array:26 [
  "pii" => "S217420491500080X"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2015.04.002"
  "estado" => "S300"
  "fechaPublicacion" => "2015-05-01"
  "aid" => "635"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2015"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "cor"
  "cita" => "Rev Port Cardiol. 2015;34:371"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2533
    "formatos" => array:3 [
      "EPUB" => 167
      "HTML" => 1870
      "PDF" => 496
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:20 [
      "pii" => "S0870255115001043"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2015.03.004"
      "estado" => "S300"
      "fechaPublicacion" => "2015-05-01"
      "aid" => "635"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "cor"
      "cita" => "Rev Port Cardiol. 2015;34:371"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2498
        "formatos" => array:3 [
          "EPUB" => 202
          "HTML" => 1752
          "PDF" => 544
        ]
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta ao Editor</span>"
        "titulo" => "Resposta &#224; Carta ao Editor &#171;Inflammation&#44; systemic lupus erythematosus and the Kounis mast cell acitvation&#8208;associated syndrome&#187;"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:1 [
            "paginaInicial" => "371"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Reply to the Letter to the Editor &#8220;Inflammation&#44; systemic lupus erythematosus and the Kounis mast cell activation&#8208;associated syndrome&#8221;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Alexandre de Matos Soeiro"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Alexandre"
                "apellidos" => "de Matos Soeiro"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S217420491500080X"
          "doi" => "10.1016/j.repce.2015.04.002"
          "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/S217420491500080X?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115001043?idApp=UINPBA00004E"
      "url" => "/08702551/0000003400000005/v1_201505200240/S0870255115001043/v1_201505200240/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S217420491500118X"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2015.05.006"
    "estado" => "S300"
    "fechaPublicacion" => "2015-05-01"
    "aid" => "333"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "ssu"
    "cita" => "Rev Port Cardiol. 2015;34:373-80"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2832
      "formatos" => array:3 [
        "EPUB" => 178
        "HTML" => 2090
        "PDF" => 564
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editors&#8217; Network</span>"
      "titulo" => "Fostering diffusion of scientific contents of National Society Cardiovascular Journals&#58; The new ESC search engine"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "373"
          "paginaFinal" => "380"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1014
              "Ancho" => 1806
              "Tamanyo" => 306162
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Results page with relevant information about the documents found&#46; On the left&#44; there is a toolbar with a &#64257;ltering system to re&#64257;ne the search&#46;</p>"
          ]
        ]
      ]
      "autores" => array:2 [
        0 => array:2 [
          "autoresLista" => "Fernando Alfonso, Lino Gon&#231;alves, Fausto Pinto, Adam Timmis, Hugo Ector, Giuseppe Ambrosio, Panos Vardas"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Alfonso"
            ]
            1 => array:2 [
              "nombre" => "Lino"
              "apellidos" => "Gon&#231;alves"
            ]
            2 => array:2 [
              "nombre" => "Fausto"
              "apellidos" => "Pinto"
            ]
            3 => array:2 [
              "nombre" => "Adam"
              "apellidos" => "Timmis"
            ]
            4 => array:2 [
              "nombre" => "Hugo"
              "apellidos" => "Ector"
            ]
            5 => array:2 [
              "nombre" => "Giuseppe"
              "apellidos" => "Ambrosio"
            ]
            6 => array:2 [
              "nombre" => "Panos"
              "apellidos" => "Vardas"
            ]
            7 => array:1 [
              "colaborador" => "on behalf of the Editors&#8217; Network European Society of Cardiology Task Force"
            ]
          ]
        ]
        1 => array:2 [
          "autoresLista" => ""
          "autores" => array:1 [
            0 => array:1 [
              "colaborador" => "Editors&#8217; Network members"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0870255113002114"
        "doi" => "10.1016/j.repc.2013.09.003"
        "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/S0870255113002114?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491500118X?idApp=UINPBA00004E"
    "url" => "/21742049/0000003400000005/v1_201506091454/S217420491500118X/v1_201506091454/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2174204915000811"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2015.01.004"
    "estado" => "S300"
    "fechaPublicacion" => "2015-05-01"
    "aid" => "634"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Rev Port Cardiol. 2015;34:369-70"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2833
      "formatos" => array:3 [
        "EPUB" => 167
        "HTML" => 2136
        "PDF" => 530
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Inflammation&#44; systemic lupus erythematosus and the Kounis mast cell activation-associated syndrome"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "369"
          "paginaFinal" => "370"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Inflama&#231;&#227;o&#44; l&#250;pus eritematoso sist&#233;mico e s&#237;ndrome de Kounis associada &#224; ativa&#231;&#227;o dos mast&#243;citos"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Nicholas G&#46; Kounis"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Nicholas G&#46;"
              "apellidos" => "Kounis"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0870255115001031"
        "doi" => "10.1016/j.repc.2015.01.009"
        "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/S0870255115001031?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915000811?idApp=UINPBA00004E"
    "url" => "/21742049/0000003400000005/v1_201506091454/S2174204915000811/v1_201506091454/en/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:20 [
      "pii" => "S2174204915000811"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2015.01.004"
      "estado" => "S300"
      "fechaPublicacion" => "2015-05-01"
      "aid" => "634"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "cor"
      "cita" => "Rev Port Cardiol. 2015;34:369-70"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2833
        "formatos" => array:3 [
          "EPUB" => 167
          "HTML" => 2136
          "PDF" => 530
        ]
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
        "titulo" => "Inflammation&#44; systemic lupus erythematosus and the Kounis mast cell activation-associated syndrome"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "369"
            "paginaFinal" => "370"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Inflama&#231;&#227;o&#44; l&#250;pus eritematoso sist&#233;mico e s&#237;ndrome de Kounis associada &#224; ativa&#231;&#227;o dos mast&#243;citos"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Nicholas G&#46; Kounis"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Nicholas G&#46;"
                "apellidos" => "Kounis"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0870255115001031"
          "doi" => "10.1016/j.repc.2015.01.009"
          "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/S0870255115001031?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915000811?idApp=UINPBA00004E"
      "url" => "/21742049/0000003400000005/v1_201506091454/S2174204915000811/v1_201506091454/en/main.assets"
    ]
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Reply to the Letter to the Editor &#8220;Inflammation&#44; systemic lupus erythematosus and the Kounis mast cell activation-associated syndrome&#8221;"
    "tieneTextoCompleto" => true
    "saludo" => "To the Editor&#44;"
    "paginas" => array:1 [
      0 => array:1 [
        "paginaInicial" => "371"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Alexandre de Matos Soeiro"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Alexandre"
            "apellidos" => "de Matos Soeiro"
            "email" => array:1 [
              0 => "alexandre&#46;soeiro&#64;bol&#46;com&#46;br"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Unidade Cl&#237;nica de Emerg&#234;ncia do Instituto do Cora&#231;&#227;o &#40;InCor&#41;&#44; Faculdade de Medicina&#44; Universidade de S&#227;o Paulo&#44; S&#227;o Paulo&#44; Brazil"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Resposta &#224; Carta ao Editor &#171;Inflammation&#44; systemic lupus erythematosus and the Kounis mast cell acitvation-associated syndrome&#187;"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read with interest the Letter to the Editor titled &#8220;Inflammation&#44; systemic lupus erythematosus and the Kounis mast cell activation-associated syndrome&#8221; from Nicholas G Kounis&#46; In it&#44; the author suggests a possible pathophysiological mechanism related to coronary vasospasm due to mast cell activation as the main reason for acute coronary syndrome in patients with systemic lupus erythematosus&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">I would by no means dismiss this as a possible factor&#44; and indeed the literature describes thrombophilias as an associated mechanism that should always be borne in mind&#46; However&#44; I consider that the author&#44; in attempting to demystify the subject&#44; runs the risk of simplifying a disease that is complex&#44; highly prevalent and an important risk factor for cardiovascular disease&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The author appears to go against all the efforts by researchers to clarify the main cause of acute myocardial infarction in young patients with lupus&#46; All recently published studies draw the same conclusion&#44; that these patients&#8217; coronary arteries show diffuse early atherosclerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;6</span></a> Chronic systemic inflammation is probably the main cause of the atherosclerotic process&#44; and mast cells may well be involved&#46; However&#44; once again I stress that we should not associate this with vasospasm and put forward a pathophysiological theory as the absolute truth&#44; especially when it is contradicted by the findings of cine coronary angiography in all relevant studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;6</span></a> In conclusion&#44; I believe that further studies are still needed in this area&#46; But until proven otherwise&#44; early atherosclerosis is the best-established process in this disease and rigorous control of conventional risk factors such as systemic hypertension&#44; dyslipidemia&#44; smoking and diabetes is essential&#44; together with appropriate control of the systemic inflammatory disease&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The author has no conflict of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; de Matos Soeiro A&#46; Resposta &#224; Carta ao Editor &#171;Inflammation&#44; systemic lupus erythematosus and the Kounis mast cell acitvation-associated syndrome&#187;&#46; Rev Port Cardiol&#46; 2015&#59;34&#58;371&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics and in-hospital outcome of patients with acute coronary syndromes and systemic lupus erythematosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; De Matos Soeiro"
                            1 => "M&#46;C&#46; Soeiro"
                            2 => "M&#46;T&#46; Oliveira Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2014.01.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2014"
                        "volumen" => "33"
                        "paginaInicial" => "685"
                        "paginaFinal" => "690"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25443337"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Premature atherosclerosis and acute coronary syndrome in systemic lupus erythematosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Mattu"
                            1 => "J&#46; Petrini"
                            2 => "S&#46; Swencki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajem.2004.12.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Emerg Med"
                        "fecha" => "2005"
                        "volumen" => "23"
                        "paginaInicial" => "696"
                        "paginaFinal" => "703"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16140181"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic inflammation and coronary microvascular dysfunction in patients without risk factors for coronary artery disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Recio-Mayoral"
                            1 => "J&#46;C&#46; Mason"
                            2 => "J&#46;C&#46; Kaski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehp205"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2009"
                        "volumen" => "30"
                        "paginaInicial" => "1837"
                        "paginaFinal" => "1843"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19502228"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Coronary artery disease in patients with systemic lupus erythematosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Galindo"
                            1 => "L&#46; Chung"
                            2 => "S&#46;D&#46; Crockett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ncprheum0037"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Clin Pract Rheumatol"
                        "fecha" => "2005"
                        "volumen" => "1"
                        "paginaInicial" => "55"
                        "paginaFinal" => "59"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16932628"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atherosclerosis in systemic lupus erythematosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Stojan"
                            1 => "M&#46; Petri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/FJC.0b013e31829dd857"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cardiovasc Pharmacol"
                        "fecha" => "2013"
                        "volumen" => "62"
                        "paginaInicial" => "255"
                        "paginaFinal" => "262"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23792700"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for clinical coronary heart disease in systemic lupus erythematosus&#58; the lupus and atherosclerosis evaluation of risk &#40;LASER&#41; study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Haque"
                            1 => "C&#46; Gordon"
                            2 => "D&#46; Isenberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3899/jrheum.090306"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2010"
                        "volumen" => "37"
                        "paginaInicial" => "322"
                        "paginaFinal" => "329"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19955047"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003400000005/v1_201506091454/S217420491500080X/v1_201506091454/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "29282"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003400000005/v1_201506091454/S217420491500080X/v1_201506091454/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491500080X?idApp=UINPBA00004E"
]
Share
Journal Information
Vol. 34. Issue 5.
Pages 371 (May 2015)
Vol. 34. Issue 5.
Pages 371 (May 2015)
Letter to the Editor
Open Access
Reply to the Letter to the Editor “Inflammation, systemic lupus erythematosus and the Kounis mast cell activation-associated syndrome”
Resposta à Carta ao Editor «Inflammation, systemic lupus erythematosus and the Kounis mast cell acitvation-associated syndrome»
Visits
5116
Alexandre de Matos Soeiro
Unidade Clínica de Emergência do Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
Related content
Nicholas G. Kounis
This item has received

Under a Creative Commons license
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text
To the Editor,

I read with interest the Letter to the Editor titled “Inflammation, systemic lupus erythematosus and the Kounis mast cell activation-associated syndrome” from Nicholas G Kounis. In it, the author suggests a possible pathophysiological mechanism related to coronary vasospasm due to mast cell activation as the main reason for acute coronary syndrome in patients with systemic lupus erythematosus.

I would by no means dismiss this as a possible factor, and indeed the literature describes thrombophilias as an associated mechanism that should always be borne in mind. However, I consider that the author, in attempting to demystify the subject, runs the risk of simplifying a disease that is complex, highly prevalent and an important risk factor for cardiovascular disease.

The author appears to go against all the efforts by researchers to clarify the main cause of acute myocardial infarction in young patients with lupus. All recently published studies draw the same conclusion, that these patients’ coronary arteries show diffuse early atherosclerosis.1–6 Chronic systemic inflammation is probably the main cause of the atherosclerotic process, and mast cells may well be involved. However, once again I stress that we should not associate this with vasospasm and put forward a pathophysiological theory as the absolute truth, especially when it is contradicted by the findings of cine coronary angiography in all relevant studies.1–6 In conclusion, I believe that further studies are still needed in this area. But until proven otherwise, early atherosclerosis is the best-established process in this disease and rigorous control of conventional risk factors such as systemic hypertension, dyslipidemia, smoking and diabetes is essential, together with appropriate control of the systemic inflammatory disease.

Conflicts of interest

The author has no conflict of interest to declare.

References
[1]
A. De Matos Soeiro, M.C. Soeiro, M.T. Oliveira Jr., et al.
Clinical characteristics and in-hospital outcome of patients with acute coronary syndromes and systemic lupus erythematosus.
Rev Port Cardiol, 33 (2014), pp. 685-690
[2]
A. Mattu, J. Petrini, S. Swencki, et al.
Premature atherosclerosis and acute coronary syndrome in systemic lupus erythematosus.
Am J Emerg Med, 23 (2005), pp. 696-703
[3]
A. Recio-Mayoral, J.C. Mason, J.C. Kaski, et al.
Chronic inflammation and coronary microvascular dysfunction in patients without risk factors for coronary artery disease.
Eur Heart J, 30 (2009), pp. 1837-1843
[4]
M. Galindo, L. Chung, S.D. Crockett, et al.
Coronary artery disease in patients with systemic lupus erythematosus.
Nat Clin Pract Rheumatol, 1 (2005), pp. 55-59
[5]
G. Stojan, M. Petri.
Atherosclerosis in systemic lupus erythematosus.
J Cardiovasc Pharmacol, 62 (2013), pp. 255-262
[6]
S. Haque, C. Gordon, D. Isenberg, et al.
Risk factors for clinical coronary heart disease in systemic lupus erythematosus: the lupus and atherosclerosis evaluation of risk (LASER) study.
J Rheumatol, 37 (2010), pp. 322-329

Please cite this article as: de Matos Soeiro A. Resposta à Carta ao Editor «Inflammation, systemic lupus erythematosus and the Kounis mast cell acitvation-associated syndrome». Rev Port Cardiol. 2015;34:371.

Copyright © 2015. Sociedade Portuguesa de Cardiologia
Download PDF
Idiomas
Revista Portuguesa de Cardiologia (English edition)
Article options
Tools
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.