array:25 [
  "pii" => "S217420491930159X"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2019.06.009"
  "estado" => "S300"
  "fechaPublicacion" => "2019-05-01"
  "aid" => "1393"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Cardiol. 2019;38:349-57"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 341
    "formatos" => array:3 [
      "EPUB" => 63
      "HTML" => 168
      "PDF" => 110
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S0870255118300933"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2018.07.010"
      "estado" => "S300"
      "fechaPublicacion" => "2019-05-01"
      "aid" => "1393"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Cardiol. 2019;38:349-57"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 795
        "formatos" => array:3 [
          "EPUB" => 59
          "HTML" => 523
          "PDF" => 213
        ]
      ]
      "en" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
        "titulo" => "Short- and medium-term prognosis of Takotsubo syndrome in a Portuguese population"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "349"
            "paginaFinal" => "357"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Progn&#243;stico a curto e m&#233;dio prazo da s&#237;ndrome de Takotsubo numa popula&#231;&#227;o portuguesa"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Dina Bento, Olga Azevedo, Rui Santos, Ana Almeida, Kevin Domingues, Bruno Marmelo, Liliana Reis, Catarina Ruivo, Rui Guerreiro, Rui Lima, Ricardo Faria, Ana Marreiros, Nuno Marques"
            "autores" => array:14 [
              0 => array:2 [
                "nombre" => "Dina"
                "apellidos" => "Bento"
              ]
              1 => array:2 [
                "nombre" => "Olga"
                "apellidos" => "Azevedo"
              ]
              2 => array:2 [
                "nombre" => "Rui"
                "apellidos" => "Santos"
              ]
              3 => array:2 [
                "nombre" => "Ana"
                "apellidos" => "Almeida"
              ]
              4 => array:2 [
                "nombre" => "Kevin"
                "apellidos" => "Domingues"
              ]
              5 => array:2 [
                "nombre" => "Bruno"
                "apellidos" => "Marmelo"
              ]
              6 => array:2 [
                "nombre" => "Liliana"
                "apellidos" => "Reis"
              ]
              7 => array:2 [
                "nombre" => "Catarina"
                "apellidos" => "Ruivo"
              ]
              8 => array:2 [
                "nombre" => "Rui"
                "apellidos" => "Guerreiro"
              ]
              9 => array:2 [
                "nombre" => "Rui"
                "apellidos" => "Lima"
              ]
              10 => array:2 [
                "nombre" => "Ricardo"
                "apellidos" => "Faria"
              ]
              11 => array:2 [
                "nombre" => "Ana"
                "apellidos" => "Marreiros"
              ]
              12 => array:2 [
                "nombre" => "Nuno"
                "apellidos" => "Marques"
              ]
              13 => array:1 [
                "colaborador" => "on behalf of the SUNSHINE Investigators group"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S217420491930159X"
          "doi" => "10.1016/j.repce.2019.06.009"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491930159X?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255118300933?idApp=UINPBA00004E"
      "url" => "/08702551/0000003800000005/v3_201911281014/S0870255118300933/v3_201911281014/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2174204919301606"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2019.06.010"
    "estado" => "S300"
    "fechaPublicacion" => "2019-05-01"
    "aid" => "1390"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "dis"
    "cita" => "Rev Port Cardiol. 2019;38:359-60"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 277
      "formatos" => array:3 [
        "EPUB" => 65
        "HTML" => 130
        "PDF" => 82
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
      "titulo" => "Prognosis of Takotsubo syndrome in Portugal"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "359"
          "paginaFinal" => "360"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Progn&#243;stico de s&#237;ndrome de Takotsubo em Portugal"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jorge Mimoso"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Mimoso"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0870255119303270"
        "doi" => "10.1016/j.repc.2019.06.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119303270?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919301606?idApp=UINPBA00004E"
    "url" => "/21742049/0000003800000005/v2_201911300820/S2174204919301606/v2_201911300820/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2174204919301539"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2019.06.003"
    "estado" => "S300"
    "fechaPublicacion" => "2019-05-01"
    "aid" => "1397"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "dis"
    "cita" => "Rev Port Cardiol. 2019;38:347-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 260
      "formatos" => array:3 [
        "EPUB" => 42
        "HTML" => 135
        "PDF" => 83
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
      "titulo" => "Heartfelt exercise&#58; Physical exercise gets the cardiovascular system into shape"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "347"
          "paginaFinal" => "348"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Sistema cardiovascular em forma com exerc&#237;cio f&#237;sico"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Frederico C&#46; Pereira"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Frederico"
              "apellidos" => "C&#46; Pereira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:2 [
      "pt" => array:9 [
        "pii" => "S0870255118300751"
        "doi" => "10.1016/j.repc.2018.08.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255118300751?idApp=UINPBA00004E"
      ]
      "en" => array:9 [
        "pii" => "S0870255119303385"
        "doi" => "10.1016/j.repc.2019.06.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119303385?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204919301539?idApp=UINPBA00004E"
    "url" => "/21742049/0000003800000005/v2_201911300820/S2174204919301539/v2_201911300820/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Short- and medium-term prognosis of Takotsubo syndrome in a Portuguese population"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "349"
        "paginaFinal" => "357"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Dina Bento, Olga Azevedo, Rui Santos, Ana Almeida, Kevin Domingues, Bruno Marmelo, Liliana Reis, Catarina Ruivo, Rui Guerreiro, Rui Lima, Ricardo Faria, Ana Marreiros, Nuno Marques"
        "autores" => array:14 [
          0 => array:4 [
            "nombre" => "Dina"
            "apellidos" => "Bento"
            "email" => array:1 [
              0 => "dinabento@gmail.com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Olga"
            "apellidos" => "Azevedo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Rui"
            "apellidos" => "Santos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Ana"
            "apellidos" => "Almeida"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Kevin"
            "apellidos" => "Domingues"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Bruno"
            "apellidos" => "Marmelo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Liliana"
            "apellidos" => "Reis"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Catarina"
            "apellidos" => "Ruivo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Rui"
            "apellidos" => "Guerreiro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">j</span>"
                "identificador" => "aff0050"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Rui"
            "apellidos" => "Lima"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">k</span>"
                "identificador" => "aff0055"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Ricardo"
            "apellidos" => "Faria"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "Ana"
            "apellidos" => "Marreiros"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">l</span>"
                "identificador" => "aff0060"
              ]
            ]
          ]
          12 => array:3 [
            "nombre" => "Nuno"
            "apellidos" => "Marques"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">l</span>"
                "identificador" => "aff0060"
              ]
            ]
          ]
          13 => array:1 [
            "colaborador" => "on behalf of the SUNSHINE Investigators group"
          ]
        ]
        "afiliaciones" => array:12 [
          0 => array:3 [
            "entidad" => "Cardiology Department&#44; Centro Hospitalar Universit&#225;rio do Algarve Faro&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Algarve Biomedical Center&#44; Faro&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Cardiology Department&#44; Hospital da Senhora da Oliveira&#44; Guimar&#227;es&#44; Portugal"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Cardiology Department&#44; Centro Hospitalar do T&#226;mega e Sousa&#44; Penafiel&#44; Portugal"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Cardiology Department&#44; Hospital Garcia de Orta&#44; Almada&#44; Portugal"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Cardiology Department&#44; Hospital de Santar&#233;m&#44; Santar&#233;m&#44; Portugal"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Cardiology Department&#44; Centro Hospitalar Tondela-Viseu&#44; Portugal"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Cardiology Department&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#44; Coimbra&#44; Portugal"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "Cardiology Department&#44; Centro Hospitalar de Leiria&#44; Leiria&#44; Portugal"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
          9 => array:3 [
            "entidad" => "Cardiology Department&#44; Hospital do Esp&#237;rito Santo&#44; &#201;vora&#44; Portugal"
            "etiqueta" => "j"
            "identificador" => "aff0050"
          ]
          10 => array:3 [
            "entidad" => "Cardiology Department&#44; Unidade Local de Sa&#250;de do Alto Minho&#44; Viana do Castelo&#44; Portugal"
            "etiqueta" => "k"
            "identificador" => "aff0055"
          ]
          11 => array:3 [
            "entidad" => "Departamento de Ci&#234;ncias Biom&#233;dicas e Medicina&#44; Universidade do Algarve&#44; Faro&#44; Portugal"
            "etiqueta" => "l"
            "identificador" => "aff0060"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Progn&#243;stico a curto e m&#233;dio prazo da s&#237;ndrome de Takotsubo numa popula&#231;&#227;o portuguesa"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Takotsubo syndrome &#40;TTS&#41; was first described in the Japanese population in the early 1990s&#46; It takes its name from the Japanese octopus trap named <span class="elsevierStyleItalic">takotsubo</span> because the left ventricle in systole takes a similar shape to the trap&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The syndrome is characterized by transient left ventricular &#40;LV&#41; systolic dysfunction&#44; electrocardiographic changes that mimic acute myocardial infarction and minimal release of myocardial necrosis enzymes&#44; in the absence of obstructive coronary artery disease &#40;CAD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">2</span></a> It has been estimated to account for 1-2&#37; of cases of suspected acute coronary syndrome &#40;ACS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">3</span></a> However&#44; this figure is probably an underestimate&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In other series&#44; 90&#37; of patients were female and aged over 50 years&#46; In about two-thirds of cases&#44; there was an emotional or physical triggering factor&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The underlying mechanism of TTS is not fully understood&#46; However&#44; the most commonly accepted theory is of catecholamine-induced cardiotoxicity in response to an emotional or physical stimulus&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical presentation is very similar to an ACS&#44; and TTS needs a differential workup to distinguish between the two entities&#46; To establish a diagnosis of TTS&#44; coronary angiography is needed to exclude obstructive CAD as the cause of LV dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The most commonly used diagnostic criteria for TTS are those proposed by the Mayo Clinic&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">7</span></a> The Heart Failure Association of the European Society of Cardiology recently published updated diagnostic criteria<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">4</span></a> that distinguish between primary and secondary TTS&#46; In the primary subtype&#44; cardiac symptoms are the primary reason for seeking medical care&#44; while in the secondary subtype the patient has an underlying primary disease that precipitated TTS&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Therapy is supportive&#44; usually consisting of vasodilators&#44; beta-blockers and diuretics&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Although the syndrome has previously been described as benign&#44; more recent series have revealed a significant rate of in-hospital complications&#44; and the short- and medium-term prognosis may be less favorable than previously described&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The aim of this study was to characterize a Portuguese population with TTS and to determine their short- and medium-term prognosis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Patient population</span><p id="par0050" class="elsevierStylePara elsevierViewall">In this observational multicenter study involving 12 Portuguese hospitals&#44; all patients diagnosed with TTS from 2002 to 2016 were included&#44; retrospectively until 2012 and prospectively since 2012&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Patients were selected according to the Mayo Clinic diagnostic criteria&#58; transient abnormality in LV wall motion beyond a single epicardial coronary artery perfusion territory&#59; absence of obstructive CAD or angiographic evidence of acute plaque rupture&#59; new electrocardiographic abnormalities or modest elevation in cardiac troponin levels&#59; and the absence of pheochromocytoma or myocarditis&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">An exception to these criteria was the inclusion of patients who died during the acute phase&#44; prior to complete recovery of myocardial function&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Data collection</span><p id="par0065" class="elsevierStylePara elsevierViewall">The data were collected by consulting the clinical records of patients diagnosed with TTS&#44; retrospectively before 2012 and prospectively after 2012&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Demographic data&#44; personal history&#44; cardiovascular risk factors&#44; triggering factors&#44; clinical presentation&#44; electrocardiographic findings&#44; coronary angiography findings and complications during hospitalization were collected&#46; Coronary angiography was performed in all patients&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">TTS was classified as apical&#44; midventricular&#44; basal or focal according to the LV ballooning pattern on the transthoracic echocardiogram&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">6</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Chronic kidney disease &#40;CKD&#41; was defined as glomerular filtration rate &#60;60 ml&#47;min for at least three months&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">QT interval was measured by each patient&#39;s cardiologist&#46; Corrected QT interval &#40;QTc&#41; was calculated using Bazett&#39;s formula and was defined as prolonged if &#62;450 ms for males and &#62;470 ms for females&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Transthoracic echocardiography was performed on admission&#44; at discharge and during follow-up&#46; Complete echocardiographic recovery was defined as the normalization of regional wall motion abnormalities present on the initial transthoracic echocardiogram&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The in-hospital complications included were acute heart failure&#44; cardiogenic shock&#44; new-onset atrial fibrillation &#40;AF&#41;&#44; ventricular fibrillation&#47;ventricular tachycardia&#44; complete atrioventricular block&#44; stroke&#47;transient ischemic attack &#40;TIA&#41;&#44; LV thrombus and death from any cause&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Acute heart failure was defined as the presence of dyspnea&#44; pulmonary edema and&#47;or oxygen desaturation requiring drug therapy and&#47;or mechanical support&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Cardiogenic shock was defined as systolic blood pressure &#60;90 mmHg with signs of tissue hypoperfusion requiring inotropic agents and&#47;or fluid therapy&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Follow-up data were obtained from clinical visits&#44; medical records and telephone interviews&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The follow-up analysis included all-cause mortality&#44; cardiovascular mortality and major cardiovascular events &#40;stroke&#47;TIA&#44; myocardial infarction and recurrence of TTS&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Cardiovascular mortality was defined as death caused by heart failure&#44; arrhythmia&#44; myocardial infarction&#44; cerebrovascular disease&#44; pulmonary embolism or sudden cardiac death&#46; Any death not covered by these definitions was defined as non-cardiovascular mortality&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Myocardial infarction was defined using the criteria of the third universal definition of myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0130" class="elsevierStylePara elsevierViewall">A descriptive analysis was carried out to characterize the sample profile&#46; Continuous variables are presented as means and standard deviation and categorical variables are presented as percentages&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The chi-square test was used to analyze associations between categorical variables&#44; and the Student&#39;s&#44; Mann-Whitney and Kruskal-Wallis tests were applied to continuous variables&#46; The Kolmogorov-Smirnov test was used to verify normality of distribution&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Binary logistic regression was used to measure predictors of in-hospital and follow-up events&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A p-value &#60;0&#46;05 &#40;significance level of 95&#37;&#41; was considered statistically significant&#46; The statistical analysis was performed using IBM SPSS version 24&#46;0&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Baseline characteristics of the study population</span><p id="par0150" class="elsevierStylePara elsevierViewall">The baseline characteristics of the study population are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">A total of 234 patients with TTS were included&#44; 210 &#40;89&#46;7&#37;&#41; female&#44; mean age 68&#177;12 years&#46; In 65&#37; of the patients a triggering factor was identified&#44; emotional stress in 46&#46;6&#37; and physical stress in 18&#46;4&#37;&#46; On admission&#44; chest pain was the most frequent symptom &#40;87&#46;2&#37;&#41;&#44; followed by dyspnea &#40;21&#46;8&#37;&#41; and syncope &#40;5&#46;6&#37;&#41;&#46; The admission electrocardiogram &#40;ECG&#41; revealed negative T waves in 40&#46;2&#37;&#44; ST-segment elevation in 17&#46;9&#37; and prolonged QTc in 10&#46;3&#37;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In 12&#46;9&#37; of the patients&#44; coronary angiography identified significant CAD in myocardial areas not corresponding to the wall motion abnormalities found on the transthoracic echocardiogram&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Regarding the classification of TTS&#44; the apical form was the most frequent &#40;77&#46;8&#37;&#41;&#44; followed by midventricular &#40;15&#46;8&#37;&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Clinical complications during hospitalization</span><p id="par0170" class="elsevierStylePara elsevierViewall">Complications and interventions during hospitalization are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">During hospitalization&#44; 32&#46;9&#37; of the patients had complications&#44; of which acute heart failure was the most frequent &#40;24&#46;4&#37;&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Regarding intensive care measures&#44; 8&#46;1&#37; of patients received inotropic support and 3&#46;4&#37; underwent mechanical ventilation&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">During hospitalization&#44; 49&#46;1&#37; of patients completely recovered LV function&#44; while five &#40;2&#46;2&#37;&#41; died&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Factors associated with complications were history of heart failure &#40;p&#60;0&#46;001&#41;&#44; CKD &#40;p&#61;0&#46;001&#41;&#44; physical stress as triggering factor &#40;p&#61;0&#46;036&#41;&#44; presentation without chest pain &#40;p&#61;0&#46;001&#41;&#44; presentation with dyspnea &#40;p&#60;0&#46;001&#41;&#44; presence of atherosclerotic lesions in the epicardial coronary arteries &#40;p&#61;0&#46;013&#41;&#44; and lower left ventricular ejection fraction &#40;LVEF&#41; on admission transthoracic echocardiography &#40;p&#60;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0195" class="elsevierStylePara elsevierViewall">In multivariate analysis&#44; the presence of atherosclerotic lesions in the coronary arteries &#40;p&#61;0&#46;027&#41;&#44; lower LVEF on admission &#40;p&#61;0&#46;003&#41;&#44; CKD &#40;p&#61;0&#46;02&#41; and clinical presentation with dyspnea &#40;p&#61;0&#46;019&#41; were independent predictors of in-hospital clinical complications &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Clinical complications during follow-up</span><p id="par0200" class="elsevierStylePara elsevierViewall">At the mean follow-up of 33&#177;33 months&#44; 12&#46;2&#37; of the patients had complications&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In 4&#46;4&#37; of patients there was recurrence of TTS&#44; 3&#46;1&#37; had stroke&#47;TIA and 0&#46;4&#37; had myocardial infarction&#46; All-cause mortality was 4&#46;4&#37; and cardiovascular mortality was 0&#46;9&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0210" class="elsevierStylePara elsevierViewall">Prolonged QTc on the admission ECG was associated with clinical complications at follow-up &#40;p&#61;0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0215" class="elsevierStylePara elsevierViewall">Our multicenter study of TTS patients is one of the largest and its follow-up is among the longest&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Baseline characteristics</span><p id="par0220" class="elsevierStylePara elsevierViewall">The baseline characteristics of our study population were similar to other series with respect to mean age of diagnosis &#40;68&#177;12 years&#41; and the predominance of female gender &#40;90&#37;&#41;&#46; TTS more frequently affects women over 50 years of age&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;12&#8211;14</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Regarding cardiovascular risk factors&#44; hypertension was the most prevalent &#40;68&#37;&#41;&#44; followed by dyslipidemia &#40;54&#37;&#41;&#46; The prevalence of these factors is in line with that expected for the age group of patients with TTS&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Only 18&#37; of our patients had been diagnosed with diabetes&#44; which is in agreement with the prevalence reported by other series &#40;5-25&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;12&#8211;17</span></a> Patients with TTS have a lower prevalence of diabetes compared to patients with acute coronary syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">18</span></a> It is not known whether the presence of diabetes is a protective factor for TTS&#44; but this is possible in view of the hypothesis that the autonomic neuropathy of diabetes may influence the myocardial response to an adrenergic storm&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Clinical presentation</span><p id="par0235" class="elsevierStylePara elsevierViewall">Chest pain is the most common form of clinical presentation of TTS&#46; In our cohort&#44; 87&#37; of the patients presents with chest pain&#44; as in the series by Eitel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">19</span></a> &#40;88&#37;&#41; and N&#250;&#241;ez-Gil et al&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">20</span></a> &#40;90&#46;2&#37;&#41;&#46; Other series reported slightly lower rates&#44; between 69&#37; and 81&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;13&#44;14&#44;17&#44;21</span></a> Dyspnea is the second most frequent symptom associated with TTS&#44; with a wide range of prevalences ranging between 8&#37; and 47&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;13&#44;14&#44;17&#44;21&#8211;24</span></a> In our cohort&#44; dyspnea was the predominant symptom in 21&#46;8&#37; of the patients&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">As for the triggering factor&#44; emotional stress was the most common &#40;46&#46;6&#37;&#41;&#44; as also observed in the studies by Yayehd et al&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">14</span></a> &#40;45&#37;&#41; and Prevital et al&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">23</span></a> &#40;36&#37;&#41;&#46; However&#44; other studies found that physical factors were more important than emotional factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;12&#44;13&#44;19&#44;25</span></a> In about one third of our patients&#44; no triggering factor was identified&#44; as in several published studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;12&#44;13&#44;23&#44;25</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Electrocardiogram</span><p id="par0245" class="elsevierStylePara elsevierViewall">Negative T waves were the most frequent finding on the admission ECG &#40;40&#46;2&#37;&#41;&#46; Other series reported similar rates&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;19&#44;20&#44;23</span></a> However&#44; there are some differences between our data and the literature with regard to ST-segment elevation&#46; In our study&#44; only 17&#46;9&#37; of patients had ST-segment elevation&#44; but other series reported higher rates &#40;38-44&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;19&#44;23</span></a> In our cohort&#44; 17&#46;9&#37; of the patients had pathological Q waves on the admission ECG&#44; while in Yayehd et al&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">14</span></a> and Schneider et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">21</span></a> this figure was 29&#37;&#46; In the study by Schneider et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">21</span></a> pathological Q waves were a predictor of complications during hospitalization&#46; However&#44; further studies are needed to understand their prognostic impact in TTS patients&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Prolonged QTc was found in 10&#46;3&#37; of our patients on the initial ECG&#46; Some studies have reported an association between TTS and prolonged QTc&#44; however the prevalence of this association is unknown&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">26&#8211;29</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">Electrocardiographic changes in TTS are dynamic and differences in time from symptom onset to admission may explain the discrepancies between studies&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Biomarkers of myocardial necrosis</span><p id="par0260" class="elsevierStylePara elsevierViewall">The majority of our TTS patients had troponin elevation during hospitalization &#40;89&#46;7&#37;&#41;&#44; which is in line with other published series&#44; although these use different types of troponin with different units of measurement&#44; which hampers comparisons of the extent of elevation and consequently the interpretation of its clinical significance&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;14&#44;16&#44;17&#44;19&#44;23&#44;24</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Left ventricular ejection fraction</span><p id="par0265" class="elsevierStylePara elsevierViewall">TTS is characterized by the presence of LV systolic dysfunction at hospital admission&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">7</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">In our population&#44; mean LVEF on admission was similar to other series &#40;43&#177;11&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;14&#44;17&#44;20&#44;23&#44;30</span></a> This suggests that patients with TTS suffer myocardial stunning of similar magnitude&#44; regardless of differences in other clinical variables&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">At hospital discharge&#44; 49&#46;1&#37; of the patients showed recovery of myocardial function&#44; which was complete in all patients at follow-up&#44; in accordance with the diagnostic criteria of TTS&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Classification of Takotsubo syndrome</span><p id="par0280" class="elsevierStylePara elsevierViewall">Concerning the classification of TTS&#44; the apical type was the most frequent &#40;77&#46;8&#37;&#41; followed by midventricular &#40;15&#46;8&#37;&#41; and basal &#40;1&#46;7&#37;&#41;&#44; similar findings to those in other series&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;24&#44;30</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Coronary artery disease</span><p id="par0285" class="elsevierStylePara elsevierViewall">TTS and CAD are not mutually exclusive&#46; Given the mean age at diagnosis and the prevalence of cardiovascular risk factors&#44; CAD can coexist with TTS&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">31</span></a> In our cohort&#44; 12&#46;9&#37; of patients had concomitant CAD&#46; In the literature&#44; reported rates are between 9&#46;8&#37; and 19&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;25&#44;31&#8211;34</span></a></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Clinical complications during hospitalization</span><p id="par0290" class="elsevierStylePara elsevierViewall">Initially&#44; TTS was described as a benign condition&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">2</span></a> However&#44; more recent series have shown high rates of in-hospital complications that should not be overlooked &#40;21&#46;8-52&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;21&#44;22&#44;30&#44;35&#44;36</span></a></p><p id="par0295" class="elsevierStylePara elsevierViewall">In our population&#44; 32&#46;9&#37; of patients presented complications&#44; of which acute heart failure was the most common &#40;24&#46;4&#37;&#41;&#46; In fact&#44; acute heart failure is the main clinical complication in TTS&#44; with rates reported in the literature between 16&#37; and 44&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">15&#8211;17&#44;20&#44;25&#44;35&#44;37</span></a></p><p id="par0300" class="elsevierStylePara elsevierViewall">In the heart failure spectrum&#44; cardiogenic shock is the most severe manifestation&#46; In our study&#44; this complication occurred in 8&#46;1&#37; of patients&#44; while other studies report rates between 4&#46;7&#37; and 12&#46;4&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;13&#44;15&#44;30&#44;34&#44;36</span></a> Due to the reversibility of LV dysfunction&#44; it could be expected that cardiogenic shock in TTS would have a lower prognostic impact than in ACS&#44; but Stiermaier et al&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">30</span></a> demonstrated that it is associated with higher short- and long-term mortality&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">AF was the most common arrhythmia in our cohort&#44; being found in 15&#37; of our patients&#44; with other series reporting rates between 6&#37; and 15&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">13&#44;21&#44;24&#44;38&#44;39</span></a> El-Battrawy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">39</span></a> demonstrated that the presence of previously known or first diagnosed AF is associated with higher mortality&#44; both in-hospital and in long-term follow-up&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">In our population&#44; 2&#46;6&#37; of the patients had ventricular arrhythmias&#44; a lower figure than in other series&#44; such as Citro et al&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">37</span></a> &#40;4&#46;5&#37;&#41; and Schneider et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">21</span></a> &#40;8&#37;&#41;&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">Complete atrioventricular block&#44; stroke and LV thrombus are less frequent clinical complications&#44; with rates ranging from 0&#46;6&#37; to 3&#46;8&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;15&#44;21&#44;23&#44;37&#44;40</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Predictors of in-hospital clinical complications</span><p id="par0320" class="elsevierStylePara elsevierViewall">In our cohort&#44; a history of CKD &#40;p&#61;0&#46;02&#41;&#44; clinical presentation with dyspnea &#40;p&#61;0&#46;019&#41;&#44; atherosclerotic lesions in the epicardial coronary arteries&#44; and lower LVEF on admission &#40;p&#61;0&#46;003&#41; were predictors of in-hospital clinical complications&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">CKD is known to be associated with worse cardiovascular prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">41</span></a> However&#44; to our knowledge&#44; this association has not yet been reported in TTS&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">To our knowledge&#44; our work is the first to identify CAD as a predictor of in-hospital complications in patients with TTS&#46; Parodi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">31</span></a> found no differences in short- and medium-term prognosis in patients with CAD&#44; whereas Bill et al&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">33</span></a> identified this factor as a predictor of medium-term all-cause mortality&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">LV systolic dysfunction would be expected to be associated with a worse outcome&#46; In the study by Citro et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">24</span></a> LVEF was a predictor of heart failure&#44; and in series by Schneider et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">21</span></a> and Ribeiro et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">22</span></a> LVEF of &#8804;30&#37; and &#8804;35&#37;&#44; respectively&#44; predicted in-hospital complications&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">Templin et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">6</span></a> studying 1750 patients&#44; identified LVEF on admission&#44; physical stress&#44; troponin level and neurological or psychiatric disease as predictors of complications&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">Other series&#44; with significantly smaller numbers of patients&#44; have identified other predictors&#44; such as the presence of pathological Q waves on admission&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">21</span></a> age &#8805;75 years&#44;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">37</span></a> brain natriuretic peptide and white blood cell count&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">25</span></a> heart rate&#44; and sum of ST-segment elevation on the 12-lead ECG&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">25</span></a></p><p id="par0350" class="elsevierStylePara elsevierViewall">Differences in sample sizes and in the characteristics of study populations result in the identification of different predictors of complications&#46; This makes it difficult to accurately stratify in-hospital risk for TTS patients&#46;</p><p id="par0355" class="elsevierStylePara elsevierViewall">Our series constitutes the second largest series of TTS patients in which predictors of in-hospital complications are identified&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">In-hospital mortality</span><p id="par0360" class="elsevierStylePara elsevierViewall">In-hospital mortality in our population was 2&#46;2&#37;&#44; a relatively low figure considering the high rate of acute complications&#46; Other studies report rates between 0&#37; and 12&#46;2&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;13&#8211;16&#44;21&#44;24&#44;25&#44;32&#44;42&#44;43</span></a></p><p id="par0365" class="elsevierStylePara elsevierViewall">Asian series<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">25&#44;32&#44;42&#44;43</span></a> have higher mortality &#40;8&#46;4-12&#46;2&#37;&#41;&#44; probably due to differences in the baseline characteristics of the included patients&#44; such as higher percentages of male gender and physical stress as a triggering factor&#46; In support of this hypothesis&#44; Sobue et al&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">42</span></a> identified male gender and physical stress as predictors of in-hospital mortality&#46; Beyond these factors&#44; it has been demonstrated that in-hospital mortality is associated with underlying serious illness such as sepsis&#44; acute renal injury&#44; respiratory failure and cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">15&#44;42</span></a></p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Prognosis in follow-up</span><p id="par0370" class="elsevierStylePara elsevierViewall">The medium and long-term prognosis of TTS patients is described as favorable&#44; with rapid and complete recovery of LV systolic function&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">7&#44;19&#44;44</span></a></p><p id="par0375" class="elsevierStylePara elsevierViewall">Patients in our study had a good prognosis at the mean follow-up of 33&#177;33 months&#44; with all-cause mortality of 4&#46;4&#37;&#46; Other studies&#44; with different follow-up times&#44; reported all-cause mortality between 2&#46;9&#37; and 24&#46;7&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">13&#44;16&#44;17&#44;22&#44;43&#44;45&#8211;47</span></a> In our study&#44; most deaths were from non-cardiac causes &#40;3&#46;5&#37; of the sample&#41;&#46; Other series have also shown that medium- and long-term mortality of TTS patients is more often due to non-cardiac causes than to the syndrome itself&#46; Thus&#44; comorbidities significantly affect the prognosis of these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">13&#44;40&#44;45</span></a></p><p id="par0380" class="elsevierStylePara elsevierViewall">The recurrence rate of TTS was 4&#46;4&#37;&#46; Other series have reported rates between 0&#37; and 11&#46;4&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">6&#44;13&#44;14&#44;16&#44;17&#44;23&#44;47</span></a> Elesber et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">17</span></a> in a study of 100 patients with TTS&#44; observed recurrence in 11&#46;4&#37; at four years of follow-up&#46; Lower rates are reported by series with shorter follow-up&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">13&#44;14&#44;23</span></a></p><p id="par0385" class="elsevierStylePara elsevierViewall">Regarding cardiovascular and cerebrovascular events&#44; in our study 3&#46;1&#37; of patients had stroke&#47;TIA and 0&#46;4&#37; had myocardial infarction&#46; In Templin et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">6</span></a> the rate of major cardiovascular and cerebrovascular events was 9&#46;9&#37;&#47;year and the rate of stroke&#47;TIA was 1&#46;7&#37;&#47;year&#46;</p><p id="par0390" class="elsevierStylePara elsevierViewall">The observed variability in mortality and clinical complications is related to the number of patients included and the follow-up times in the different series&#46;</p><p id="par0395" class="elsevierStylePara elsevierViewall">In our study&#44; prolonged QTc on admission was associated with events in follow-up &#40;p&#61;0&#46;001&#41;&#46; Some studies have observed an association between TTS and prolonged QTc&#44; but there is little evidence on its prognostic impact&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">26&#44;28&#44;43</span></a></p><p id="par0400" class="elsevierStylePara elsevierViewall">Song et al&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">43</span></a> found that patients with long QTc presented a higher prevalence of cardiogenic shock and ventricular arrhythmias and lower LVEF compared to the group with normal QT interval&#46; Similarly&#44; Imran et al&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">28</span></a> demonstrated that prolonged QTc was associated with in-hospital clinical complications&#46;</p></span></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Limitations</span><p id="par0405" class="elsevierStylePara elsevierViewall">Certain limitations should be borne in mind when assessing our results&#46; This was a retrospective observational study and as such is subject to inherent bias&#46; However&#44; it is a multicenter study with a significant number of patients&#46; The small number of events at follow-up meant it was not possible to identify predictors of medium-term prognosis or of in-hospital and follow-up mortality&#46; In this study&#44; treatment administered on admission and during follow-up was not analyzed&#44; which is a limitation&#46; The centers participating in the study did not routinely use laboratory hormone tests or imaging to exclude pheochromocytoma or myocarditis&#46; The degree of coronary stenosis was not assessed by fractional flow reserve&#44; nor were atherosclerotic plaques characterized by intravascular ultrasound or optical coherence tomography&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Conclusion</span><p id="par0410" class="elsevierStylePara elsevierViewall">Our study confirms the low mortality associated with TTS&#46; However&#44; the high rate of in-hospital complications shows that TTS is not as benign as previously described&#46; In our study&#44; CKD&#44; clinical presentation with dyspnea&#44; CAD and lower LVEF on admission were predictors of in-hospital clinical complications&#46;</p><p id="par0415" class="elsevierStylePara elsevierViewall">In the medium term&#44; TTS has a good prognosis&#44; with low rates of mortality&#44; stroke and recurrence&#46; Mortality at follow-up is predominantly due to non-cardiac causes&#46; Prolonged QTc on admission was associated with complications at follow-up&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Conflicts of interest</span><p id="par0420" class="elsevierStylePara elsevierViewall">SUNSHINE is supported by BIAL&#44; MSD&#44; Shire&#44; Pfizer&#44; BMS and Trigenius&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres1270538"
          "titulo" => "Abstract"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Aim"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Methods"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Results"
            ]
            4 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1175808"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1270537"
          "titulo" => "Resumo"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Introdu&#231;&#227;o"
            ]
            1 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Objetivo"
            ]
            2 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "M&#233;todos"
            ]
            3 => array:2 [
              "identificador" => "abst0045"
              "titulo" => "Resultados"
            ]
            4 => array:2 [
              "identificador" => "abst0050"
              "titulo" => "Conclus&#227;o"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1175809"
          "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" => "Patient population"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Data collection"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Results"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Baseline characteristics of the study population"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Clinical complications during hospitalization"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Clinical complications during follow-up"
            ]
          ]
        ]
        7 => array:3 [
          "identificador" => "sec0050"
          "titulo" => "Discussion"
          "secciones" => array:11 [
            0 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Baseline characteristics"
            ]
            1 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Clinical presentation"
            ]
            2 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Electrocardiogram"
            ]
            3 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Biomarkers of myocardial necrosis"
            ]
            4 => array:2 [
              "identificador" => "sec0075"
              "titulo" => "Left ventricular ejection fraction"
            ]
            5 => array:2 [
              "identificador" => "sec0080"
              "titulo" => "Classification of Takotsubo syndrome"
            ]
            6 => array:2 [
              "identificador" => "sec0085"
              "titulo" => "Coronary artery disease"
            ]
            7 => array:2 [
              "identificador" => "sec0090"
              "titulo" => "Clinical complications during hospitalization"
            ]
            8 => array:2 [
              "identificador" => "sec0095"
              "titulo" => "Predictors of in-hospital clinical complications"
            ]
            9 => array:2 [
              "identificador" => "sec0100"
              "titulo" => "In-hospital mortality"
            ]
            10 => array:2 [
              "identificador" => "sec0105"
              "titulo" => "Prognosis in follow-up"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0110"
          "titulo" => "Limitations"
        ]
        9 => array:2 [
          "identificador" => "sec0115"
          "titulo" => "Conclusion"
        ]
        10 => array:2 [
          "identificador" => "sec0120"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:2 [
          "identificador" => "xack436057"
          "titulo" => "Acknowledgments"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-02-03"
    "fechaAceptado" => "2018-07-18"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1175808"
          "palabras" => array:5 [
            0 => "Takotsubo syndrome"
            1 => "Complications"
            2 => "Mortality"
            3 => "Prognosis"
            4 => "Follow-up"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec1175809"
          "palabras" => array:5 [
            0 => "S&#237;ndrome de Takotsubo"
            1 => "Complica&#231;&#245;es"
            2 => "Progn&#243;stico"
            3 => "Mortalidade"
            4 => "<span class="elsevierStyleItalic">Follow-up</span>"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Takotsubo syndrome &#40;TTS&#41; is characterized by transient left ventricular &#40;LV&#41; systolic dysfunction&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Aim</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To characterize a Portuguese population with TTS and to determine their short- and medium-term prognosis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We conducted a multicenter study in Portuguese hospitals that included all patients diagnosed with TTS&#44; initially retrospectively and subsequently prospectively&#46; Short- and medium-term clinical complications and mortality were assessed&#46; Independent predictors of in-hospital complications and prognostic factors were determined&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 234 patients &#40;210 female&#44; age 68&#177;12 years&#41; were included&#46; During hospitalization&#44; 32&#46;9&#37; of patients had complications&#58; acute heart failure &#40;24&#46;4&#37;&#41;&#44; atrial fibrillation &#40;9&#46;0&#37;&#41;&#44; ventricular arrhythmias &#40;2&#46;6&#37;&#41;&#44; complete atrioventricular block &#40;2&#46;1&#37;&#41;&#44; stroke&#47;transient ischemic attack &#40;1&#46;7&#37;&#41;&#44; and LV thrombus &#40;1&#46;3&#37;&#41;&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Chronic kidney disease &#40;CKD&#41; &#40;p&#61;0&#46;02&#41;&#44; coronary artery disease &#40;CAD&#41; &#40;p&#61;0&#46;027&#41;&#44; lower LV ejection fraction &#40;LVEF&#41; on admission &#40;p&#61;0&#46;003&#41;&#44; and dyspnea at presentation &#40;p&#61;0&#46;019&#41; were predictors of in-hospital complications&#46; In-hospital mortality was 2&#46;2&#37;&#46; At the mean follow-up of 33&#177;33 months&#44; all-cause mortality was 4&#46;4&#37;&#44; cardiovascular mortality was 0&#46;9&#37; and TTS recurrence was 4&#46;4&#37;&#46; Prolonged QTc interval on admission was associated with complications in follow-up &#40;p&#61;0&#46;001&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">TTS has a good short- and medium-term prognosis&#46; However&#44; the rate of in-hospital complications is high and should not be overlooked&#46; Dyspnea at presentation&#44; CKD&#44; CAD and lower LVEF on admission were independent predictors of in-hospital complications&#46; Prolonged QTc on admission was associated with complications in follow-up&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Aim"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introdu&#231;&#227;o</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A s&#237;ndrome de Takotsubo &#40;TTS&#41; caracteriza-se por disfun&#231;&#227;o sist&#243;lica ventricular esquerda transit&#243;ria&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Caracterizar uma popula&#231;&#227;o portuguesa com TTS e determinar o seu progn&#243;stico a curto e m&#233;dio prazo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudo multic&#234;ntrico portugu&#234;s com inclus&#227;o retrospetiva e prospetiva de todos os doentes diagnosticados com TTS&#46; Foram avaliadas as complica&#231;&#245;es cl&#237;nicas e a mortalidade a curto e m&#233;dio prazo&#46; Determinaram-se os preditores independentes de complica&#231;&#245;es intra-hospitalares e os fatores associados ao progn&#243;stico&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Foram inclu&#237;dos 234 doentes &#40;210 mulheres&#44; 68&#177;12 anos&#41;&#46; Durante o internamento&#44; 32&#44;9&#37; dos doentes apresentaram complica&#231;&#245;es cl&#237;nicas&#58; insufici&#234;ncia card&#237;aca &#40;24&#44;4&#37;&#41;&#44; fibrilha&#231;&#227;o auricular &#40;9&#44;0&#37;&#41;&#44; arritmias ventriculares &#40;2&#44;6&#37;&#41;&#44; bloqueio auriculoventricular completo &#40;2&#44;1&#37;&#41;&#44; acidente vascular cerebral&#47;acidente isqu&#233;mico transit&#243;rio &#40;1&#44;7&#37;&#41; e trombo no ventr&#237;culo esquerdo &#40;1&#44;3&#37;&#41;&#46; Doen&#231;a renal cr&#243;nica &#40;DRC&#41; &#40;p&#61;0&#44;02&#41;&#44; apresenta&#231;&#227;o com dispneia &#40;p&#61;0&#44;019&#41;&#44; presen&#231;a de doen&#231;a arterial coron&#225;ria &#40;DAC&#41; &#40;p&#61;0&#44;027&#41; e menor fra&#231;&#227;o de eje&#231;&#227;o ventricular esquerda &#40;FEVE&#41; na admiss&#227;o &#40;p&#61;0&#44;003&#41; foram preditores independentes de complica&#231;&#245;es intra-hospitalares&#46; A taxa de mortalidade intra-hospitalar foi de 2&#44;2&#37;&#46; No <span class="elsevierStyleItalic">follow-up</span> m&#233;dio de 33&#177; 33 meses&#44; a taxa de mortalidade global foi de 4&#44;4&#37;&#44; 0&#44;9&#37; de causa card&#237;aca&#46; A taxa de recorr&#234;ncia de TTS foi 4&#44;4&#37;&#46; O prolongamento do intervalo QTc na admiss&#227;o associou-se a complica&#231;&#245;es cl&#237;nicas no <span class="elsevierStyleItalic">follow-up</span> &#40;p&#61;0&#44;001&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclus&#227;o</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A TTS tem bom progn&#243;stico a curto e a m&#233;dio prazo&#46; Contudo&#44; a taxa de complica&#231;&#245;es intra-hospitalares &#233; elevada e n&#227;o deve ser menosprezada&#46; A DRC&#44; apresenta&#231;&#227;o como dispneia&#44; DAC concomitante e menor FEVE na admiss&#227;o s&#227;o preditores de complica&#231;&#245;es intra-hospitalares&#46; O prolongamento do intervalo QTc na admiss&#227;o associou-se a complica&#231;&#245;es no <span class="elsevierStyleItalic">follow-up</span>&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introdu&#231;&#227;o"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "M&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CKD&#58; chronic kidney disease&#59; COPD&#58; chronic obstructive pulmonary disease&#59; LBBB&#58; left bundle branch block&#59; LVEF&#58; left ventricular ejection fraction&#59; LVOT&#58; left ventricular outflow tract&#59; MI&#58; myocardial infarction&#59; QTc&#58; corrected QT interval&#59; TTE&#58; transthoracic echocardiogram&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Information presented as mean &#177; standard deviation or n &#40;&#37;&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Demographic data</span></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"><span class="elsevierStyleHsp" style=""></span>Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#177;12&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Female gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">210 &#40;89&#46;7&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Women aged over 50 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">192 &#40;91&#46;3&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Postmenopausal women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">168 &#40;80&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cardiovascular risk factors</span></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"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">159 &#40;67&#46;9&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127 &#40;54&#46;3&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;18&#46;8&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;14&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Personal history</span></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"><span class="elsevierStyleHsp" style=""></span>Angina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;8&#46;1&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>CKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;6&#46;4&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;4&#46;7&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Anemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;3&#46;4&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#46;6&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Valvular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#46;6&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>MI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-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"><span class="elsevierStyleItalic">Triggering factor</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">152 &#40;65&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Emotional stress&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109 &#40;46&#46;6&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Physical stress&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;18&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Clinical presentation</span></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"><span class="elsevierStyleHsp" style=""></span>Chest pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">204 &#40;87&#46;2&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Dyspnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;21&#46;8&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Syncope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-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"><span class="elsevierStyleItalic">Killip class &#8805;2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;21&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Electrocardiogram</span></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"><span class="elsevierStyleHsp" style=""></span>Sinus rhythm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">216 &#40;92&#46;3&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Negative T waves&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 &#40;40&#46;2&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>ST-segment elevation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;17&#46;9&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Pathological Q waves&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;17&#46;9&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Prolonged QTc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;10&#46;3&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>ST-segment depression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;9&#46;0&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>LBBB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-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"><span class="elsevierStyleItalic">Elevated troponin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">208 &#40;89&#46;7&#41;&nbsp;\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"><span class="elsevierStyleItalic">No significant CAD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">195 &#40;87&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TTE</span></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"><span class="elsevierStyleHsp" style=""></span>LVEF&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#177;11&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Significant &#40;grade 3-4&#41; mitral regurgitation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;3&#46;8&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>LVOT obstruction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;3&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Classification</span></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"><span class="elsevierStyleHsp" style=""></span>Apical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">182 &#40;77&#46;8&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Midventricular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;15&#46;8&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Basal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;4&#46;7&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Focal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-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"><span class="elsevierStyleItalic">Hospital stay&#44; days</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#177;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2173415.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of patients with Takotsubo syndrome &#40;n&#61;234&#41;&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">AV&#58; atrioventricular&#59; LV&#58; left ventricular&#59; TIA&#58; transient ischemic attack&#59; VF ventricular fibrillation&#59; VT&#58; ventricular tachycardia&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Information presented as n &#40;&#37;&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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"><span class="elsevierStyleItalic">Clinical complications</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;32&#46;9&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Acute heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57 &#40;24&#46;4&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>New-onset atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;9&#46;0&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Cardiogenic shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;8&#46;1&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>VT&#47;VF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#46;6&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;2&#46;2&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Complete AV block&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;2&#46;1&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Stroke&#47;TIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;1&#46;7&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>LV thrombus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Interventions</span></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"><span class="elsevierStyleHsp" style=""></span>Inotropic support&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;8&#46;1&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Mechanical ventilation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;3&#46;4&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Temporary pacemaker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2173416.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Clinical complications and interventions during hospitalization &#40;n&#61;234&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; CKD&#58; chronic kidney disease&#59; LVEF&#58; left ventricular ejection fraction&#59; OR&#58; odds ratio&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">&nbsp;\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">No complications&nbsp;\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">Complications&nbsp;\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&nbsp;\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">Unadjusted OR &#40;95&#37; CI&#41;&nbsp;\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">History of heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\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">CKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;4 &#40;1&#46;96-20&#46;75&#41;&nbsp;\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">Physical stress&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;0 &#40;1&#46;04-4&#46;01&#41;&nbsp;\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">Chest pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;27 &#40;0&#46;12-0&#46;60&#41;&nbsp;\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">Dyspnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;2 &#40;2&#46;67-9&#46;99&#41;&nbsp;\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">Atherosclerotic coronary lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;7 &#40;1&#46;21-5&#46;87&#41;&nbsp;\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">LVEF on admission&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#177;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#177;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;3&#46;98-11&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2173411.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Variables associated with clinical complications during hospitalization&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; CKD&#58; chronic kidney disease&#59; LVEF&#58; left ventricular ejection fraction&#59; OR&#58; odds ratio&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">&nbsp;\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&nbsp;\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">Adjusted OR &#40;95&#37; CI&#41;&nbsp;\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">CKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;99 &#40;1&#46;39-45&#46;79&#41;&nbsp;\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">Dyspnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;82 &#40;1&#46;25-11&#46;7&#41;&nbsp;\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">Atherosclerotic coronary lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;87 &#40;1&#46;17- 12&#46;76&#41;&nbsp;\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">LVEF on admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;93 &#40;0&#46;89-0&#46;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2173414.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Predictors of in-hospital clinical complications&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">TIA&#58; transient ischemic attack&#59; TTS&#58; Takotsubo syndrome&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Information presented as n &#40;&#37;&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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">All-cause mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;4&#46;4&#41;&nbsp;\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">Non-cardiovascular mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;3&#46;5&#41;&nbsp;\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">Cardiovascular mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#46;9&#41;&nbsp;\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">TTS recurrence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;4&#46;4&#41;&nbsp;\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">Stroke&#47;TIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;3&#46;1&#41;&nbsp;\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">Myocardial infarction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2173413.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Clinical complications at follow-up &#40;n&#61;229&#41;&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at6"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; OR&#58; odds ratio&#59; QTc&#58; corrected QT interval&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><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">&nbsp;\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">No clinical complications&nbsp;\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">Clinical complications&nbsp;\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">p&nbsp;\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">Unadjusted OR &#40;95&#37; CI&#41;&nbsp;\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">Prolonged QTc on admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;6 &#40;1&#46;76-12&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2173412.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Variables associated with clinical complications at follow-up&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:47 [
            0 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Takotsubo-type cardiomyopathy due to multivessel spasm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Sato"
                            1 => "H&#46; Tateishi"
                            2 => "T&#46; Uchida"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "editores" => "K&#46;Kodama, K&#46;Haze, M&#46;Hon"
                        "titulo" => "Clinical aspect of myocardial injury&#58; from ischemia to heart failure"
                        "paginaInicial" => "56"
                        "paginaFinal" => "64"
                        "serieFecha" => "1990"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Apical ballooning syndrome or takotsubo cardiomyopathy&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Gianni"
                            1 => "F&#46; Dentali"
                            2 => "A&#46;M&#46; Grandi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehl032"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2006"
                        "volumen" => "27"
                        "paginaInicial" => "1523"
                        "paginaFinal" => "1529"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16720686"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Madhavan"
                            1 => "A&#46; Prasad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00059-010-3339-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Herz"
                        "fecha" => "2010"
                        "volumen" => "35"
                        "paginaInicial" => "240"
                        "paginaFinal" => "243"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20582391"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "4"
              "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2016"
                        "volumen" => "18"
                        "paginaInicial" => "8"
                        "paginaFinal" => "27"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Takotsubo cardiomyopathy&#58; a new form of acute&#44; reversible heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "Y&#46;J&#46; Akashi"
                            1 => "D&#46;S&#46; Goldstein"
                            2 => "G&#46; Barbaro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.108.767012"
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2008"
                        "volumen" => "118"
                        "paginaInicial" => "2754"
                        "paginaFinal" => "2762"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19106400"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S147444220670415X"
                          "estado" => "S300"
                          "issn" => "14744422"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "6"
              "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Apical ballooning syndrome &#40;Tako-Tsubo or stress cardiomyopathy&#41;&#58; a mimic of acute myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Prasad"
                            1 => "A&#46; Lerman"
                            2 => "C&#46;S&#46; Rihal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ahj.2007.11.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2008"
                        "volumen" => "155"
                        "paginaInicial" => "408"
                        "paginaFinal" => "417"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18294473"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Takotsubo cardiomyopathy&#58; overview"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46; Bossone"
                            1 => "G&#46; Savarese"
                            2 => "F&#46; Ferrara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hfc.2012.12.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Fail Clin"
                        "fecha" => "2013"
                        "volumen" => "9"
                        "paginaInicial" => "249"
                        "paginaFinal" => "266"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23562126"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "K&#47;DOQI clinical practice guidelines for chronic kidney disease&#58; evaluation&#44; classification&#44; and stratification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "National Kidney Foundation"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Kidney Dis"
                        "fecha" => "2002"
                        "volumen" => "39"
                        "paginaInicial" => "S1"
                        "paginaFinal" => "S266"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11904577"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An analysis of the time-relations of the electrocardiograms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;C&#46; Bazett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Heart"
                        "fecha" => "1920"
                        "volumen" => "7"
                        "paginaInicial" => "353"
                        "paginaFinal" => "370"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Third universal definition of myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Thygesen"
                            1 => "J&#46;S&#46; Alpert"
                            2 => "A&#46;S&#46; Jaffe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e31826e1058"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2012"
                        "volumen" => "126"
                        "paginaInicial" => "2020"
                        "paginaFinal" => "2035"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22923432"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic usefulness of the ballooning pattern in patients with Takotsubo cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Stiermaier"
                            1 => "C&#46; M&#246;ller"
                            2 => "T&#46; Graf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2016.08.055"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2016"
                        "volumen" => "118"
                        "paginaInicial" => "1737"
                        "paginaFinal" => "1741"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27670792"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Natural history of tako-tsubo cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Parodi"
                            1 => "B&#46; Bellandi"
                            2 => "S&#46; Del Pace"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.10-1041"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2011"
                        "volumen" => "139"
                        "paginaInicial" => "887"
                        "paginaFinal" => "892"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20884730"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of Takotsubo cardiomyopathy in non-academic hospitals in France&#58; the Observational French SyndromEs of TakoTsubo &#40;OFFSET&#41; study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Yayehd"
                            1 => "N&#46; N&#8217;da"
                            2 => "L&#46; Belle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.acvd.2015.08.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Cardiovasc Dis"
                        "fecha" => "2016"
                        "volumen" => "109"
                        "paginaInicial" => "4"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26507532"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "In-hospital mortality among patients with takotsubo cardiomyopathy&#58; a study of the National Inpatient Sample 2008 to 2009"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46; Brinjikji"
                            1 => "A&#46; El-Sayed"
                            2 => "S&#46; Salka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ahj.2012.04.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J"
                        "fecha" => "2012"
                        "volumen" => "164"
                        "paginaInicial" => "215"
                        "paginaFinal" => "221"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22877807"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of short- and long-term outcomes of takotsubo cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Gopalakrishnan"
                            1 => "A&#46; Hassan"
                            2 => "D&#46; Villines"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2015.08.024"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2015"
                        "volumen" => "116"
                        "paginaInicial" => "1586"
                        "paginaFinal" => "1590"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26431577"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Four-year recurrence rate and prognosis of the apical ballooning syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Elesber"
                            1 => "A&#46; Prasad"
                            2 => "R&#46; Lennon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2007.03.050"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2007"
                        "volumen" => "50"
                        "paginaInicial" => "448"
                        "paginaFinal" => "452"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17662398"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low prevalence of diabetes mellitus in patients with Takotsubo syndrome&#58; a plausible &#8216;protective&#8217; effect with pathophysiologic connotations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;E&#46; Madias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/2048872615570761"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J Acute Cardiovasc Care"
                        "fecha" => "2016"
                        "volumen" => "5"
                        "paginaInicial" => "164"
                        "paginaFinal" => "170"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25673782"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics and cardiovascular magnetic resonance findings in stress &#40;takotsubo&#41; cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I&#46; Eitel"
                            1 => "F&#46; von Knobelsdorff-Brenkenhoff"
                            2 => "P&#46; Bernhardt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2011.992"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2011"
                        "volumen" => "306"
                        "paginaInicial" => "277"
                        "paginaFinal" => "286"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21771988"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    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 [
                            0 => "I&#46;J&#46; N&#250;&#241;ez Gil"
                            1 => "M&#46; Andr&#233;s"
                            2 => "M&#46; 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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications in the clinical course of tako-tsubo cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Schneider"
                            1 => "A&#46; Athanasiadis"
                            2 => "J&#46; Schwab"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2014.07.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2014"
                        "volumen" => "176"
                        "paginaInicial" => "199"
                        "paginaFinal" => "205"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25049018"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Short and long-term outcome of stress-induced cardiomyopathy&#58; what can we expect&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "V&#46;F&#46; Ribeiro"
                            1 => "M&#46; Vasconcelos"
                            2 => "F&#46; Mel&#227;o"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics and outcome of left ventricular balloooning syndrome in a European population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Previtali"
                            1 => "A&#46; Repetto"
                            2 => "R&#46; Camporotondo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2010.08.055"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2011"
                        "volumen" => "107"
                        "paginaInicial" => "120"
                        "paginaFinal" => "125"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21146699"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Echocardiographic correlates of acute heart failure cardiogenic shock&#44; and in-hospital mortality in Tako-Tsubo cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Citro"
                            1 => "F&#46; Rigo"
                            2 => "A&#46; D&#8217;Andrea"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcmg.2013.09.020"
                      "Revista" => array:6 [
                        "tituloSerie" => "JACC Cardiovasc Imaging"
                        "fecha" => "2014"
                        "volumen" => "7"
                        "paginaInicial" => "119"
                        "paginaFinal" => "129"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24412188"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characterization of predictors of in-hospital cardiac complications of takotsubo cardiomyopathy&#58; multi-center registry from Tokyo CCU Network"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Murakami"
                            1 => "T&#46; Yoshikawa"
                            2 => "Y&#46; Maekawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jjcc.2013.09.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cardiol"
                        "fecha" => "2014"
                        "volumen" => "63"
                        "paginaInicial" => "269"
                        "paginaFinal" => "273"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24139869"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acquired long QT syndrome from stress cardiomyopathy is associated with ventricular arrhythmias and torsades de pointes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Madias"
                            1 => "T&#46;P&#46; Fitzgibbons"
                            2 => "A&#46;A&#46; Alsheikh-Ali"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hrthm.2010.12.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Rhythm"
                        "fecha" => "2011"
                        "volumen" => "8"
                        "paginaInicial" => "555"
                        "paginaFinal" => "561"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21146632"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The QT prolongation and clinical features in patients with takotsubo cardiomyopathy&#58; experiences of two tertiary cardiovascular centers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;G&#46; Song"
                            1 => "S&#46;M&#46; Chung"
                            2 => "S&#46;H&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5152/akd.2013.4745"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anadolu Kardiyol Derg"
                        "fecha" => "2014"
                        "volumen" => "14"
                        "paginaInicial" => "162"
                        "paginaFinal" => "169"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24449633"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "QT prolongation and clinical outcomes in patients with Takotsubo cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46;F&#46; Imran"
                            1 => "I&#46; Rahman"
                            2 => "S&#46; Dikdan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pace.12864"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pacing Clin Electrophysiol"
                        "fecha" => "2016"
                        "volumen" => "39"
                        "paginaInicial" => "607"
                        "paginaFinal" => "611"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27062153"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical significance of changes in the corrected QT interval in stress-induced cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;H&#46; Lee"
                            1 => "J&#46;S&#46; Uhm"
                            2 => "D&#46;G&#46; Shin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3904/kjim.2015.330"
                      "Revista" => array:6 [
                        "tituloSerie" => "Korean J Intern Med"
                        "fecha" => "2016"
                        "volumen" => "31"
                        "paginaInicial" => "507"
                        "paginaFinal" => "516"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27052264"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence&#44; determinants and prognostic relevance of cardiogenic shock in patients with Takotsubo cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Stiermaier"
                            1 => "C&#46; Eitel"
                            2 => "S&#46; Desch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/2048872615612456"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J Acute Cardiovasc Care"
                        "fecha" => "2016"
                        "volumen" => "5"
                        "paginaInicial" => "489"
                        "paginaFinal" => "496"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26474843"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tako-tsubo cardiomyopathy and coronary artery disease&#58; a possible association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Parodi"
                            1 => "R&#46; Citro"
                            2 => "B&#46; Bellandi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCA.0b013e3283645c4e"
                      "Revista" => array:6 [
                        "tituloSerie" => "Coron Artery Dis"
                        "fecha" => "2013"
                        "volumen" => "24"
                        "paginaInicial" => "527"
                        "paginaFinal" => "533"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23863780"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diverse left ventricular morphology and predictors of short-term outcome in patients with stress-induced cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;W&#46; Kwon"
                            1 => "B&#46;O&#46; Kim"
                            2 => "M&#46;H&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2012.09.050"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2013"
                        "volumen" => "168"
                        "paginaInicial" => "331"
                        "paginaFinal" => "337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23041089"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coincidental coronary artery disease impairs outcome in patients with Takotsubo cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "V&#46; Bill"
                            1 => "I&#46; El-Battrawy"
                            2 => "K&#46; Schramm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/qjmed/hcx035"
                      "Revista" => array:6 [
                        "tituloSerie" => "QJM"
                        "fecha" => "2017"
                        "volumen" => "110"
                        "paginaInicial" => "483"
                        "paginaFinal" => "488"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28340038"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality in takotsubo syndrome is similar to mortality in myocardial infarction &#8211; a report from the SWEDEHEART registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46; Redfors"
                            1 => "R&#46; Vedad"
                            2 => "O&#46; Anger&#229;s"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2015.03.162"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2015"
                        "volumen" => "185"
                        "paginaInicial" => "282"
                        "paginaFinal" => "289"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25818540"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Usefulness of SUM of ST-segment elevation on electrocardiograms &#40;limb leads&#41; for predicting in-hospital complications in patients with stress &#40;takotsubo&#41; cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Takashio"
                            1 => "M&#46; Yamamuro"
                            2 => "S&#46; Kojima"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2012.01.393"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2012"
                        "volumen" => "109"
                        "paginaInicial" => "1651"
                        "paginaFinal" => "1656"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22440122"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multiple unfavorable echocardiographic findings in Takotsubo cardiomyopathy are associated with increased in-hospital events and mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Kagiyama"
                            1 => "H&#46; Okura"
                            2 => "Y&#46; Matsue"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.echo.2016.08.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Echocardiogr"
                        "fecha" => "2016"
                        "volumen" => "29"
                        "paginaInicial" => "1179"
                        "paginaFinal" => "1187"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27742241"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Differences in clinical features and in-hospital outcomes of older adults with tako-tsubo cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Citro"
                            1 => "F&#46; Rigo"
                            2 => "M&#46; Previtali"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1532-5415.2011.03730.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Geriatr Soc"
                        "fecha" => "2012"
                        "volumen" => "60"
                        "paginaInicial" => "93"
                        "paginaFinal" => "98"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22092251"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transient left ventricular apical ballooning without coronary artery stenosis&#58; a novel heart syndrome mimicking acute myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Tsuchihashi"
                            1 => "K&#46; Ueshima"
                            2 => "T&#46; Uchida"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0735-1097(01)01316-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2001"
                        "volumen" => "38"
                        "paginaInicial" => "11"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11451258"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of concomitant atrial fibrillation on the prognosis of Takotsubo cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I&#46; El-Battrawy"
                            1 => "S&#46; Lang"
                            2 => "U&#46; Ansari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/europace/euw293"
                      "Revista" => array:6 [
                        "tituloSerie" => "Europace"
                        "fecha" => "2017"
                        "volumen" => "19"
                        "paginaInicial" => "1288"
                        "paginaFinal" => "1292"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27702871"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Natural history and expansive clinical profile of stress &#40;tako-tsubo&#41; cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;W&#46; Sharkey"
                            1 => "D&#46;C&#46; Windenburg"
                            2 => "J&#46;R&#46; Lesser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2009.08.057"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2010"
                        "volumen" => "55"
                        "paginaInicial" => "333"
                        "paginaFinal" => "341"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20117439"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46;S&#46; Anavekar"
                            1 => "J&#46;J&#46; McMurray"
                            2 => "E&#46;J&#46; Velazquez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa041365"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2004"
                        "volumen" => "351"
                        "paginaInicial" => "1285"
                        "paginaFinal" => "1295"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15385655"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physically triggered takotsubo cardiomyopathy has a higher in-hospital mortality rate"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "Y&#46; Sobue"
                            1 => "E&#46; Watanabe"
                            2 => "T&#46; Ichikawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2017.02.090"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2017"
                        "volumen" => "235"
                        "paginaInicial" => "87"
                        "paginaFinal" => "93"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28262347"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics&#44; ballooning pattern&#44; and long-term prognosis of transient left ventricular ballooning syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;G&#46; Song"
                            1 => "J&#46;Y&#46; Hahn"
                            2 => "S&#46;J&#46; Cho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hrtlng.2009.07.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Lung"
                        "fecha" => "2010"
                        "volumen" => "39"
                        "paginaInicial" => "188"
                        "paginaFinal" => "195"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20457338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0455"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Takotsubo cardiomyopathy&#58; a unique cardiomyopathy with variable ventricular morphology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;T&#46; Hurst"
                            1 => "A&#46; Prasad"
                            2 => "J&#46;W&#46; Askew III"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcmg.2010.01.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "JACC Cardiovasc Imaging"
                        "fecha" => "2010"
                        "volumen" => "3"
                        "paginaInicial" => "641"
                        "paginaFinal" => "649"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20541719"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0460"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term excess mortality in takotsubo cardiomyopathy&#58; predictors&#44; causes and clinical consequences"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Stiermaier"
                            1 => "C&#46; Moeller"
                            2 => "K&#46; Oehler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ejhf.494"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2016"
                        "volumen" => "18"
                        "paginaInicial" => "650"
                        "paginaFinal" => "656"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26990821"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0465"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical features and three-year outcomes of Takotsubo &#40;stress&#41; cardiomyopathy&#58; observational data from one center"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Glaveckait&#279;"
                            1 => "P&#46; &#352;erpytis"
                            2 => "D&#46; Pe&#269;i&#363;rait&#279;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hjc.2016.11.016"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hellenic J Cardiol"
                        "fecha" => "2016"
                        "volumen" => "57"
                        "paginaInicial" => "428"
                        "paginaFinal" => "434"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28087310"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0470"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tako-tsubo syndrome and heart failure&#58; long-term follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I&#46;J&#46; N&#250;&#241;ez-Gil"
                            1 => "M&#46; Molina"
                            2 => "E&#46; Bernardo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.recesp.2012.04.016"
                      "Revista" => array:7 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2012"
                        "volumen" => "65"
                        "paginaInicial" => "996"
                        "paginaFinal" => "1002"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22819220"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1525505017303414"
                          "estado" => "S300"
                          "issn" => "15255050"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack436057"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0425" class="elsevierStylePara elsevierViewall">SUNSHINE group investigators&#58;</p><p id="par0430" class="elsevierStylePara elsevierViewall">Ana Marques1&#59; Ana Pereira1&#59; Andreia Pereira2&#59; Bebiana Faria3&#59; Bruno Pi&#231;arra4&#59; Carolina N&#233;grier5&#59; Catarina Gomes1&#59; Clara Cordeiro6&#44;7&#59; Daniela Silva6&#44;8&#59; Davide Moreira9&#59; Emanuel Correia9&#59; Fernando S&#225;5&#44; Hugo Antunes9&#59; In&#234;s Cruz1&#59; Joana Chin10&#59; Joana Silva5&#59; Jo&#227;o Bispo6&#44;8&#59; Jo&#227;o Guedes6&#44;8&#59; Jo&#227;o Portugu&#234;s3&#59; J&#250;lio Pereira9&#59; Lucy Calvo3&#59; Lu&#237;s Abreu9&#59; Lu&#237;s Lopes1&#59; Lu&#237;s Morais11&#59; Luis Puga5&#59; Lu&#237;sa Gon&#231;alves9&#59; Margarida Oliveira3&#59; Maria Vieira12&#59; Micaela Neto2&#44; Miguel Alves12&#59; Nuno Craveiro5&#59; Pedro Azevedo6&#44;8&#59; Pedro Daniel1&#59; Pedro Magalh&#227;es13&#59; Pedro von Hafe3&#59; Renata Gomes14&#59; Rog&#233;rio Teixeira5&#59; R&#250;ben Ramos&#59; Samuel Almeida12&#59; S&#237;lvia Le&#227;o13&#59; Sofia Alegria9&#59; Sofia Carvalho13&#46;</p><p id="par0435" class="elsevierStylePara elsevierViewall">1 Cardiology Department&#44; Hospital Garcia de Orta&#44; Almada&#44; Portugal</p><p id="par0440" class="elsevierStylePara elsevierViewall">2 Cardiology Department&#44; Hospital Dr&#46; N&#233;lio Mendon&#231;a&#44; Funchal&#44; Portugal</p><p id="par0445" class="elsevierStylePara elsevierViewall">3 Cardiology Department&#44; Hospital da Senhora da Oliveira&#44; Guimar&#227;es&#44; Portugal</p><p id="par0450" class="elsevierStylePara elsevierViewall">4 Cardiology Department&#44; Hospital do Esp&#237;rito Santo&#44; &#201;vora&#44; Portugal</p><p id="par0455" class="elsevierStylePara elsevierViewall">5 Cardiology Department&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#44; Coimbra&#44; Portugal</p><p id="par0460" class="elsevierStylePara elsevierViewall">6 Algarve Biomedical Center&#44; Faro&#44; Portugal</p><p id="par0465" class="elsevierStylePara elsevierViewall">7 Departamento de Ci&#234;ncias Biom&#233;dicas e Medicina&#44; Universidade do Algarve&#44; Faro&#44; Portugal</p><p id="par0470" class="elsevierStylePara elsevierViewall">8 Cardiology Department&#44; Centro Hospitalar Universit&#225;rio do Algarve&#44; Faro&#44; Portugal</p><p id="par0475" class="elsevierStylePara elsevierViewall">9 Cardiology Department&#44; Centro Hospitalar Tondela-Viseu&#44; Portugal</p><p id="par0480" class="elsevierStylePara elsevierViewall">10 Cardiology Department&#44; Centro Hospitalar Barreiro-Montijo&#44; Montijo&#44; Portugal</p><p id="par0485" class="elsevierStylePara elsevierViewall">11 Cardiology Department&#44; Hospital de Santa Marta&#44; Centro Hospitalar Lisboa Central&#44; Lisboa&#44; Portugal</p><p id="par0490" class="elsevierStylePara elsevierViewall">12 Cardiology Department&#44; Hospital de Santar&#233;m&#44; Santar&#233;m&#44; Portugal</p><p id="par0495" class="elsevierStylePara elsevierViewall">13 Cardiology Department&#44; Centro Hospitalar de Tr&#225;s-os-Montes e Alto Douro&#44; Vila Real&#44; Portugal</p><p id="par0500" class="elsevierStylePara elsevierViewall">14Cardiology Department&#44; Hospital de Santo Esp&#237;rito da Ilha Terceira&#44; Angra do Hero&#237;smo&#44; Portugal</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003800000005/v2_201911300820/S217420491930159X/v2_201911300820/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9917"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003800000005/v2_201911300820/S217420491930159X/v2_201911300820/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491930159X?idApp=UINPBA00004E"
]