => array:6 [ "tituloSerie" => "Nat Rev - Cardiol" "fecha" => "2015" "volumen" => "12" "paginaInicial" => "387" "paginaFinal" => "397" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25855605" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0130" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The ‘broken heart syndrome’: state of the art" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Nóbrega" 1 => "D. Brito" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2012.02.014" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2012" "volumen" => "31" "paginaInicial" => "589" "paginaFinal" => "596" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22795894" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0135" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features and outcomes of Takotsubo (stress) cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Templin" 1 => "J.R. Ghadri" 2 => "J. Diekmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1406761" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2015" "volumen" => "373" "paginaInicial" => "929" "paginaFinal" => "938" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26332547" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0140" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takotsubo cardiomyopathy systematic review: pathophysiologic process, clinical presentation and diagnostic approach to Takotsubo cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Ono" 1 => "L.M. Falcão" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2016.02.012" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2016" "volumen" => "209" "paginaInicial" => "196" "paginaFinal" => "205" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26896623" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0145" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Sato" 1 => "T. Uchida" 2 => "K. Dote" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "K.Kodama, K.Haze, M.Hori" "titulo" => "Clinical aspect of myocardial injury: from ischemia to heart failure" "paginaInicial" => "56" "paginaFinal" => "64" "serieFecha" => "1990" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0150" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short and long-term outcome of stress-induced cardiomyopathy: what can we expect?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V.F.A. Ribeiro" 1 => "M. Vasconcelos" 2 => "F. Melão" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5935/abc.20130228" "Revista" => array:6 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "2014" "volumen" => "102" "paginaInicial" => "80" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24270862" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0155" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characterization of Tako-tsubo cardiomyopathy in Spain: results from the RETAKO National Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "I.J. Núñez Gil" 1 => "M. Andrés" 2 => "M. Almendro Delia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rec.2014.07.026" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2015" "volumen" => "68" "paginaInicial" => "505" "paginaFinal" => "512" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25544669" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0160" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case-control study of risk markers and mortality in Takotsubo stress cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Tornvall" 1 => "O. Collste" 2 => "E. Ehrenborg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2016.02.029" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2016" "volumen" => "67" "paginaInicial" => "1931" "paginaFinal" => "1936" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27102508" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0165" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathophysiology of Takotsubo syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Pelliccia" 1 => "J.C. Kaski" 2 => "F. Crea" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "2017" "volumen" => "135" "paginaInicial" => "2426" "paginaFinal" => "2441" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0170" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takotsubo cardiomyopathy, a new concept of cardiomyopathy: clinical features and pathophysiology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Yoshikawa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2014" "volumen" => "182C" "paginaInicial" => "297" "paginaFinal" => "303" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0175" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Takotsubo cardiomyopathy: pathophysiology, diagnosis and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Komamura" 1 => "M. Fukui" 2 => "T. Iwasaku" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "World J Cardiol" "fecha" => "2014" "volumen" => "6" "paginaInicial" => "602" "paginaFinal" => "609" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0180" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Mor-Avi" 1 => "R.M. Lang" 2 => "L.P. Badano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ejechocard/jer021" "Revista" => array:6 [ "tituloSerie" => "Eur J Echocardiogr" "fecha" => "2011" "volumen" => "12" "paginaInicial" => "167" "paginaFinal" => "205" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21385887" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0185" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.M. Lang" 1 => "L.P. Badano" 2 => "V. Mor-Avi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ehjci/jev014" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J Cardiovasc Imaging" "fecha" => "2015" "volumen" => "16" "paginaInicial" => "233" "paginaFinal" => "270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25712077" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0190" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Standard and advanced echocardiography in takotsubo (stress) cardiomyopathy: clinical and prognostic implications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Citro" 1 => "A.R. Lyon" 2 => "P. Meimoun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.echo.2014.08.020" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Echocardiogr" "fecha" => "2015" "volumen" => "28" "paginaInicial" => "57" "paginaFinal" => "74" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25282664" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0195" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Two-dimensional strain in Takotsubo cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.B.G. Gomes" 1 => "G.J. Veras" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s0066-782x2010001200023" "Revista" => array:6 [ "tituloSerie" => "Arq Bras Cardiol" "fecha" => "2010" "volumen" => "95" "paginaInicial" => "e35" "paginaFinal" => "e37" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20857046" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0200" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global and regional myocardial function quantification by two-dimensional strain in Takotsubo cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Heggemann" 1 => "C. Weiss" 2 => "K. 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Original Article

Myocardial dysfunction in Takotsubo syndrome: More than meets the eye?

Disfunção miocárdica na síndrome de Takotsubo – Primeira impressão enganadora?

Gonçalo Pestana

Corresponding author

gpestana.md@gmail.com

Corresponding author.

, Marta Tavares-Silva, Carla Sousa, Roberto Pinto, Vânia Ribeiro, Mariana Vasconcelos, Pedro Bernardo Almeida, M. Júlia Maciel, Filipe Macedo

Serviço de Cardiologia, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal

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        "titulo" => "Disfun&#231;&#227;o mioc&#225;rdica na s&#237;ndrome de Takotsubo &#8211; Primeira impress&#227;o enganadora&#63;"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Examples of polar maps of peak systolic longitudinal strain obtained from a Takotsubo syndrome patient &#40;left&#41; and an anterior ST-segment elevation myocardial infarction patient &#40;right&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Takotsubo syndrome &#40;TTS&#41; typically presents with symptoms&#44; electrocardiographic changes and mild elevation of cardiac enzymes that mimic myocardial infarction&#46; It is characterized by transient left ventricular &#40;LV&#41; dysfunction extending beyond a single coronary territory&#44; in the absence of obstructive coronary artery disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1&#8211;3</span></a> The classic echocardiographic description is of apical akinesia&#44; with or without mid-ventricular involvement&#44; associated with basal hypercontractility&#59; alternative patterns of regional dysfunction have been described&#44; although less frequently&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4&#44;5</span></a> These features&#44; which most frequently follow an emotional or physical trigger&#44; were first described by Sato and colleagues in the 1990s&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a> Initially believed to be a benign entity&#44; it has been shown to be associated with non-negligible complications and an estimated 4-5&#37; mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4&#44;7&#8211;9</span></a> Its etiology is still somewhat elusive&#44; but the most widely accepted hypotheses focus on catecholamine increase owing to sympathetic stimulation&#44; which could cause myocardial dysfunction through adrenoceptor-mediated damage&#44; direct toxicity&#44; and endothelial dysfunction&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">10&#8211;12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Myocardial deformation analysis with speckle-tracking echocardiography has been shown to be more sensitive to lesser degrees of dysfunction than parameters such as ejection fraction&#44; and is nowadays part of standard practice for detection of subclinical dysfunction in settings such as chemotherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">13&#44;14</span></a> Its use in TTS patients has been described in small reports&#44; mainly focusing on serial assessment and possible persisting subclinical dysfunction&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">15&#8211;17</span></a> Some groups have also described abnormalities particular to this entity&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">18&#44;19</span></a> however these findings have not been reproduced in larger studies&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our goal was to characterize global and regional myocardial dysfunction in TTS using standard parameters as well as strain assessment with speckle-tracking echocardiography&#46; A comparison with ST-segment elevation myocardial infarction &#40;STEMI&#41; sought to find patterns distinguishing between the two entities&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0020" class="elsevierStylePara elsevierViewall">We retrospectively included 17 patients admitted to our hospital with a diagnosis of TTS&#46; This was defined according to the Heart Failure Association diagnostic criteria&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">1</span></a> which include transient regional wall motion abnormalities in the absence of culprit atherosclerotic coronary artery disease on invasive angiography or other pathological conditions to explain the LV dysfunction&#59; new and reversible electrocardiographic abnormalities&#44; elevated serum natriuretic peptide and small elevation in cardiac troponin during the acute phase&#59; and recovery of ventricular systolic function on cardiac imaging at follow-up&#46; Predominantly basal and&#47;or mid-ventricular involvement was an exclusion criterion&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A control group was formed of 20 randomly selected subjects with no prior history of coronary artery disease admitted to our department for anterior wall STEMI&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Besides the above criteria&#44; inclusion in both groups required availability of transthoracic echocardiography acquisitions suitable for speckle-tracking strain assessment obtained within 48 hours of symptom onset&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Echocardiogram</span><p id="par0035" class="elsevierStylePara elsevierViewall">All patients underwent comprehensive transthoracic echocardiographic examination after admission&#46; Standard acquisitions were obtained using a 2&#46;5 MHz phased-array transducer and either a Vivid 6 or Vivid 7 machine &#40;GE Ultrasound&#41;&#46; Post-processing of apical 4-&#44; 2- and 3-chamber images at 50-80 frames per second was performed using the 2D strain module of the EchoPAC software &#40;GE Ultrasound&#41;&#46; Endocardial borders were defined from end-systolic frames&#44; with further adjustments when necessary to optimize automated speckle tracking&#44; according to published guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">13&#44;20</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Peak systolic longitudinal strain was determined for each myocardial segment using an 18-segment model&#44; and global longitudinal strain was calculated as the mean of all segments&#46; In addition&#44; three LV slices &#8211; apical&#44; midventricular and basal &#8211; were analyzed&#44; and the mean of the peak systolic longitudinal strain in the six segments in each slice was calculated&#44; from which the basal&#47;apical ratio was derived&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Continuous variables are presented as mean &#177; standard deviation or median &#91;interquartile range&#93;&#46; Comparisons of continuous data were performed using the independent samples t test or Mann-Whitney U test&#44; as appropriate&#46; Categorical variables were compared using the chi-square test or Fisher&#39;s exact test&#44; as appropriate&#46; A p-value &#60;0&#46;05 was considered statistically significant&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">All statistical analysis was performed using IBM SPSS Statistics version 22&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 17 TTS patients were compared with 20 STEMI controls&#46; Baseline demographic&#44; clinical and laboratory features are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; All TTS patients were female&#44; with a mean age of 64 years &#40;ranging from 33 to 84 years&#41;&#44; while 19 of the STEMI patients were male&#44; with mean age 57 years &#40;37-76 years&#41;&#46; The overall cardiovascular risk factor profile of the two groups was similar&#44; except for current or previous smoking&#44; which was more prevalent in STEMI than in TTS patients&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In the TTS group&#44; 11 patients developed symptoms after an emotional stressor&#44; two after a physical stressor&#44; and four had no identifiable trigger&#59; 16 presented with primary TTS and only one with secondary TTS&#46; The electrocardiogram at hospital admission showed ST-segment elevation in six patients&#44; T-wave inversion in four&#44; ST-segment depression in one and other nonspecific changes in the remaining six patients&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">All STEMI patients underwent emergent coronary angiography which showed a culprit left anterior descending &#40;LAD&#41; artery lesion &#40;11 in the proximal segment&#44; eight mid and one distal&#41;&#44; with single-vessel disease in 11 of them &#40;55&#37;&#41;&#46; Primary angioplasty with stent implantation was performed in 18 patients &#40;90&#37;&#41;&#44; the others being two cases of spontaneous reperfusion&#44; one with no need for intervention and the other with three-vessel disease for deferred surgical revascularization&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Laboratory tests showed that peak troponin I levels were higher in STEMI patients and peak brain natriuretic peptide &#40;BNP&#41; was higher in TTS patients&#46; The BNP&#47;troponin I ratio was also significantly higher in the latter&#44; as previously reported&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a> By contrast&#44; neutrophil count and acute-phase reactant levels were not significantly different&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Transthoracic echocardiography on admission showed significant LV systolic dysfunction in TTS and STEMI patients&#44; and ejection fraction was similar in the two groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Diastolic function parameters were also comparable in patients in both groups&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">As with ejection fraction&#44; LV global longitudinal strain was impaired in both groups&#44; although with no statistically significant difference &#40;-10&#46;3&#177;2&#46;9 in TTS vs&#46; -10&#46;1&#177;3&#46;7&#37; in STEMI&#44; p&#61;0&#46;9&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Regarding regional function&#44; longitudinal strain was worse in TTS patients in basal inferolateral and mid anterolateral segments and&#44; conversely&#44; worse in STEMI patients in the apical anteroseptal segment &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Concerning the three LV slices&#44; mean mid and apical longitudinal strain did not differ significantly between the two groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; Basal longitudinal strain&#44; however&#44; was worse in TTS than in STEMI patients &#40;-9&#46;8&#177;2&#46;9 vs&#46; -12&#46;4&#177;4&#46;1&#37;&#44; p&#61;0&#46;010&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Analyzing the differences in dysfunction throughout the LV axis&#44; the ratio between mean longitudinal strain in the basal and apical slices was significantly lower in TTS patients as well &#40;1&#46;51&#177;0&#46;86 vs&#46; 2&#46;94&#177;1&#46;88&#44; p&#61;0&#46;006&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A subanalysis comparing TTS and STEMI patients with non-proximal LAD culprit lesions showed similar results&#44; with worse basal longitudinal strain &#40;-9&#46;8&#177;2&#46;9 vs&#46; -13&#46;9&#177;2&#46;7&#37;&#44; p&#61;0&#46;002&#41; and lower basal&#47;apical ratio in the former &#40;1&#46;51&#177;0&#46;86 vs&#46; 3&#46;23&#177;2&#46;51&#44; p&#61;0&#46;016&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A trend towards worse basal longitudinal strain was also seen in TTS compared to STEMI patients with proximal LAD culprit lesions&#44; although this did not reach statistical significance &#40;-9&#46;8&#177;2&#46;9 vs&#46; -11&#46;3&#177;3&#46;0&#37;&#44; p&#61;0&#46;19&#41;&#46; By contrast&#44; proximal LAD patients had worse basal longitudinal strain than TTS &#40;-8&#46;4&#177;5&#46;2 vs&#46; -4&#46;9&#177;2&#46;2&#44; p&#61;0&#46;046&#41;&#59; moreover&#44; this resulted in a still statistically significant lower basal&#47;apical ratio in TTS patients &#40;1&#46;51&#177;0&#46;86 vs&#46; 2&#46;70&#177;1&#46;23&#44; p&#61;0&#46;005&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Our study shows that&#44; while LV dysfunction is obviously a key feature in both TTS and myocardial infarction patients&#44; the former have worse mean longitudinal strain in basal segments&#46; This finding challenges the eyeball appearance of basal hypercontractility&#44; possibly related to the contrasting markedly akinetic mid and apical segments with a ballooning appearance&#46; The basal strain impairment could be explained&#44; first of all&#44; by unfavorable loading effects and geometrical changes due to remote dysfunctional segments&#44; as has been described in acute myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> Additionally&#44; the trend toward worse longitudinal strain in TTS patients in inferior&#44; inferolateral and anterolateral segments&#44; similar to the findings of Heggemann et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a> suggests more global myocardial dysfunction&#44; as would be expected considering the different pathophysiological mechanisms&#46; Still&#44; we would be inclined to interpret these segmental results with caution&#44; due not only to the number of patients but also to the statistical limitations of using multiple comparisons&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The difference between the two groups lost significance when STEMI patients with proximal LAD culprit lesions only were analyzed&#44; which could be due to the limited sample size&#44; as the numerical difference persisted&#46; Nevertheless&#44; the resulting lower basal&#47;apical longitudinal strain ratio in TTS remained statistically significant both in the entire sample and in each STEMI subgroup&#44; translating into a smaller &#8216;dysfunction gradient&#8217;&#44; providing further evidence of more generalized myocardial impairment in these patients &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Unlike previous studies&#44; we did not identify worse global LV systolic function in TTS than in STEMI patients as assessed by ejection fraction or global longitudinal strain&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">18&#44;23</span></a> This might help explain why we did not find the more severe midventricular and apical impairment in TTS described by the same authors&#59; nevertheless&#44; this could also be an indicator of better comparability between the two groups&#44; and thus increase confidence in the differences found&#46; Neither do our findings support the existence of the &#8216;evil eye&#8217; pattern of symmetrical apical involvement in TTS described by Sosa and Banchs&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> On the contrary&#44; there was a trend towards worse longitudinal strain in all apical segments in STEMI patients&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Some limitations in our work should be acknowledged&#44; first of all those inherent to any study with a retrospective design&#46; Additionally&#44; owing to the inclusion criteria used&#44; our findings are only valid for classical TTS&#46; The lack of gender matching is self-evident&#44; but it is closely linked to the contrasting epidemiology of these diseases&#46; The relatively small sample is also a limitation&#44; as previously stated&#44; that is related not only to the relative rarity of this diagnosis but also to the need to use information on patients whose echocardiograms were obtained from only one manufacturer&#44; as speckle-tracking strain analysis is still not fully standardized across different platforms&#46; Nevertheless&#44; we believe these limitations are overcome by the importance of adding to knowledge on a disease about which our understanding still has important gaps&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">One of the ultimate goals in TTS research is the ability to quickly and safely distinguish it from STEMI&#44; thus enabling appropriate decisions on the appropriate timing for coronary angiography&#46; Echocardiography is a readily accessible tool in clinical practice and&#44; with appropriately validated specific features&#44; would be the ideal means to this end&#46; Right now&#44; we believe that identifying potential parameters of interest and assessing them in different settings&#44; as we sought to do&#44; is essential for this objective&#44; and will enable adequately powered prospective studies to be performed in the near future&#46; Moreover&#44; the identification of such distinctive characteristics is of great value in advancing our knowledge on the pathophysiology of TTS&#44; which in turn is inextricably linked to research into new therapeutic strategies&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0135" class="elsevierStylePara elsevierViewall">Our main findings are the worse mean longitudinal strain in basal LV segments of TTS compared with STEMI patients&#44; and the smaller basal&#47;apical longitudinal strain ratio in the former group&#46; This smaller &#8216;dysfunction gradient&#8217; compared to the localized phenomenon that is coronary artery disease is indicative of more generalized myocardial impairment than initially realized&#46; If confirmed by further studies&#44; it could help identify echocardiographic patterns specific to TTS and enhance both our knowledge of this disease and the clinical approach&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Takotsubo syndrome &#40;TTS&#41; is characterized by transient left ventricular &#40;LV&#41; dysfunction&#44; typically mimicking an anterior wall myocardial infarction &#40;MI&#41;&#44; without obstructive coronary artery disease&#46; In the few published reports assessing myocardial deformation in TTS and MI&#44; no consistent differences have been described between the two entities&#46; We sought to characterize global and regional function in TTS and to compare it with a population with MI&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical data&#44; including echocardiography&#44; were gathered from 17 TTS patients and 20 anterior wall ST-segment elevation myocardial infarction &#40;STEMI&#41; controls&#46; Peak systolic longitudinal strain was determined for each LV segment using speckle tracking imaging&#44; and global and mean apical&#44; midventricular and basal longitudinal strain were calculated from these&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Both TTS and STEMI patients presented significant LV systolic dysfunction&#44; and there were no significant differences in ejection fraction or global longitudinal strain&#46; Regional longitudinal strain was more severely impaired in basal inferolateral and mid anterolateral segments in the TTS group and in apical anteroseptal segments in the STEMI group&#46; Mean longitudinal strain was worse in the basal segments of TTS patients &#40;-9&#46;8&#177;2&#46;9 vs&#46; -12&#46;4&#177;4&#46;1&#37;&#44; p&#61;0&#46;010&#41;&#44; with no significant differences in mid and apical segments&#46; The basal&#47;apical ratio was significantly lower in this group as well &#40;1&#46;51&#177;0&#46;86 vs&#46; 2&#46;94&#177;1&#46;88&#44; p&#61;0&#46;006&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">While both TTS and STEMI feature significantly impaired global systolic function&#44; we found a regional pattern of worse basal longitudinal strain and a lower basal&#47;apical ratio in the former&#46; These suggest generalized myocardial impairment in TTS&#44; providing new clues about its pathophysiology and possible specific echocardiographic changes&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A s&#237;ndrome de Takotsubo &#40;TTS&#41; &#233; caracterizada por disfun&#231;&#227;o ventricular esquerda transit&#243;ria&#44; habitualmente simulando um enfarte agudo do mioc&#225;rdio &#40;STEMI&#41; anterior&#44; sem doen&#231;a coron&#225;ria obstrutiva&#46; Nos poucos trabalhos publicados avaliando deforma&#231;&#227;o mioc&#225;rdica n&#227;o est&#227;o descritas diferen&#231;as consistentes entre as duas entidades&#46; Procur&#225;mos caracterizar a fun&#231;&#227;o global e regional na TTS e compar&#225;-la com uma popula&#231;&#227;o com STEMI&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Reunimos dados cl&#237;nicos&#44; incluindo ecocardiogr&#225;ficos&#44; de 17 doentes com TTS e 20 controlos com STEMI anterior&#46; O pico sist&#243;lico de <span class="elsevierStyleItalic">strain</span> longitudinal foi determinado para cada segmento ventricular usando <span class="elsevierStyleItalic">speckle tracking</span>&#59; a partir destes calculou-se o <span class="elsevierStyleItalic">strain</span> longitudinal global e a m&#233;dia dos segmentos apicais&#44; m&#233;dios e basais&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Tanto os doentes com TTS como STEMI apresentaram disfun&#231;&#227;o sist&#243;lica ventricular esquerda importante&#44; sem diferen&#231;a significativa da fra&#231;&#227;o de eje&#231;&#227;o e <span class="elsevierStyleItalic">strain</span> longitudinal global&#46; O <span class="elsevierStyleItalic">strain</span> regional foi pior nos segmentos basal inferolateral e m&#233;dio anterolateral do grupo com TTS e no apical anteroseptal dos doentes com STEMI&#46; O <span class="elsevierStyleItalic">strain</span> longitudinal m&#233;dio dos segmentos basais foi pior nos doentes com TTS &#40;-9&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;9 <span class="elsevierStyleItalic">versus</span> -12&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;1&#37;&#44; p&#61;0&#44;010&#41;&#44; sem diferen&#231;a significativa nos m&#233;dios ou apicais&#46; A raz&#227;o basal&#47;apical tamb&#233;m foi mais baixa neste grupo &#40;1&#44;51&#177;0&#44;86 <span class="elsevierStyleItalic">versus</span> 2&#44;94&#177;1&#44;88&#44; p&#61;0&#44;006&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Apesar de tanto a TTS como o STEMI apresentarem disfun&#231;&#227;o sist&#243;lica global importante&#44; encontr&#225;mos um padr&#227;o de pior <span class="elsevierStyleItalic">strain</span> longitudinal basal e uma raz&#227;o basal&#47;apical mais baixa nos primeiros&#46; Isto sugere uma disfun&#231;&#227;o mioc&#225;rdica generalizada na TTS e fornece novas pistas relativamente &#224; sua fisiopatologia e poss&#237;veis altera&#231;&#245;es ecocardiogr&#225;ficas espec&#237;ficas&#46;</p></span>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Examples of polar maps of peak systolic longitudinal strain obtained from a Takotsubo syndrome patient &#40;left&#41; and an anterior ST-segment elevation myocardial infarction patient &#40;right&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">BNP&#58; brain natriuretic peptide&#59; CRP&#58; C-reactive protein&#59; STEMI&#58; ST-segment elevation myocardial infarction&#59; TTS&#58; Takotsubo syndrome&#46;</p>"
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                  \t\t\t\t">546 &#91;164-1185&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">310&#46;1 &#91;90&#46;4-704&#46;1&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;6 &#91;0&#46;2-2&#46;2&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">CRP&#44; mg&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Albumin&#44; g&#47;l<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;93&#177;0&#46;38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">E&#44; cm&#47;s&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">E&#47;A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">E&#47;e&#8217;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#46;7&#177;3&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#46;9&#177;2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">TR velocity&#44; m&#47;s&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">LA volume index&#44; ml&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inferolateral&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
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                0 => "xTab2057629.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Peak systolic regional longitudinal strain &#40;&#37;&#41; by left ventricular segment&#46;</p>"
        ]
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        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Values are mean &#177; standard deviation&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">STEMI&#58; ST-segment elevation myocardial infarction&#59; TTS&#58; Takotsubo syndrome&#46;</p>"
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              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current state of knowledge on Takotsubo syndrome&#58; a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;R&#46; Lyon"
                            1 => "E&#46; Bossone"
                            2 => "B&#46; Schneider"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2016"
                        "volumen" => "18"
                        "paginaInicial" => "8"
                        "paginaFinal" => "27"
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology and pathophysiology of Takotsubo syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Y&#46;J&#46; Akashi"
                            1 => "H&#46;M&#46; Nef"
                            2 => "A&#46;R&#46; Lyon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrcardio.2015.39"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev - Cardiol"
                        "fecha" => "2015"
                        "volumen" => "12"
                        "paginaInicial" => "387"
                        "paginaFinal" => "397"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25855605"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The &#8216;broken heart syndrome&#8217;&#58; state of the art"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; N&#243;brega"
                            1 => "D&#46; Brito"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2012.02.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2012"
                        "volumen" => "31"
                        "paginaInicial" => "589"
                        "paginaFinal" => "596"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22795894"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0135"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical features and outcomes of Takotsubo &#40;stress&#41; cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Templin"
                            1 => "J&#46;R&#46; Ghadri"
                            2 => "J&#46; Diekmann"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1406761"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2015"
                        "volumen" => "373"
                        "paginaInicial" => "929"
                        "paginaFinal" => "938"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26332547"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0140"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Takotsubo cardiomyopathy systematic review&#58; pathophysiologic process&#44; clinical presentation and diagnostic approach to Takotsubo cardiomyopathy"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                            1 => "L&#46;M&#46; Falc&#227;o"
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                      ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2016.02.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2016"
                        "volumen" => "209"
                        "paginaInicial" => "196"
                        "paginaFinal" => "205"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26896623"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            1 => "T&#46; Uchida"
                            2 => "K&#46; Dote"
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                    0 => array:1 [
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                        "titulo" => "Clinical aspect of myocardial injury&#58; from ischemia to heart failure"
                        "paginaInicial" => "56"
                        "paginaFinal" => "64"
                        "serieFecha" => "1990"
                      ]
                    ]
                  ]
                ]
              ]
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            6 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "7"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Short and long-term outcome of stress-induced cardiomyopathy&#58; what can we expect&#63;"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5935/abc.20130228"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Bras Cardiol"
                        "fecha" => "2014"
                        "volumen" => "102"
                        "paginaInicial" => "80"
                        "paginaFinal" => "85"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24270862"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0155"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Characterization of Tako-tsubo cardiomyopathy in Spain&#58; results from the RETAKO National Registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            2 => "M&#46; Almendro Delia"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rec.2014.07.026"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2015"
                        "volumen" => "68"
                        "paginaInicial" => "505"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25544669"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0160"
              "etiqueta" => "9"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "A case-control study of risk markers and mortality in Takotsubo stress cardiomyopathy"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2016.02.029"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2016"
                        "volumen" => "67"
                        "paginaInicial" => "1931"
                        "paginaFinal" => "1936"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27102508"
                            "web" => "Medline"
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              "identificador" => "bib0165"
              "etiqueta" => "10"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathophysiology of Takotsubo syndrome"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Pelliccia"
                            1 => "J&#46;C&#46; Kaski"
                            2 => "F&#46; Crea"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2017"
                        "volumen" => "135"
                        "paginaInicial" => "2426"
                        "paginaFinal" => "2441"
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              "identificador" => "bib0170"
              "etiqueta" => "11"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Takotsubo cardiomyopathy&#44; a new concept of cardiomyopathy&#58; clinical features and pathophysiology"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46; Yoshikawa"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2014"
                        "volumen" => "182C"
                        "paginaInicial" => "297"
                        "paginaFinal" => "303"
                      ]
                    ]
                  ]
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              "identificador" => "bib0175"
              "etiqueta" => "12"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Takotsubo cardiomyopathy&#58; pathophysiology&#44; diagnosis and treatment"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Komamura"
                            1 => "M&#46; Fukui"
                            2 => "T&#46; Iwasaku"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "World J Cardiol"
                        "fecha" => "2014"
                        "volumen" => "6"
                        "paginaInicial" => "602"
                        "paginaFinal" => "609"
                      ]
                    ]
                  ]
                ]
              ]
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            12 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics&#58; ASE&#47;EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            2 => "L&#46;P&#46; Badano"
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                    0 => array:2 [
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                        "tituloSerie" => "Eur J Echocardiogr"
                        "fecha" => "2011"
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                        "paginaInicial" => "167"
                        "paginaFinal" => "205"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21385887"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
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              "identificador" => "bib0185"
              "etiqueta" => "14"
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                    0 => array:2 [
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                        "paginaInicial" => "233"
                        "paginaFinal" => "270"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                      "titulo" => "Two-dimensional strain in Takotsubo cardiomyopathy"
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                        "paginaInicial" => "e35"
                        "paginaFinal" => "e37"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20857046"
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                      "titulo" => "Global and regional myocardial function quantification by two-dimensional strain in Takotsubo cardiomyopathy"
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                          "etal" => true
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                            0 => "F&#46; Heggemann"
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                        "tituloSerie" => "Eur J Echocardiogr"
                        "fecha" => "2009"
                        "volumen" => "10"
                        "paginaInicial" => "760"
                        "paginaFinal" => "764"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19477932"
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                    0 => array:2 [
                      "titulo" => "Global and regional myocardial function quantification in Takotsubo cardiomyopathy in comparison to acute anterior myocardial infarction using two-dimensional &#40;2D&#41; strain echocardiography"
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                        0 => array:2 [
                          "etal" => true
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                      ]
                    ]
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                        "tituloSerie" => "Echocardiography"
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                        "paginaInicial" => "715"
                        "paginaFinal" => "719"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21545518"
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                      ]
                    ]
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                ]
              ]
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              "etiqueta" => "19"
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                    0 => array:2 [
                      "titulo" => "Early recognition of apical ballooning syndrome by global longitudinal strain using speckle tracking imaging&#8211;the evil eye pattern&#44; a case series"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1111/echo.12875"
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                        "tituloSerie" => "Echocardiography"
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                        "volumen" => "32"
                        "paginaInicial" => "1184"
                        "paginaFinal" => "1192"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25556622"
                            "web" => "Medline"
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                ]
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                    0 => array:2 [
                      "titulo" => "Definitions for a common standard for 2D speckle tracking echocardiography&#58; consensus document of the EACVI&#47;ASE&#47;Industry Task Force to standardize deformation imaging"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Heart J Cardiovasc Imaging"
                        "fecha" => "2015"
                        "volumen" => "16"
                        "paginaInicial" => "1"
                        "paginaFinal" => "11"
                      ]
                    ]
                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Diagnostic utility of cardiac biomarkers in discriminating Takotsubo cardiomyopathy from acute myocardial infarction"
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                        0 => array:2 [
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                    0 => array:2 [
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                        "tituloSerie" => "J Card Fail"
                        "fecha" => "2014"
                        "volumen" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24858056"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "Remote noninfarcted region dysfunction soon after first anterior myocardial infarction&#46; A magnetic resonance tagging study"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Circulation"
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                        "paginaInicial" => "660"
                        "paginaFinal" => "666"
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                    ]
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                      "titulo" => "Left ventricular systolic and diastolic function in patients with apical ballooning syndrome compared with patients with acute anterior ST-segment elevation myocardial infarction&#58; a functional paradox"
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                          "etal" => true
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                        "paginaFinal" => "521"
                        "link" => array:1 [
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2019.05.013

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Year/Month	Html	Pdf	Total

2024 November	8	7	15
2024 October	28	31	59
2024 September	46	27	73
2024 August	40	31	71
2024 July	32	23	55
2024 June	23	28	51
2024 May	37	24	61
2024 April	40	31	71
2024 March	38	18	56
2024 February	38	22	60
2024 January	37	29	66
2023 December	42	28	70
2023 November	45	41	86
2023 October	27	13	40
2023 September	38	19	57
2023 August	28	20	48
2023 July	28	9	37
2023 June	35	11	46
2023 May	77	24	101
2023 April	59	8	67
2023 March	62	18	80
2023 February	43	19	62
2023 January	33	17	50
2022 December	68	20	88
2022 November	38	36	74
2022 October	51	28	79
2022 September	34	28	62
2022 August	28	28	56
2022 July	43	40	83
2022 June	39	35	74
2022 May	39	36	75
2022 April	46	30	76
2022 March	39	40	79
2022 February	41	29	70
2022 January	33	32	65
2021 December	36	33	69
2021 November	35	31	66
2021 October	42	49	91
2021 September	31	21	52
2021 August	38	30	68
2021 July	29	32	61
2021 June	27	23	50
2021 May	35	30	65
2021 April	113	58	171
2021 March	52	26	78
2021 February	47	13	60
2021 January	42	16	58
2020 December	45	13	58
2020 November	21	13	34
2020 October	29	12	41
2020 September	22	14	36
2020 August	13	6	19
2020 July	27	14	41
2020 June	23	19	42
2020 May	19	5	24
2020 April	24	16	40
2020 March	19	12	31
2020 February	32	10	42
2020 January	13	8	21
2019 December	20	4	24
2019 November	10	5	15
2019 October	16	6	22
2019 September	14	7	21
2019 August	9	4	13
2019 July	11	12	23
2019 June	26	29	55

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