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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hypertrophic cardiomyopathy &#40;HCM&#41; is a common primary myocardial disease&#44; defined as left ventricular hypertrophy in the absence of abnormal loading conditions&#46; It is inherited as an autosomal dominant trait and is caused by mutations in cardiac sarcomere protein genes&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> The disease is characterized by marked genetic heterogeneity&#44; diverse clinical phenotypes and a highly variable natural history&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Sudden cardiac death &#40;SCD&#41; remains the most devastating and feared clinical event for both HCM patients and their cardiologists&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> Early studies from tertiary centers demonstrated alarmingly high rates of SCD&#44; reaching up to 6&#37; per year&#44; although this was probably due to referral bias&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> With increased awareness of the disease&#44; lower-risk patients are now more likely to be diagnosed and more recent studies demonstrate an annual SCD rate of 0&#46;5-1&#37; per year&#46; Unfortunately young and asymptomatic patients are often affected&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#44;5&#44;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">SCD in HCM is mainly caused by ventricular arrhythmias&#46; The unpredictable ventricular arrhythmogenic substrate is thought to be the result of the histopathological hallmarks of myocyte disarray&#44; interstitial collagen deposition and replacement fibrosis after myocyte death as a consequence of coronary microvascular-mediated flow dysfunction and ischemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Effective prevention of SCD with implantable cardioverter-defibrillator &#40;ICD&#41; therapy is the major factor in the significant reduction in HCM-related mortality and has provided HCM patients with the chance of normal life expectancy&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> Estimation of SCD risk is therefore now an integral part of clinical management of these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients who have previously experienced aborted SCD and malignant ventricular arrhythmias are at higher risk for further arrhythmic events &#40;10&#37; per year&#41; and both the American College of Cardiology Foundation&#47;American Heart Association &#40;ACCF&#47;AHA&#41; and European Society of Cardiology &#40;ESC&#41; guidelines for the management of HCM recommend ICD implantation in such patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">However&#44; the selection of patients to receive an ICD for purposes of primary prevention is more difficult&#44; and the above recommendations differ and to some extent conflict regarding this issue&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In fact&#44; the greatest challenge lies in identifying the minority of patients at sufficiently high risk of SCD to justify the possibility of device-related complications&#44; mainly inappropriate shocks and lead-related complications such as displacement&#44; malfunction&#44; thrombosis or infection&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> On the other hand&#44; it is important to provide reassurance to those deemed to be at low risk for sudden death&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Research conducted in recent decades has identified a number of phenotypic characteristics associated with the occurrence of adverse events&#46; Different stratification strategies have emerged&#59; however&#44; consistent with the clinical diversity of the disease&#44; none has proved infallible in predicting future adverse events&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Interestingly&#44; in a study conducted by Spirito et al&#46; including 668 HCM patients without conventional risk factors and with no or mild symptoms&#44; the risk of sudden death was not negligible&#44; with an event rate of 0&#46;6&#37; per year&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> This finding underscores the importance of expanding risk stratification&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Another important consideration is that patient age itself influences the weight that should be given to specific risk factors&#44; which have greater significance in younger patients&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">As mentioned above&#44; there are currently two distinct strategies for risk stratifying patients with HCM for ICD therapy &#40;ACCF&#47;AHA and ESC&#41;&#46; Of note&#44; no randomized clinical trial has been conducted and the present recommendations are based on observational&#44; retrospective cohort studies&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The 2011 ACCF&#47;AHA primary prevention stratification relies on identification of one or more major risk markers to guide ICD implantation&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> An individual clinical approach with the flexibility to incorporate emerging risk modifiers &#40;like the presence of apical aneurysms and diffuse&#47;extensive fibrosis identified on late gadolinium enhancement cardiac magnetic resonance study&#41; is proposed&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Since 2014&#44; the ESC has recommended the use of a novel quantitative risk score &#40;HCM Risk-SCD&#41;&#44; with an online decision-making tool composed of seven disease-related features&#44; to predict sudden death events over five years&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> Based on this score&#44; patients are stratified into three subgroups for ICD recommendation for primary prevention&#58; low &#40;&#60;4&#37;&#44; ICD generally not indicated&#41;&#44; intermediate &#40;4-6&#37;&#44; ICD may be considered&#41; and high risk &#40;&#8805;6&#37;&#44; ICD should be considered&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">To assess the discrimination performance of the 2014 HCM Risk-SCD score&#44; Wang and colleagues recently performed a systematic review and meta-analysis including 13 studies validating the model&#39;s usefulness&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> They concluded that the model has excellent specificity&#44; although it has poor sensitivity when setting a recommended cutoff value of 6&#37; for identifying high-risk patients&#44; indicating that it is likely to miss a subgroup of high-risk patients&#46; Moreover&#44; subgroup meta-analysis based on geographic distribution showed a slightly weaker predictive ability for North America compared with other regions&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">On the other hand&#44; the results from a recently published single-center observational longitudinal study including 2094 HCM patients demonstrated that the enhanced ACCF&#47;AHA algorithm for SCD prevention is highly sensitive&#44; resulting in identification of nearly all at-risk patients&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> In the same study&#44; the ESC risk score was much less sensitive for identifying patients requiring ICD therapy &#40;sensitivity only 34&#37; vs&#46; 95&#37; for ACCF&#47;AHA&#41;&#46; However&#44; it was associated with relatively high specificity&#44; suggesting that it could reduce the number of ICD implants in low-risk patients and limit ICD overuse&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Considering the importance of SCD risk stratification and the unsatisfactory results to date&#44; it is understandable that the medical community wishes to pursue research in this field&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The study by Ruivo et al&#46; published in the current issue of the <span class="elsevierStyleItalic">Journal</span> sets out to assess SCD risk in Portuguese HCM patients&#44; to develop a new SCD risk prediction model for this population and to compare its accuracy with the current ESC model&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The authors collected data on a cohort of 1022 patients enrolled in the Portuguese nationwide HCM registry &#40;mean age 53&#46;2&#177;16&#46;4 years&#44; 59&#37; male&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">During a median follow-up of five years&#44; the observed rate of adverse events&#44; defined as sudden cardiac death&#44; aborted SCD or appropriate ICD shock therapy&#44; was 1&#46;9&#37;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Four variables were independently associated with the occurrence of adverse events&#44; that were subsequently included in the new five-year SCD predictor model proposed by the authors&#44; which they call SHIFT&#58; unexplained Syncope&#44; Heart failure signs&#44; Interventricular septum thickness &#8805;19 mm and FragmenTed QRS complex&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Of interest&#44; in this study population&#44; the authors found that heart failure signs and fragmented QRS complex on the surface electrocardiogram &#40;ECG&#41; &#40;as an indirect sign of myocardial fibrosis&#41; provide additional information for SCD risk stratification&#46; These parameters are not considered in the current guidelines&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Intuitively&#44; the presence of heart failure signs may be associated with a more advanced stage of the disease and therefore worse prognosis&#59; the outcome of patients with so-called end-stage HCM is poor&#44; not only due to high rates of heart failure-related complications and mortality but also because of a high incidence of SCD&#44; exceeding 10&#37; per year&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Fragmented QRS complexes on a 12-lead ECG reflect conduction delay from inhomogeneous activation of the ventricles and have high predictive value for myocardial scar and mortality in patients with coronary artery disease&#44; as well as being associated with poor prognosis in patients with non-ischemic cardiomyopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> However&#44; previous studies regarding the use of the ECG in risk stratification of HCM patients have shown conflicting results&#44; and no ECG pattern can currently be used for clinical decision-making regarding prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In the study by Ruivo et al&#46;&#44; the HCM Risk-SCD model was additionally applied in a subgroup of patients for whom complete data were available on the eight risk factors used to calculate the ESC SCD risk score &#40;349 patients&#41;&#44; of whom 2&#46;3&#37; had SCD or an equivalent event during the five-year follow-up&#46; Compared to the ESC model&#44; the new proposed SHIFT model seemed to have better prognostic performance&#44; with a C-index of 0&#46;81 &#40;95&#37; confidence interval &#91;CI&#93;&#58; 0&#46;77-0&#46;83&#41; for SHIFT vs&#46; 0&#46;77 &#40;95&#37; CI&#58; 0&#46;73-0&#46;81&#41; for the ESC model &#40;p&#61;0&#46;246&#44; z&#58; -1&#46;160&#41;&#59; D-statistic of 2&#46;38 &#40;95&#37; CI&#58; 0&#46;95-4&#46;35&#41; for SHIFT vs&#46; 1&#46;97 &#40;95&#37; CI&#58; 0&#46;82-3&#46;22&#41; for ESC&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In summary&#44; although most HCM cases have a benign prognosis&#44; identifying patients at the highest risk for sudden death warranting lifesaving prophylactic ICD therapy remains a critical management priority&#46; However&#44; many gray zones remain regarding this topic&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Despite the limitations inherent to the design of the study conducted by Ruivo et al&#46;&#44; and the need for future external validation&#44; its results are highly encouraging&#46; The SHIFT model is easy to use and may add prognostic value in SCD risk stratification&#44; especially for the subgroup of Portuguese patients with HCM&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Classification of the cardiomyopathies&#58; a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Elliott"
                            1 => "B&#46; Andersson"
                            2 => "E&#46; Arbustini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehm342"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2008"
                        "volumen" => "29"
                        "paginaInicial" => "270"
                        "paginaFinal" => "276"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17916581"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patterns of disease progression in hypertrophic cardiomyopathy&#58; an individualized approach to clinical staging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I&#46; Olivotto"
                            1 => "F&#46; Cecchi"
                            2 => "C&#46; Poggesi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCHEARTFAILURE.112.967026"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Heart Fail"
                        "fecha" => "2012"
                        "volumen" => "5"
                        "paginaInicial" => "535"
                        "paginaFinal" => "546"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22811549"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical course and management of hypertrophic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;J&#46; Maron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMc1812159"
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2018"
                        "volumen" => "379"
                        "paginaInicial" => "1977"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30428294"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognosis in hypertrophic cardiomyopathy&#58; role of age and clinical&#44; electrocardiographic and hemodynamic features"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W&#46; McKenna"
                            1 => "J&#46; Deanfield"
                            2 => "A&#46; Faruqui"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0002-9149(81)90535-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "1981"
                        "volumen" => "47"
                        "paginaInicial" => "532"
                        "paginaFinal" => "538"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7193406"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of hypertrophic cardiomyopathy-related death&#58; revisited in a large non-referral-based patient population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;J&#46; Maron"
                            1 => "I&#46; Olivotto"
                            2 => "P&#46; Spirito"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.cir.102.8.858"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2000"
                        "volumen" => "102"
                        "paginaInicial" => "858"
                        "paginaFinal" => "864"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10952953"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Historical trends in reported survival rates in patients with hypertrophic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;M&#46; Elliot"
                            1 => "J&#46;R&#46; Gimeno"
                            2 => "Thaman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/hrt.2005.068577"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart"
                        "fecha" => "2006"
                        "volumen" => "92"
                        "paginaInicial" => "785"
                        "paginaFinal" => "791"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16216855"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sudden cardiac death in hypertrophic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; O&#8217;Mahony"
                            1 => "P&#46; Elliot"
                            2 => "W&#46; McKenna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCEP.111.962043"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Arrhythm Electrophysiol"
                        "fecha" => "2013"
                        "volumen" => "6"
                        "paginaInicial" => "443"
                        "paginaFinal" => "451"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23022709"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0140"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perspectives on the overall risks of living with hypertrophic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;J&#46; Maron"
                            1 => "M&#46;S&#46; Maron"
                            2 => "E&#46;J&#46; Rowin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.117.027738"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2017"
                        "volumen" => "135"
                        "paginaInicial" => "2317"
                        "paginaFinal" => "2319"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28606946"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2011 ACCF&#47;AHA Guideline for the diagnosis and treatment of hypertrophic cardiomyopathy&#58; a report of the American College of Cardiology Foundation&#47;American Heart Association Task Force on Practice Guidelines&#44; Developed in collaboration with the American Association for Thoracic Surgery&#44; American Society of Echocardiography&#44; American Society of Nuclear Cardiology&#44; Heart Failure Society of America&#44; Heart Rhythm Society&#44; Society for Cardiovascular Angiography and Interventions&#44; and Society of Thoracic Surgeons"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;J&#46; Gersh"
                            1 => "B&#46;J&#46; Maron"
                            2 => "R&#46;O&#46; Bonow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e318223e2bd"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2011"
                        "volumen" => "124"
                        "paginaInicial" => "e783"
                        "paginaFinal" => "e831"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22068434"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy&#58; The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology &#40;ESC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;M&#46; Elliott"
                            1 => "A&#46; Anastasakis"
                            2 => "M&#46;A&#46; Borger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehu284"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2014"
                        "volumen" => "35"
                        "paginaInicial" => "2733"
                        "paginaFinal" => "2779"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25173338"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S2468125319300123"
                          "estado" => "S300"
                          "issn" => "24681253"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival after cardiac arrest or sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;M&#46; Elliott"
                            1 => "S&#46; Sharma"
                            2 => "A&#46; Varnava"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0735-1097(99)00056-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1999"
                        "volumen" => "33"
                        "paginaInicial" => "1596"
                        "paginaFinal" => "1601"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10334430"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy&#58; an updated systematic review and meta-analysis of outcomes and complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Wang"
                            1 => "A&#46; Xie"
                            2 => "R&#46; Tjahjono"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.21037/acs.2017.07.05"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Cardiothorac Surg"
                        "fecha" => "2017"
                        "volumen" => "6"
                        "paginaInicial" => "298"
                        "paginaFinal" => "306"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28944170"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of sudden death in hypertrophic cardiomyopathy&#58; bridging the gaps in knowledge"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Weissler-Snir"
                            1 => "A&#46; Adler"
                            2 => "L&#46; Williams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehw268"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2017"
                        "volumen" => "38"
                        "paginaInicial" => "1728"
                        "paginaFinal" => "1737"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27371714"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of sudden death and outcome in patients with hypertrophic cardiomyopathy with benign presentation and without risk factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Spirito"
                            1 => "C&#46; Autore"
                            2 => "F&#46; Formisano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2014.01.435"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2014"
                        "volumen" => "113"
                        "paginaInicial" => "1550"
                        "paginaFinal" => "1555"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24630786"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk stratification and outcome of patients with hypertrophic cardiomyopathy &#8805;60 years of age"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;J&#46; Maron"
                            1 => "Rowin ej"
                            2 => "S&#46;A&#46; Casey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.112.136085"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2013"
                        "volumen" => "127"
                        "paginaInicial" => "585"
                        "paginaFinal" => "593"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23275385"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Variable and limited predictive value of the European Society of Cardiology hypertrophic cardiomyopathy sudden-death risk model&#58; a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Wang"
                            1 => "Z&#46; Zhang"
                            2 => "L&#46; Yuancheng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cjca.2019.05.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Cardiol"
                        "fecha" => "2019"
                        "volumen" => "35"
                        "paginaInicial" => "1791"
                        "paginaFinal" => "1799"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31474312"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
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Editorial comment
Sudden cardiac death in hypertrophic cardiomyopathy: Improved risk stratification strategies are needed
Morte súbita cardíaca na miocardiopatia hipertrófica: é necessário melhorar as estratégias de estratificação de risco
Inês Cruz
Serviço de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hypertrophic cardiomyopathy &#40;HCM&#41; is a common primary myocardial disease&#44; defined as left ventricular hypertrophy in the absence of abnormal loading conditions&#46; It is inherited as an autosomal dominant trait and is caused by mutations in cardiac sarcomere protein genes&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> The disease is characterized by marked genetic heterogeneity&#44; diverse clinical phenotypes and a highly variable natural history&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Sudden cardiac death &#40;SCD&#41; remains the most devastating and feared clinical event for both HCM patients and their cardiologists&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> Early studies from tertiary centers demonstrated alarmingly high rates of SCD&#44; reaching up to 6&#37; per year&#44; although this was probably due to referral bias&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> With increased awareness of the disease&#44; lower-risk patients are now more likely to be diagnosed and more recent studies demonstrate an annual SCD rate of 0&#46;5-1&#37; per year&#46; Unfortunately young and asymptomatic patients are often affected&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#44;5&#44;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">SCD in HCM is mainly caused by ventricular arrhythmias&#46; The unpredictable ventricular arrhythmogenic substrate is thought to be the result of the histopathological hallmarks of myocyte disarray&#44; interstitial collagen deposition and replacement fibrosis after myocyte death as a consequence of coronary microvascular-mediated flow dysfunction and ischemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Effective prevention of SCD with implantable cardioverter-defibrillator &#40;ICD&#41; therapy is the major factor in the significant reduction in HCM-related mortality and has provided HCM patients with the chance of normal life expectancy&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> Estimation of SCD risk is therefore now an integral part of clinical management of these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients who have previously experienced aborted SCD and malignant ventricular arrhythmias are at higher risk for further arrhythmic events &#40;10&#37; per year&#41; and both the American College of Cardiology Foundation&#47;American Heart Association &#40;ACCF&#47;AHA&#41; and European Society of Cardiology &#40;ESC&#41; guidelines for the management of HCM recommend ICD implantation in such patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">However&#44; the selection of patients to receive an ICD for purposes of primary prevention is more difficult&#44; and the above recommendations differ and to some extent conflict regarding this issue&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In fact&#44; the greatest challenge lies in identifying the minority of patients at sufficiently high risk of SCD to justify the possibility of device-related complications&#44; mainly inappropriate shocks and lead-related complications such as displacement&#44; malfunction&#44; thrombosis or infection&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> On the other hand&#44; it is important to provide reassurance to those deemed to be at low risk for sudden death&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Research conducted in recent decades has identified a number of phenotypic characteristics associated with the occurrence of adverse events&#46; Different stratification strategies have emerged&#59; however&#44; consistent with the clinical diversity of the disease&#44; none has proved infallible in predicting future adverse events&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Interestingly&#44; in a study conducted by Spirito et al&#46; including 668 HCM patients without conventional risk factors and with no or mild symptoms&#44; the risk of sudden death was not negligible&#44; with an event rate of 0&#46;6&#37; per year&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> This finding underscores the importance of expanding risk stratification&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Another important consideration is that patient age itself influences the weight that should be given to specific risk factors&#44; which have greater significance in younger patients&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">As mentioned above&#44; there are currently two distinct strategies for risk stratifying patients with HCM for ICD therapy &#40;ACCF&#47;AHA and ESC&#41;&#46; Of note&#44; no randomized clinical trial has been conducted and the present recommendations are based on observational&#44; retrospective cohort studies&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The 2011 ACCF&#47;AHA primary prevention stratification relies on identification of one or more major risk markers to guide ICD implantation&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> An individual clinical approach with the flexibility to incorporate emerging risk modifiers &#40;like the presence of apical aneurysms and diffuse&#47;extensive fibrosis identified on late gadolinium enhancement cardiac magnetic resonance study&#41; is proposed&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Since 2014&#44; the ESC has recommended the use of a novel quantitative risk score &#40;HCM Risk-SCD&#41;&#44; with an online decision-making tool composed of seven disease-related features&#44; to predict sudden death events over five years&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> Based on this score&#44; patients are stratified into three subgroups for ICD recommendation for primary prevention&#58; low &#40;&#60;4&#37;&#44; ICD generally not indicated&#41;&#44; intermediate &#40;4-6&#37;&#44; ICD may be considered&#41; and high risk &#40;&#8805;6&#37;&#44; ICD should be considered&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">To assess the discrimination performance of the 2014 HCM Risk-SCD score&#44; Wang and colleagues recently performed a systematic review and meta-analysis including 13 studies validating the model&#39;s usefulness&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> They concluded that the model has excellent specificity&#44; although it has poor sensitivity when setting a recommended cutoff value of 6&#37; for identifying high-risk patients&#44; indicating that it is likely to miss a subgroup of high-risk patients&#46; Moreover&#44; subgroup meta-analysis based on geographic distribution showed a slightly weaker predictive ability for North America compared with other regions&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">On the other hand&#44; the results from a recently published single-center observational longitudinal study including 2094 HCM patients demonstrated that the enhanced ACCF&#47;AHA algorithm for SCD prevention is highly sensitive&#44; resulting in identification of nearly all at-risk patients&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> In the same study&#44; the ESC risk score was much less sensitive for identifying patients requiring ICD therapy &#40;sensitivity only 34&#37; vs&#46; 95&#37; for ACCF&#47;AHA&#41;&#46; However&#44; it was associated with relatively high specificity&#44; suggesting that it could reduce the number of ICD implants in low-risk patients and limit ICD overuse&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Considering the importance of SCD risk stratification and the unsatisfactory results to date&#44; it is understandable that the medical community wishes to pursue research in this field&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The study by Ruivo et al&#46; published in the current issue of the <span class="elsevierStyleItalic">Journal</span> sets out to assess SCD risk in Portuguese HCM patients&#44; to develop a new SCD risk prediction model for this population and to compare its accuracy with the current ESC model&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The authors collected data on a cohort of 1022 patients enrolled in the Portuguese nationwide HCM registry &#40;mean age 53&#46;2&#177;16&#46;4 years&#44; 59&#37; male&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">During a median follow-up of five years&#44; the observed rate of adverse events&#44; defined as sudden cardiac death&#44; aborted SCD or appropriate ICD shock therapy&#44; was 1&#46;9&#37;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Four variables were independently associated with the occurrence of adverse events&#44; that were subsequently included in the new five-year SCD predictor model proposed by the authors&#44; which they call SHIFT&#58; unexplained Syncope&#44; Heart failure signs&#44; Interventricular septum thickness &#8805;19 mm and FragmenTed QRS complex&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Of interest&#44; in this study population&#44; the authors found that heart failure signs and fragmented QRS complex on the surface electrocardiogram &#40;ECG&#41; &#40;as an indirect sign of myocardial fibrosis&#41; provide additional information for SCD risk stratification&#46; These parameters are not considered in the current guidelines&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Intuitively&#44; the presence of heart failure signs may be associated with a more advanced stage of the disease and therefore worse prognosis&#59; the outcome of patients with so-called end-stage HCM is poor&#44; not only due to high rates of heart failure-related complications and mortality but also because of a high incidence of SCD&#44; exceeding 10&#37; per year&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Fragmented QRS complexes on a 12-lead ECG reflect conduction delay from inhomogeneous activation of the ventricles and have high predictive value for myocardial scar and mortality in patients with coronary artery disease&#44; as well as being associated with poor prognosis in patients with non-ischemic cardiomyopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> However&#44; previous studies regarding the use of the ECG in risk stratification of HCM patients have shown conflicting results&#44; and no ECG pattern can currently be used for clinical decision-making regarding prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In the study by Ruivo et al&#46;&#44; the HCM Risk-SCD model was additionally applied in a subgroup of patients for whom complete data were available on the eight risk factors used to calculate the ESC SCD risk score &#40;349 patients&#41;&#44; of whom 2&#46;3&#37; had SCD or an equivalent event during the five-year follow-up&#46; Compared to the ESC model&#44; the new proposed SHIFT model seemed to have better prognostic performance&#44; with a C-index of 0&#46;81 &#40;95&#37; confidence interval &#91;CI&#93;&#58; 0&#46;77-0&#46;83&#41; for SHIFT vs&#46; 0&#46;77 &#40;95&#37; CI&#58; 0&#46;73-0&#46;81&#41; for the ESC model &#40;p&#61;0&#46;246&#44; z&#58; -1&#46;160&#41;&#59; D-statistic of 2&#46;38 &#40;95&#37; CI&#58; 0&#46;95-4&#46;35&#41; for SHIFT vs&#46; 1&#46;97 &#40;95&#37; CI&#58; 0&#46;82-3&#46;22&#41; for ESC&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In summary&#44; although most HCM cases have a benign prognosis&#44; identifying patients at the highest risk for sudden death warranting lifesaving prophylactic ICD therapy remains a critical management priority&#46; However&#44; many gray zones remain regarding this topic&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Despite the limitations inherent to the design of the study conducted by Ruivo et al&#46;&#44; and the need for future external validation&#44; its results are highly encouraging&#46; The SHIFT model is easy to use and may add prognostic value in SCD risk stratification&#44; especially for the subgroup of Portuguese patients with HCM&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:20 [
            0 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Classification of the cardiomyopathies&#58; a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Elliott"
                            1 => "B&#46; Andersson"
                            2 => "E&#46; Arbustini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehm342"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2008"
                        "volumen" => "29"
                        "paginaInicial" => "270"
                        "paginaFinal" => "276"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17916581"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patterns of disease progression in hypertrophic cardiomyopathy&#58; an individualized approach to clinical staging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I&#46; Olivotto"
                            1 => "F&#46; Cecchi"
                            2 => "C&#46; Poggesi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCHEARTFAILURE.112.967026"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Heart Fail"
                        "fecha" => "2012"
                        "volumen" => "5"
                        "paginaInicial" => "535"
                        "paginaFinal" => "546"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22811549"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical course and management of hypertrophic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;J&#46; Maron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMc1812159"
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2018"
                        "volumen" => "379"
                        "paginaInicial" => "1977"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30428294"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognosis in hypertrophic cardiomyopathy&#58; role of age and clinical&#44; electrocardiographic and hemodynamic features"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W&#46; McKenna"
                            1 => "J&#46; Deanfield"
                            2 => "A&#46; Faruqui"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0002-9149(81)90535-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "1981"
                        "volumen" => "47"
                        "paginaInicial" => "532"
                        "paginaFinal" => "538"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7193406"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of hypertrophic cardiomyopathy-related death&#58; revisited in a large non-referral-based patient population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;J&#46; Maron"
                            1 => "I&#46; Olivotto"
                            2 => "P&#46; Spirito"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.cir.102.8.858"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2000"
                        "volumen" => "102"
                        "paginaInicial" => "858"
                        "paginaFinal" => "864"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10952953"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Historical trends in reported survival rates in patients with hypertrophic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;M&#46; Elliot"
                            1 => "J&#46;R&#46; Gimeno"
                            2 => "Thaman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/hrt.2005.068577"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart"
                        "fecha" => "2006"
                        "volumen" => "92"
                        "paginaInicial" => "785"
                        "paginaFinal" => "791"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16216855"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sudden cardiac death in hypertrophic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; O&#8217;Mahony"
                            1 => "P&#46; Elliot"
                            2 => "W&#46; McKenna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCEP.111.962043"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Arrhythm Electrophysiol"
                        "fecha" => "2013"
                        "volumen" => "6"
                        "paginaInicial" => "443"
                        "paginaFinal" => "451"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23022709"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0140"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perspectives on the overall risks of living with hypertrophic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;J&#46; Maron"
                            1 => "M&#46;S&#46; Maron"
                            2 => "E&#46;J&#46; Rowin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.117.027738"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2017"
                        "volumen" => "135"
                        "paginaInicial" => "2317"
                        "paginaFinal" => "2319"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28606946"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2011 ACCF&#47;AHA Guideline for the diagnosis and treatment of hypertrophic cardiomyopathy&#58; a report of the American College of Cardiology Foundation&#47;American Heart Association Task Force on Practice Guidelines&#44; Developed in collaboration with the American Association for Thoracic Surgery&#44; American Society of Echocardiography&#44; American Society of Nuclear Cardiology&#44; Heart Failure Society of America&#44; Heart Rhythm Society&#44; Society for Cardiovascular Angiography and Interventions&#44; and Society of Thoracic Surgeons"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;J&#46; Gersh"
                            1 => "B&#46;J&#46; Maron"
                            2 => "R&#46;O&#46; Bonow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e318223e2bd"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2011"
                        "volumen" => "124"
                        "paginaInicial" => "e783"
                        "paginaFinal" => "e831"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22068434"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy&#58; The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology &#40;ESC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;M&#46; Elliott"
                            1 => "A&#46; Anastasakis"
                            2 => "M&#46;A&#46; Borger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehu284"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2014"
                        "volumen" => "35"
                        "paginaInicial" => "2733"
                        "paginaFinal" => "2779"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25173338"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S2468125319300123"
                          "estado" => "S300"
                          "issn" => "24681253"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival after cardiac arrest or sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;M&#46; Elliott"
                            1 => "S&#46; Sharma"
                            2 => "A&#46; Varnava"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0735-1097(99)00056-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "1999"
                        "volumen" => "33"
                        "paginaInicial" => "1596"
                        "paginaFinal" => "1601"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10334430"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy&#58; an updated systematic review and meta-analysis of outcomes and complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Wang"
                            1 => "A&#46; Xie"
                            2 => "R&#46; Tjahjono"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.21037/acs.2017.07.05"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Cardiothorac Surg"
                        "fecha" => "2017"
                        "volumen" => "6"
                        "paginaInicial" => "298"
                        "paginaFinal" => "306"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28944170"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of sudden death in hypertrophic cardiomyopathy&#58; bridging the gaps in knowledge"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Weissler-Snir"
                            1 => "A&#46; Adler"
                            2 => "L&#46; Williams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehw268"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2017"
                        "volumen" => "38"
                        "paginaInicial" => "1728"
                        "paginaFinal" => "1737"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27371714"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of sudden death and outcome in patients with hypertrophic cardiomyopathy with benign presentation and without risk factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Spirito"
                            1 => "C&#46; Autore"
                            2 => "F&#46; Formisano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2014.01.435"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2014"
                        "volumen" => "113"
                        "paginaInicial" => "1550"
                        "paginaFinal" => "1555"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24630786"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk stratification and outcome of patients with hypertrophic cardiomyopathy &#8805;60 years of age"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;J&#46; Maron"
                            1 => "Rowin ej"
                            2 => "S&#46;A&#46; Casey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.112.136085"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2013"
                        "volumen" => "127"
                        "paginaInicial" => "585"
                        "paginaFinal" => "593"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23275385"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Variable and limited predictive value of the European Society of Cardiology hypertrophic cardiomyopathy sudden-death risk model&#58; a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Wang"
                            1 => "Z&#46; Zhang"
                            2 => "L&#46; Yuancheng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cjca.2019.05.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Cardiol"
                        "fecha" => "2019"
                        "volumen" => "35"
                        "paginaInicial" => "1791"
                        "paginaFinal" => "1799"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31474312"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enhanced American College of Cardiology&#47;American Heart Association Strategy for prevention of sudden cardiac death in high-risk patients with hypertrophic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;S&#46; Maron"
                            1 => "E&#46;J&#46; Rowin"
                            2 => "B&#46;S&#46; Wessler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamacardio.2019.1391"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Cardiol"
                        "fecha" => "2019"
                        "volumen" => "4"
                        "paginaInicial" => "644"
                        "paginaFinal" => "657"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31116360"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The SHIFT model combines clinical&#44; electrocardiographic and echocardiographic parameters to predict sudden cardiac death in hypertrophic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Ruivo"
                            1 => "F&#46;M&#46; S&#225;"
                            2 => "J&#46; Correia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2019.05.012"
                      "Revista" => array:3 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2019"
                        "volumen" => "38"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fragmented ECG as a risk marker in cardiovascular diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Jain"
                            1 => "R&#46; Singh"
                            2 => "S&#46; Yamini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2174/1573403x10666140514103451"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Cardiol Rev"
                        "fecha" => "2014"
                        "volumen" => "10"
                        "paginaInicial" => "277"
                        "paginaFinal" => "286"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24827794"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The eletrocardiogram in the diagnosis and management of patients with hypertrophic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Finocchiaro"
                            1 => "N&#46; Sheikh"
                            2 => "E&#46; Biagina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Heart Rhythm"
                        "fecha" => "2019"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
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ISSN: 21742049
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Revista Portuguesa de Cardiologia (English edition)
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