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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">A doen&#231;a cardiovascular e o cancro s&#227;o respons&#225;veis por cerca de 60&#37; das causas de morte na chamada civiliza&#231;&#227;o ocidental&#46; Em Portugal a situa&#231;&#227;o n&#227;o &#233; diferente&#44; mostrando os dados estat&#237;sticos do Instituto Nacional de Estat&#237;stica referentes a 2013&#44; que a principal causa de morte &#233; cardiovascular &#40;29&#44;5&#37;&#41;&#44; seguida pelo cancro &#40;24&#44;3&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Apesar disto&#44; nas &#250;ltimas d&#233;cadas tem vindo a aumentar a taxa de sobreviv&#234;ncia de ambas as doen&#231;as&#44; gra&#231;as a extraordin&#225;rios avan&#231;os nas terap&#234;uticas que atualmente est&#227;o dispon&#237;veis&#46; Nos EUA&#44; a taxa de sobreviv&#234;ncia aos cinco anos dos doentes diagnosticados com cancro entre 1975&#8208;1977 era de 50&#37; e aumentou para 68&#37; nos doentes diagnosticados entre 1999&#8208;2005&#44; havendo atualmente mais de 14 milh&#245;es de sobreviventes&#44; n&#250;meros inimagin&#225;veis at&#233; h&#225; poucos anos<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Contudo&#44; com uma sobreviv&#234;ncia maior&#44; os efeitos adversos cardiovasculares mais tardios destas terap&#234;uticas t&#234;m&#8208;se tornado cada vez mais importantes&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Dada a dimens&#227;o e relev&#226;ncia desta quest&#227;o&#44; faz todo o sentido falar de c&#225;rdio&#8208;oncologia como uma nova subespecialidade m&#233;dica&#46; O n&#250;mero crescente de doentes oncol&#243;gicos com problemas card&#237;acos implica uma abordagem muito espec&#237;fica&#44; que deve ser partilhada entre cardiologistas e oncologistas&#46; Curiosamente&#44; estas duas patologias t&#234;m fatores de risco em comum&#44; como &#233; o caso da obesidade e da diabetes <span class="elsevierStyleItalic">mellitus</span> e&#44; n&#227;o raramente&#44; as duas patologias podem coexistir no mesmo doente&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A cardiotoxicidade &#233; um efeito adverso frequente e conhecido de muitas terap&#234;uticas oncol&#243;gicas tradicionais &#40;como as antraciclinas ou a radioterapia tor&#225;cica&#41;&#44; mas tamb&#233;m pode ocorrer com os novos f&#225;rmacos &#8211; as chamadas terap&#234;uticas biol&#243;gicas&#46; A cardiotoxicidade pode afetar a sobreviv&#234;ncia e a qualidade de vida destes doentes&#44; independentemente do seu progn&#243;stico oncol&#243;gico&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Os efeitos adversos cardiovasculares mais frequentes das terap&#234;uticas oncol&#243;gicas incluem&#58; a disfun&#231;&#227;o ventricular esquerda sintom&#225;tica e assintom&#225;tica&#44; a hipertens&#227;o arterial &#40;HTA&#41;&#44; as arritmias&#44; QT prolongado&#44; fen&#243;menos tromboemb&#243;licos e a isquemia do mioc&#225;rdio<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ao inv&#233;s da cardiotoxicidade associada &#224; terap&#234;utica tradicional &#40;tipo <span class="elsevierStyleSmallCaps">I</span>&#41;&#44; a cardiotoxicidade associada &#224;s novas terap&#234;uticas biol&#243;gicas tende a ser revers&#237;vel &#40;tipo <span class="elsevierStyleSmallCaps">II</span>&#41; com a suspens&#227;o da terap&#234;utica &#40;ex&#58; trastuzumab&#41;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">6&#44;7</span></a>&#44; ou trat&#225;vel com terap&#234;utica m&#233;dica como a HTA associada aos inibidores da angiog&#233;nese &#40;ex&#58; sunitinib&#59; bevacizumab&#41;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; Por outro lado&#44; &#224; medida que as estrat&#233;gias terap&#234;uticas v&#227;o evoluindo&#44; &#233; previs&#237;vel que as terap&#234;uticas tradicionais sejam associadas com uma ou mais das terap&#234;uticas biol&#243;gicas&#44; aumentando a probabilidade de aparecimento de cardiotoxicidade&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Embora a cardiotoxicidade associada &#224; terap&#234;utica oncol&#243;gica sist&#233;mica convencional esteja bem estabelecida&#44; a cardiotoxicidade precoce e tardia das novas terap&#234;uticas bi&#243;logicas n&#227;o &#233; ainda bem conhecida&#44; como tamb&#233;m n&#227;o sabemos as potenciais consequ&#234;ncias precoces e tardias das associa&#231;&#245;es terap&#234;uticas<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">10</span></a>&#46; Consequentemente&#44; &#233; cada vez mais importante identificar biomarcadores precoces de envolvimento card&#237;aco<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O objetivo deste artigo &#233; fazer uma breve revis&#227;o do estado da arte e recomendar pr&#225;ticas de atua&#231;&#227;o cl&#237;nica&#44; que permitam melhorar a dete&#231;&#227;o precoce e o tratamento dos doentes com complica&#231;&#245;es cardiovasculares das terap&#234;uticas oncol&#243;gicas&#44; atrav&#233;s duma abordagem multidisciplinar numa consulta de c&#225;rdio&#8208;oncologia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Terap&#234;uticas oncol&#243;gicas farmacol&#243;gicas</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antraciclinas</span><p id="par0045" class="elsevierStylePara elsevierViewall">As antraciclinas &#40;doxorubicina&#44; epirubicina&#44; daunorubicina e idarubicina&#41; est&#227;o entre os f&#225;rmacos mais usados na quimioterapia e s&#227;o particularmente eficazes no tratamento do cancro da mama e nos linfomas&#46; Todavia&#44; esta sua efic&#225;cia pode ser prejudicada pelo aparecimento de efeitos adversos card&#237;acos&#44; nomeadamente a insufici&#234;ncia card&#237;aca&#44; que se pode manifestar numa fase precoce &#40;semanas a meses&#41; ap&#243;s a terap&#234;utica ou mais tardiamente &#40;v&#225;rios anos depois&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Investiga&#231;&#227;o recente demonstrou que as antraciclinas inibem seletivamente a express&#227;o gen&#233;tica do m&#250;sculo card&#237;aco&#46; A doxorubicina liga&#8208;se ao DNA intercalando&#8208;se entre bases espec&#237;ficas&#44; impedindo deste modo a s&#237;ntese de DNA&#44; RNA ou ambos&#44; o que vai interferir com os processos de replica&#231;&#227;o e transcri&#231;&#227;o&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O efeito cardiol&#243;gico das antraciclinas tamb&#233;m est&#225; associado com a inibi&#231;&#227;o da topoisomerase 2&#946; e com a forma&#231;&#227;o de radicais livres de oxig&#233;nio&#46; Estas altera&#231;&#245;es na express&#227;o gen&#233;tica podem originar a apoptose precoce dos cardiomiocitos e a perda progressiva de miofibrilhas da musculatura card&#237;aca<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">12&#44;13</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">O principal fator de risco para o desenvolvimento de insufici&#234;ncia card&#237;aca &#233; a dose cumulativa das antraciclinas&#46; A incid&#234;ncia de cardiotoxicidade sintom&#225;tica com a doxorubicina varia entre 5&#37; para doses de 400<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span> at&#233; 48&#37; para doses cumulativas de 700<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">14&#44;15</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Estima&#8208;se que mais de metade dos doentes que fizeram antraciclinas v&#227;o desenvolver altera&#231;&#245;es card&#237;acas nos seis anos subsequentes e t&#234;m uma probabilidade cinco vezes maior de vir a ter insufici&#234;ncia card&#237;aca do que os doentes n&#227;o tratados com este tipo de f&#225;rmacos<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Os outros fatores de risco incluem&#58; as idades mais avan&#231;adas &#40;&#62;<span class="elsevierStyleHsp" style=""></span>65 anos&#41; ou mais jovens &#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 anos&#41;&#44; g&#233;nero feminino&#44; HTA&#44; doen&#231;a card&#237;aca pr&#233;via&#44; diabetes e a irradia&#231;&#227;o tor&#225;cica pr&#233;via&#46; A terap&#234;utica combinada com ciclofosfamida e taxanos&#44; que &#233; frequentemente usada no cancro da mama&#44; pode potenciar o risco de cardiotoxicidade<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">17</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Trastuzumab</span><p id="par0075" class="elsevierStylePara elsevierViewall">O tratamento com trastuzumab&#44; um anticorpo monoclonal com alta afinidade para o recetor HER2&#44; alterou a hist&#243;ria natural das doentes com cancro da mama HER2 positivo&#44; uma variante da doen&#231;a que ocorre em cerca de 25&#37; dos casos e que est&#225; associada com pior progn&#243;stico&#46; De facto&#44; a utiliza&#231;&#227;o desta terap&#234;utica melhorou a sobreviv&#234;ncia em 33&#37; e diminuiu o risco de recorr&#234;ncias em cerca de 50&#37; destas doentes<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">18&#44;19</span></a>&#46; Todavia&#44; esta terap&#234;utica est&#225; associada a cardiotoxicidade&#44; tendo&#8208;se verificado uma maior incid&#234;ncia de disfun&#231;&#227;o ventricular esquerda sintom&#225;tica e assintom&#225;tica&#44; que pode variar entre 4&#37; em contexto adjuvante e 27&#37; em contexto metast&#225;tico<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Esta cardiotoxicidade tem caracter&#237;sticas diferentes da cardiotoxicidade associada com as antraciclinas&#44; uma vez que &#233; independente da dose utilizada e n&#227;o apresenta as altera&#231;&#245;es ultraestruturais t&#237;picas das antraciclinas&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">T&#234;m sido propostas estrat&#233;gias para reduzir a cardiotoxicidade das antraciclinas e do trastuzumab&#44; que incluem a avalia&#231;&#227;o com biomarcadores como a troponina <span class="elsevierStyleSmallCaps">I</span> e o NT&#8208;ProBNP&#44; a determina&#231;&#227;o ecocardiogr&#225;fica da fra&#231;&#227;o ventricular esquerda basal e a sua monitoriza&#231;&#227;o ao longo do tratamento&#44; assim como a avalia&#231;&#227;o da deforma&#231;&#227;o ventricular &#40;com avalia&#231;&#227;o do <span class="elsevierStyleItalic">strain</span> longitudinal global&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figura 1</a>&#41;&#44; que podem levar &#224; necessidade de interrup&#231;&#227;o transit&#243;ria ou definitiva da terap&#234;utica oncol&#243;gica e &#224; institui&#231;&#227;o de terap&#234;utica para a insufici&#234;ncia card&#237;aca<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">21&#8211;24</span></a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">A terap&#234;utica deste tipo de cardiotoxicidade&#44; caracterizada por disfun&#231;&#227;o ventricular esquerda&#44; deve ser tratada com os mesmos f&#225;rmacos usados na insufici&#234;ncia cardiaca de outras etiologias&#44; como os inibidores da enzima de convers&#227;o&#44; os antagonistas da angiotensina <span class="elsevierStyleSmallCaps">II</span> e os beta&#8208;bloqueantes&#44; como &#233; preconizado pelas orienta&#231;&#245;es cl&#237;nicas europeias e americanas<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">25&#8211;27</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Inibidores da angiog&#233;nese e hipertens&#227;o arterial</span><p id="par0095" class="elsevierStylePara elsevierViewall">Inicialmente&#44; o crescimento de um tumor &#233; alimentado pelos vasos sangu&#237;neos que lhe est&#227;o pr&#243;ximos&#46; Quando o tumor atinge um determinado tamanho&#44; esses vasos sangu&#237;neos j&#225; n&#227;o s&#227;o suficientes e o tumor para continuar o seu processo de crescimento&#44; adquire a capacidade de gerar novos vasos&#44; processo conhecido por angiog&#233;nese&#46; Assim&#44; as c&#233;lulas tumorais s&#227;o capazes de aumentar os fatores pr&#243;&#8208;angiog&#233;nicos&#44; como o fator de crescimento do endot&#233;lio vascular &#40;VEGF&#41; e diminuir os fatores inibidores da angiog&#233;nese<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">28&#8211;30</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A HTA &#233; a toxicidade cardiovascular mais frequentemente associada com os inibidores do fator de crescimento do endot&#233;lio vascular &#40;VEGFI&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Os mecanismos envolvidos na patog&#233;nese da HTA associada &#224; terap&#234;utica com os VEGFI s&#227;o complexos e multifatoriais&#44; e ainda n&#227;o est&#227;o completamente esclarecidos&#46; O VEGF &#233; um vasodilatador que atua via produ&#231;&#227;o de &#225;cido n&#237;trico&#44; e a sua inibi&#231;&#227;o origina vasoconstri&#231;&#227;o&#44; aumento da resist&#234;ncia vascular perif&#233;rica e HTA&#46; Outros fatores mediados pelo VEGFI&#44; como a disfun&#231;&#227;o endotelial&#44; a remodela&#231;&#227;o vascular&#44; a rigidez arterial e a rarefa&#231;&#227;o dos vasos capilares&#44; parecem tamb&#233;m ter um contributo importante<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">32&#8211;34</span></a>&#46; Mais recentemente&#44; a endotelina 1 &#40;ET1&#41;&#44; um potente vasoconstritor&#44; tamb&#233;m tem sido implicada na g&#233;nese da HTA mediada pelos VEGFI&#46; A sua secre&#231;&#227;o parece estar aumentada devido &#224; disfun&#231;&#227;o endotelial&#44; havendo j&#225; evid&#234;ncia em estudos cl&#237;nicos que n&#237;veis aumentados de ET1 aparecem em paralelo com subida da press&#227;o arterial &#40;TA&#41; em doentes a fazer terap&#234;utica com VEGFI<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Praticamente quase 100&#37; dos doentes tratados com VEGFI t&#234;m subida da tens&#227;o arterial&#44; havendo um subgrupo que desenvolve HTA&#46; O 1&#46;&#176; ciclo de tratamento com VEGFI &#233; a fase em que se verifica o maior aumento da tens&#227;o arterial&#46; A HTA induzida pelos VEGFI n&#227;o &#233; um efeito adverso da terap&#234;utica&#44; mas sim um mecanismo dependente da terap&#234;utica <span class="elsevierStyleItalic">on&#8208;target</span>&#46; Este facto levou ao conceito de que a HTA poder ser um marcador da efic&#225;cia terap&#234;utica dos VEGFI e uma resposta antiangiog&#233;nica positiva&#44; e&#44; como tal&#44; ser um biomarcador de bom progn&#243;stico desta terap&#234;utica<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">30&#8211;32</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Associado com o aumento da tens&#227;o arterial dose&#8208;dependente est&#225; tamb&#233;m um aumento do risco de protein&#250;ria&#46; H&#225; mesmo um subgrupo de doentes que pode desenvolver doen&#231;a glomerular ou a microangiopatia tromb&#243;tica glomerular e insufici&#234;ncia renal aguda&#44; que s&#227;o revers&#237;veis com a suspens&#227;o imediata da terap&#234;utica&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Nos doentes que desenvolvem HTA&#44; pode haver tamb&#233;m complica&#231;&#245;es neurol&#243;gicas&#44; como&#44; por exemplo&#44; a s&#237;ndrome da leucoencefalopatia posterior&#44; que &#233; revers&#237;vel com a descontinua&#231;&#227;o da terap&#234;utica&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">O aumento da TA induzida pelos VEGFI tem um perfil caracter&#237;stico&#58; acontece rapidamente&#44; poucas horas depois do in&#237;cio da terap&#234;utica&#44; sendo TA sist&#243;lica mais afetada do que a diast&#243;lica&#46; A incid&#234;ncia de HTA est&#225; relacionada com a dose e est&#225; aumentada com a utiliza&#231;&#227;o de m&#250;ltiplos agentes antiangiog&#233;nicos usados em associa&#231;&#227;o&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">O objetivo da otimiza&#231;&#227;o da terap&#234;utica anti&#8208;hipertensora &#233; permitir que a terap&#234;utica dirigida com VEGFI seja administrada sem altera&#231;&#227;o de dose&#44; de forma cont&#237;nua e segura&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Para tal&#44; &#233; recomend&#225;vel fazer uma avalia&#231;&#227;o cardiovascular basal antes de se iniciar estas terap&#234;uticas&#44; incluindo avalia&#231;&#227;o repetida da TA&#46; &#201; igualmente importante avaliar a fun&#231;&#227;o renal e a exist&#234;ncia de protein&#250;ria&#44; pois o envolvimento renal pode ser respons&#225;vel pelo aparecimento de HTA <span class="elsevierStyleItalic">de novo</span> ou agravamento de HTA pr&#233;&#8208;existente&#46; O objetivo n&#227;o &#233; excluir doentes&#44; mas sim avaliar o risco basal e iniciar monitoriza&#231;&#227;o rigorosa&#46; &#201; importante manter ou iniciar terap&#234;utica anti&#8208;hipertensora para n&#237;veis de TA de 140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Estes n&#237;veis tensionais dever&#227;o ser ajustados de acordo com a exist&#234;ncia de comorbilidades &#40;130&#47;80<span class="elsevierStyleHsp" style=""></span>mmHg&#44; se diabetes ou insufici&#234;ncia renal cr&#243;nica&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Tabela 1</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">33&#8211;36</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">V&#225;rias classes de f&#225;rmacos anti&#8208;hipertensores t&#234;m sido utilizados para tratar a HTA dos doentes oncol&#243;gicos&#46; Todos s&#227;o eficazes&#44; numa base individual&#44; n&#227;o havendo estudos que demonstrem superioridade de uma classe em rela&#231;&#227;o a outra&#46; Todavia&#44; &#233; importante ter cuidado com os antagonistas do c&#225;lcio n&#227;o&#8208;hidropirid&#237;nicos &#40;verapamil e diltiazem&#41;&#44; que tamb&#233;m s&#227;o inibidores da CYP 3A4&#46; Como o &#225;cido n&#237;trico endotelial &#233; considerado um putativo mediador da angiog&#233;nese&#44; agentes que atuem no aumento do &#225;cido n&#237;trico como os nitratos ou o nebivolol t&#234;m sido recomendados no tratamento da HTA destes doentes<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Uma vez iniciada a terap&#234;utica&#44; &#233; recomendado fazer avalia&#231;&#227;o regular da TA durante o 1&#46;&#176; ciclo da terap&#234;utica e depois a cada duas a tr&#234;s semanas durante a dura&#231;&#227;o do tratamento&#44; e os doentes devem ser aconselhados a fazer automedi&#231;&#227;o em casa&#46; A avalia&#231;&#227;o da TA poder&#225; ser mais frequente&#44; se os doentes estiverem a fazer medica&#231;&#227;o concomitante com f&#225;rmacos que aumentem o risco de HTA&#44; como os anti&#8208;inflamat&#243;rios e a eritropoetina&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">No caso de a TA sist&#243;lica subir para valores &#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mmHg ou a diast&#243;lica para &#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mmHg&#44; deve&#8208;se reduzir a dose ou suspender o tratamento oncol&#243;gico&#46; A ideia &#233; manter a dose mais alta poss&#237;vel que o doente consiga tolerar&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">O tratamento deve ter em conta a diminui&#231;&#227;o do risco a curto prazo associado com a HTA &#40;acidente vascular cerebral&#44; enfarte agudo do mioc&#225;rdio&#44; insufici&#234;ncia card&#237;aca&#41;&#44; enquanto deve assegurar a dose terap&#234;utica eficaz do tratamento oncol&#243;gico antiangiog&#233;nico&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">N&#227;o existem <span class="elsevierStyleItalic">guidelines</span> espec&#237;ficas para o tratamento da HTA induzida pelos VEGFI e&#44; assim&#44; a terap&#234;utica deve basear&#8208;se nas recomenda&#231;&#245;es existentes da Sociedade Europeia de Cardiologia e do <span class="elsevierStyleItalic">National Cancer Institute</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figura 2</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">37</span></a><span class="elsevierStyleSup">&#44;38</span>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Radioterapia</span><p id="par0165" class="elsevierStylePara elsevierViewall">A irradia&#231;&#227;o do cora&#231;&#227;o aumenta o risco de cardiotoxicidade induzida pela radioterapia &#40;RIHD&#41; e est&#225; relacionada com a dose cumulativa&#46; Pode ser potenciada pela quimioterapia&#44; nomeadamente pelas antraciclinas&#46; A dose cumulativa total &#233; fun&#231;&#227;o do n&#250;mero de tratamentos e da dose da radia&#231;&#227;o&#46; As manifesta&#231;&#245;es da RIHD podem ser agudas&#59; todavia&#44; a maior parte s&#243; se manifesta clinicamente v&#225;rios anos ap&#243;s o tratamento&#46; Os seus efeitos adversos s&#227;o m&#250;ltiplos&#44; podendo ocasionar insufici&#234;ncia card&#237;aca&#44; doen&#231;a coron&#225;ria&#44; pericardites&#44; valvulopatias e altera&#231;&#245;es do ritmo card&#237;aco&#46; Al&#233;m disso&#44; a RIHD pode tamb&#233;m ser potenciada pela exist&#234;ncia de v&#225;rios fatores de risco que s&#227;o comuns &#224;s doen&#231;as card&#237;acas e oncol&#243;gicas&#44; como a obesidade&#44; sedentarismo&#44; diabetes&#44; HTA e o tabagismo&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Est&#225; bem documentado o aumento dose&#8208;dependente das doen&#231;as cardiovasculares ap&#243;s radioterapia tor&#225;cica&#44; especialmente nos linfomas e no cancro da mama &#40;sobretudo da esquerda&#41;&#44; e as doen&#231;as cardiovasculares s&#227;o a causa n&#227;o oncol&#243;gica mais frequente de morte&#46; De facto&#44; comparando o risco&#8208;benef&#237;cio a longo prazo&#44; o efeito positivo da radioterapia pode ser parcialmente anulado pelas complica&#231;&#245;es card&#237;acas<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">39&#44;40</span></a>&#46; No entanto&#44; os dados conhecidos e reportados s&#227;o em grande parte retrospetivos e num tempo em que ainda eram utilizados os protocolos antigos&#46; Ainda n&#227;o &#233; conhecida a preval&#234;ncia de RIHD com a utiliza&#231;&#227;o dos novos protocolos da radioterapia&#44; que incluem o planeamento por tomografia tridimensional da &#225;rea a irradiar&#44; com prote&#231;&#227;o card&#237;aca&#44; redu&#231;&#227;o das doses e do tamanho do campo de irradia&#231;&#227;o&#46; Por exemplo no cancro da mama&#44; o planeamento por tomografia &#233; feito de forma a n&#227;o incluir o cora&#231;&#227;o no campo de interven&#231;&#227;o&#59; tamb&#233;m a exclus&#227;o da cadeia linf&#225;tica mam&#225;ria interna do campo permite reduzir as doses card&#237;acas&#46; Outro fator potencial &#233; o fracionamento das doses de radia&#231;&#227;o&#44; havendo alguns estudos que demonstraram que&#44; com maior fracionamento da dose total&#44; havia menor incid&#234;ncia de pericardite aguda e necrose do mioc&#225;rdio&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Com estes novos protocolos espera&#8208;se diminuir a incid&#234;ncia de RIHD&#44; embora ainda n&#227;o haja dados de seguimento a longo prazo&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">A radia&#231;&#227;o ionizante pode lesar praticamente todas as estruturas card&#237;acas&#46; As altera&#231;&#245;es no sistema vascular ocorrem a n&#237;vel micro e macrovascular&#46; A n&#237;vel microvascular&#44; traduzem&#8208;se em perda de c&#233;lulas endoteliais com subsequente resposta inflamat&#243;ria&#44; les&#227;o vascular e isquemia&#46; O aparecimento de fibrose parece estar relacionado com o processo de repara&#231;&#227;o celular e n&#227;o com o efeito ionizante direto&#46; As altera&#231;&#245;es macrovasculares incluem a arteriosclerose acelerada e a obstru&#231;&#227;o das art&#233;rias coron&#225;rias&#44; ocasionando s&#237;ndromes coron&#225;rias agudas em idades mais jovens&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A fibrose difusa ap&#243;s radioterapia&#44; que se pode identificar histologicamente tanto no mioc&#225;rdio como no peric&#225;rdio&#44; pode ocasionar miocardite restritiva e pericardite constritiva<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">41&#8211;44</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">N&#227;o existem <span class="elsevierStyleItalic">guidelines</span> para a monitoriza&#231;&#227;o card&#237;aca destes doentes&#46; Para minimizar os riscos de RIHD&#44; os doentes de alto risco para eventos card&#237;acos devem ser identificados antes de iniciar a radioterapia e&#44; quando apropriado&#44; fazerem avalia&#231;&#227;o da fun&#231;&#227;o card&#237;aca&#44; que dever&#225; depois ser repetida ao longo do per&#237;odo de sobrevida&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Os doentes que j&#225; foram submetidos a radioterapia tor&#225;cica &#233; recomend&#225;vel que fa&#231;am reavalia&#231;&#227;o da fun&#231;&#227;o card&#237;aca a cada dez anos&#46; Este intervalo de tempo pode ser reduzido para cinco anos nos doentes considerados de alto risco para RIHD &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figura 3</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">45&#44;46</span></a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Programa de c&#225;rdio&#8208;oncologia</span><p id="par0200" class="elsevierStylePara elsevierViewall">Um programa de c&#225;rdio&#8208;oncologia dever&#225; estar assente em tr&#234;s pilares&#58; 1 &#8211; componente cl&#237;nica &#8211; consulta de c&#225;rdio&#8208;oncologia&#59; 2 &#8211; componente formativa&#59; 3 &#8211; componente de investiga&#231;&#227;o&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Consulta de c&#225;rdio&#8208;oncologia</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Objetivos</span><p id="par0205" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8208;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Providenciar cuidados especializados cardiol&#243;gicos a doentes com cancro e antecedentes de doen&#231;a cardiovascular&#44; ou que desenvolveram complica&#231;&#245;es card&#237;acas durante as terap&#234;uticas oncol&#243;gicas&#46;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0215" class="elsevierStylePara elsevierViewall">Otimizar os cuidados card&#237;acos em doentes oncol&#243;gicos sob terap&#234;utica potencialmente cardiot&#243;xica&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0220" class="elsevierStylePara elsevierViewall">Melhorar o conhecimento das complica&#231;&#245;es card&#237;acas dos tratamentos oncol&#243;gicos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0225" class="elsevierStylePara elsevierViewall">Agilizar a dete&#231;&#227;o precoce de cardiotoxicidade &#40;com biomarcadores cl&#237;nicos&#44; laboratoriais e imagiol&#243;gicos&#44; tendo a ecocardiografia um papel primordial&#41; e estabelecer estrat&#233;gias de interven&#231;&#227;o para otimizar os cuidados cardiol&#243;gicos&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0230" class="elsevierStylePara elsevierViewall">Otimizar o progn&#243;stico dos doentes atrav&#233;s duma abordagem multidisciplinar e integrativa de v&#225;rios profissionais de sa&#250;de &#40;m&#233;dicos&#44; enfermeiros&#44; t&#233;cnicos&#41;&#46;</p></li></ul></p></li></ul></p><p id="par0235" class="elsevierStylePara elsevierViewall">Nesta consulta&#44; os protocolos de monitoriza&#231;&#227;o da cardiotoxicidade devem incluir as tr&#234;s etapas intervencionais &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabela 2</a>&#41;&#58; avalia&#231;&#227;o dos doentes antes do in&#237;cio da terap&#234;utica oncol&#243;gica&#44; nomeadamente nos doentes com fatores de risco cardiovasculares&#59; avalia&#231;&#227;o durante a terap&#234;utica&#44; no sentido de detetar e tratar precocemente as complica&#231;&#245;es cardiovasculares&#59; e monitoriza&#231;&#227;o ap&#243;s o tratamento&#44; como se ilustra nas <a class="elsevierStyleCrossRefs" href="#tbl0015">Tabelas 3 e 4</a>&#46; A utiliza&#231;&#227;o destes <span class="elsevierStyleItalic">scores</span> de risco permite selecionar de forma mais rigorosa quais os doentes que devem ser referenciados &#224; consulta de c&#225;rdio&#8208;oncologia &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Tabela 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0240" class="elsevierStylePara elsevierViewall">Para a monitoriza&#231;&#227;o e dete&#231;&#227;o precoce da cardiotoxicidade&#44; &#233; igualmente importante desenvolver algoritmos apropriados&#44; f&#225;ceis de utilizar e implementar na pr&#225;tica cl&#237;nica&#44; como alguns dos j&#225; descritos<a class="elsevierStyleCrossRefs" href="#bib0510"><span class="elsevierStyleSup">43&#8211;49</span></a>&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Finalmente&#44; deve ser feito controlo cont&#237;nuo de qualidade&#44; podendo ser utilizado o m&#233;todo planear&#47;desenvolver&#47;conferir&#47;atuar &#40;PDCA&#41;&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Estes indicadores ir&#227;o permitir analisar a qualidade t&#233;cnica e cient&#237;fica &#40;decis&#245;es terap&#234;uticas&#59; avalia&#231;&#227;o dos <span class="elsevierStyleItalic">outcomes</span>&#41;&#59; o perfil de seguran&#231;a e grau de satisfa&#231;&#227;o dos doentes &#40;atrav&#233;s de question&#225;rios de satisfa&#231;&#227;o&#59; recomenda&#231;&#245;es para combater fatores de risco&#59; ensino ao doente&#41;&#59; e fazer registos&#44; protocolos de estudo&#44; planos de forma&#231;&#227;o pr&#233; e p&#243;s&#8208;graduada<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">55</span></a>&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Componente formativa</span><p id="par0255" class="elsevierStylePara elsevierViewall">Esta nova &#225;rea do conhecimento m&#233;dico deve tamb&#233;m incluir&#44; como preconiza a Sociedade Europeia da Cardiologia&#44; uma componente formativa quer no ensino pr&#233;&#8208;graduado quer no ensino p&#243;s&#8208;graduado&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Seria de todo o interesse haver no internato de ambas as especialidades um per&#237;odo de forma&#231;&#227;o dedicado &#224; c&#225;rdio&#8208;oncologia &#40;n&#237;vel b&#225;sico ou mais avan&#231;ado&#44; de acordo com as op&#231;&#245;es individuais&#41;<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">50&#8211;58</span></a>&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Componente de investiga&#231;&#227;o</span><p id="par0265" class="elsevierStylePara elsevierViewall">Finalmente&#44; &#233; tamb&#233;m desej&#225;vel a implementa&#231;&#227;o de projetos de investiga&#231;&#227;o cl&#237;nicos e translacionais&#44; que permitam a identifica&#231;&#227;o precoce de cardiotoxicidade&#44; assim como a suscetibilidade individual para desenvolver cardiotoxicidade&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">A cardiotoxicidade &#233; cada vez mais causa de preocupa&#231;&#227;o nos ensaios cl&#237;nicos e pr&#233;&#8208;cl&#237;nicos com novos f&#225;rmacos&#46; Estes efeitos adversos n&#227;o raramente s&#227;o causa de suspens&#227;o da terap&#234;utica oncol&#243;gica&#46; Como tal&#44; existe necessidade crescente de prever&#44; com maior precis&#227;o&#44; o risco de cardiotoxicidade induzida por estes novos f&#225;rmacos em est&#225;dios precoces da sua investiga&#231;&#227;o<a class="elsevierStyleCrossRefs" href="#bib0590"><span class="elsevierStyleSup">59&#8211;61</span></a>&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclus&#227;o</span><p id="par0275" class="elsevierStylePara elsevierViewall">As taxas de sobreviv&#234;ncia dos doentes com cancro t&#234;m vindo a aumentar gra&#231;as &#224;s novas terap&#234;uticas oncol&#243;gicas&#46; Todavia&#44; esta enorme conquista pode ser ensombrada pelos efeitos delet&#233;rios destas terap&#234;uticas no sistema cardiovascular&#46; Esta cardiotoxicidade pode manifestar&#8208;se de forma aguda ou&#44; mais tardiamente&#44; meses ou anos ap&#243;s terminar a terap&#234;utica&#46; Podem ainda exacerbar ou at&#233; desmascarar problemas card&#237;acos pr&#233;&#8208;existentes&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">O aparecimento de doen&#231;a cardiovascular durante a terap&#234;utica oncol&#243;gica pode levar a altera&#231;&#227;o do esquema terap&#234;utico &#40;altera&#231;&#227;o de dose&#44; dura&#231;&#227;o de ciclos&#44; interrup&#231;&#227;o transit&#243;ria ou definitiva da terap&#234;utica&#41; e&#44; portanto&#44; impedir a sua total efic&#225;cia&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">A nova disciplina de c&#225;rdio&#8208;oncologia surgiu em resposta &#224; necessidade de detetar precocemente envolvimento cardiovascular e otimizar o tratamento cardiol&#243;gico dos doentes com cancro&#44; quer durante a terap&#234;utica oncol&#243;gica&#44; quer a longo prazo nos sobreviventes&#46; A import&#226;ncia da abordagem multidisciplinar tem vido a ser reconhecida por v&#225;rias sociedades e organiza&#231;&#245;es europeias e americanas&#44; e deve tornar&#8208;se <span class="elsevierStyleItalic">standard</span> no seguimento destes doentes&#46; Esta colabora&#231;&#227;o estreita entre especialidades servir&#225; tamb&#233;m para estabelecer recomenda&#231;&#245;es cl&#237;nicas&#44; protocolos de investiga&#231;&#227;o cl&#237;nica e translacional que permitam responder a quest&#245;es como prever&#44; prevenir e tratar a cardiotoxicidade&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflito de interesses</span><p id="par0290" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A taxa de sobreviv&#234;ncia dos doentes &#40;dts&#41; com cancro aumentou consideravelmente nas &#250;ltimas d&#233;cadas&#44; havendo atualmente mais de 20 milh&#245;es de sobreviventes nos EUA e na Europa&#44; n&#250;meros inimagin&#225;veis at&#233; h&#225; poucos anos&#46; Para tal&#44; muito contribuiu o aparecimento de novos f&#225;rmacos &#40;terap&#234;uticas biol&#243;gicas&#41;&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">No entanto&#44; estes benef&#237;cios na sobreviv&#234;ncia e o envelhecimento da popula&#231;&#227;o foram acompanhados de um aumento da taxa de efeitos adversos cardiovasculares&#44; sobretudo se j&#225; havia doen&#231;a card&#237;aca pr&#233;via&#46; De facto&#44; a incid&#234;ncia de cardiotoxicidade &#40;CTX&#41; tem sido continuamente mais evidente&#44; comprometendo a efic&#225;cia das terap&#234;uticas oncol&#243;gicas &#40;TO&#41;&#46; S&#227;o conhecidos os efeitos adversos card&#237;acos das TO tradicionais &#40;antraciclinas e radioterapia tor&#225;cica&#41;&#44; como a insufici&#234;ncia card&#237;aca&#46; Contudo&#44; esta representa apenas uma fra&#231;&#227;o das manifesta&#231;&#245;es de CTX&#44; pois muitas das novas terap&#234;uticas t&#234;m efeitos cardiovasculares diversos&#46; As orienta&#231;&#245;es cl&#237;nicas existentes para fazer a dete&#231;&#227;o precoce&#44; a preven&#231;&#227;o e o tratamento da CTX dos tratamentos oncol&#243;gicos&#44; n&#227;o abrangem todas as manifesta&#231;&#245;es de CTX e ainda s&#227;o poucas as ferramentas para a avalia&#231;&#227;o destes dts&#46; A ecocardiografia &#233; atualmente o m&#233;todo de escolha para avaliar os dts nas fases pr&#233;&#44; durante e ap&#243;s a TO&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dada a dimens&#227;o e relev&#226;ncia desta quest&#227;o&#44; faz todo o sentido falar de c&#225;rdio&#8208;oncologia&#44; uma nova subespecialidade m&#233;dica&#46; O n&#250;mero crescente de dts oncol&#243;gicos com problemas card&#237;acos implica uma abordagem que deve ser partilhada entre cardiologistas&#44; oncologistas e radioterapeutas&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Esta nova &#225;rea do conhecimento m&#233;dico deve tamb&#233;m incluir uma componente formativa cl&#237;nica&#44; sendo tamb&#233;m desej&#225;vel a implementa&#231;&#227;o de projetos de investiga&#231;&#227;o cl&#237;nicos e transacionais&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Considerable advances in cancer therapies in recent decades have reshaped the prognosis of cancer patients&#46; There are now estimated to be over 20 million cancer survivors in the USA and Europe&#44; numbers unimaginable a few years ago&#46; However&#44; this increase in survival&#44; along with the aging of the patient population&#44; has been accompanied by a rise in adverse cardiovascular effects&#44; particularly when there is a previous history of heart disease&#46; The incidence of cardiotoxicity continues to grow&#44; which can compromise the effectiveness of cancer therapy&#46; Cardiotoxicity associated with conventional therapies&#44; especially anthracyclines and radiation&#44; is well known&#44; and usually leads to left ventricular dysfunction&#46; However&#44; heart failure represents only a fraction of the cardiotoxicity associated with newer therapies&#44; which have diverse cardiovascular effects&#46; There are few guidelines for early detection&#44; prevention and treatment of cardiotoxicity of cancer treatments&#44; and no well&#8208;established tools for screening these patients&#46; Echocardiography is the method of choice for assessment of patients before&#44; during and after cancer treatment&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">It therefore makes sense to adopt a multidisciplinary approach to these patients&#44; involving cardiologists&#44; oncologists and radiotherapists&#44; collaborating in the development of new training modules&#44; and performing clinical and translational research in a cardio&#8208;oncology program&#46; Cardio&#8208;oncology is a new frontier in medicine and has emerged as a new medical subspecialty that concentrates knowledge&#44; understanding&#44; training and treatment of cardiovascular comorbidities&#44; risks and complications in patients with cancer in a comprehensive approach to the patient rather than to the disease&#46;</p></span>"
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          "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Algoritmo de decis&#227;o para monitoriza&#231;&#227;o e dete&#231;&#227;o de cardiotoxicidade tipo <span class="elsevierStyleSmallCaps">I</span> e tipo <span class="elsevierStyleSmallCaps">II</span> antes e durante quimioterapia &#40;adaptado de Rashi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">60</span></a>&#41;&#46; FEVE&#58; fra&#231;&#227;o de eje&#231;&#227;o ventricular esquerda&#46;</p>"
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          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o inicial e monitoriza&#231;&#227;o da press&#227;o arterial durante terap&#234;utica com f&#225;rmacos antiantiangiog&#233;nicos &#40;adaptado de Ederhy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">36</span></a>&#41;&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ACC&#58; antagonistas dos canais de c&#225;lcio&#59; IA&#58; inibidores da angiog&#233;nese&#46;</p>"
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Algoritmo para avalia&#231;&#227;o ap&#243;s radioterapia tor&#225;cica &#40;adaptado de Lancelloti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">46</span></a>&#41;&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AC&#58; antraciclinas&#59; DC&#58; doen&#231;a coron&#225;ria&#59; IC&#58; insufici&#234;ncia card&#237;aca&#59; PC&#58; pericardite constritiva&#59; RIHD&#58; cardiotoxicidade induzida pela radioterapia&#59;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">DM&#58; diabetes <span class="elsevierStyleItalic">mellitus</span>&#59; IRC&#58; insufici&#234;ncia renal cr&#243;nica&#59; LOA&#58; les&#227;o &#243;rg&#227;o&#8208;alvo&#59; TA&#58; tens&#227;o arterial&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grau NCI&#8208;CTC v4&#46;0 &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recomenda&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Classifica&#231;&#227;o SEC &#40;2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recomenda&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nenhuma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#211;tima&#58; &#60;<span class="elsevierStyleHsp" style=""></span>120&#47;80<span class="elsevierStyleHsp" style=""></span>mmHg<br>Normal&#58; 120&#8208;129&#47;80&#8208;84<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nenhuma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">1</span> &#8211; Aumento assintom&#225;tico&#44; transit&#243;rio &#40;&#60;<span class="elsevierStyleHsp" style=""></span>24H&#41;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mmHg &#40;diast&#243;lica&#41; ou<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>150&#47;100<span class="elsevierStyleHsp" style=""></span>mmHg se TA previamente normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nenhuma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Normal&#47;alta&#58; 130&#8208;139&#47;85&#8208;89<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208; Modifica&#231;&#227;o do estilo de vida se FR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">2</span> &#8211; Aumento persistente&#44; recorrente<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mmHg &#40;diast&#243;lica&#41; ou<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>150&#47;100<span class="elsevierStyleHsp" style=""></span>mmHg se TA previamente normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Iniciar terap&#234;utica anti&#8208;hipertensora &#40;monoterapia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HTA grau 1&#58; 140&#8208;159&#47;90&#8208;99<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208; Modifica&#231;&#227;o do estilo de vida<br>&#8208; Iniciar terap&#234;utica anti&#8208;hipertensora se LOA&#44; DM&#44; IRC grau 3 &#40;TA<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">3</span> &#8211; TA<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>160&#47;100<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Terap&#234;utica anti&#8208;hipertensora mais intensa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HTA grau 2&#58; 160&#8208;179&#47;100&#47;109<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208; Modifica&#231;&#227;o do estilo de vida<br>&#8208; Terap&#234;utica anti&#8208;hipertensora imediata se FR<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>1 &#40;TA<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">4</span> &#8211; HTA maligna&#44; <span class="elsevierStyleItalic">d&#233;ficit</span> neurol&#243;gico transit&#243;rio ou permanente&#44; crise hipertensiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Interven&#231;&#227;o urgente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HTA grau 3&#58; &#8805;<span class="elsevierStyleHsp" style=""></span>180&#47;110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208; Modifica&#231;&#227;o do estilo de vida<br>&#8208; Terap&#234;utica anti&#8208;hipertensora imediata&#58; DCV sintom&#225;tica&#44; DM com LOA&#44; IRC grau &#8805;<span class="elsevierStyleHsp" style=""></span>4 &#40;TA<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Gravidade da hipertens&#227;o arterial &#40;HTA&#41; e compara&#231;&#227;o das recomenda&#231;&#245;es da Sociedade Europeia de Cardiologia &#40;SEC&#41;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">37</span></a> e do <span class="elsevierStyleItalic">National Cancer Institute &#40;NCI&#41;</span><span class="elsevierStyleSup">38</span></p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Etapa pr&#233;&#8208;intervencional</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Avalia&#231;&#227;o de risco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Identifica&#231;&#227;o e controlo de fatores de risco cardiovasculares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Personalizar terap&#234;utica oncol&#243;gica&#44; minimizando os riscos cardiovasculares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Identifica&#231;&#227;o e controlo de fatores de risco cardiovasculares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Monitoriza&#231;&#227;o de sintomas e avalia&#231;&#227;o programada cardiovascular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Controlo de fatores de risco cardiovasculares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Etapas intervencionais na vigil&#226;ncia de eventos card&#237;acos durante a terap&#234;utica oncol&#243;gica</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Score</span> de risco&#58; risco relacionado com o doente<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>n&#46;&#176; de fatores de risco do doente &#40;&#62;<span class="elsevierStyleHsp" style=""></span>6 &#8211; risco muito alto&#59; 5&#8208;6 &#8211; alto risco&#59; 3&#8208;4 &#8211; risco interm&#233;dio&#59; 1&#8208;2 &#8211; risco baixo&#59; 0 &#8211; risco muito baixo&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Risco relacionado com f&#225;rmaco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fatores de risco relacionados com o doente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Alto &#40;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">score</span></span><span class="elsevierStyleBold">4&#41;</span><br>Antraciclinas&#59; ciclofosfamida&#59; herceptin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="4" align="left" valign="top"><br>&#8208; Idade&#58;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>15 ou<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>65 anos<br>&#8208; G&#233;nero&#58; feminino<br>&#8208; Comorbilidades&#58; HTA&#59; diabetes <span class="elsevierStyleItalic">mellitus</span><br>&#8208; Antecedentes de miocardiopatia&#59; insufici&#234;ncia card&#237;aca&#59; doen&#231;a coron&#225;ria&#59; doen&#231;a arterial perif&#233;rica<br>&#8208; Quimioterapia pr&#233;via</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Interm&#233;dio &#40;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">score</span></span><span class="elsevierStyleBold">2&#41;</span><br>Docetaxel&#59; pertuzumab&#59; sunitinib&#59; sorafenib&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Baixo &#40;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">score</span></span><span class="elsevierStyleBold">1&#41;</span><br>Bevacizumab&#59; desatinib&#59; imatinib&#59; lapatinib&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Raro &#40;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">score</span></span><span class="elsevierStyleBold">0&#41;</span><br>Etoposido&#59; rituxumab&#59; talidomida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Avalia&#231;&#227;o do <span class="elsevierStyleItalic">score</span> de risco de cardiotoxicidade&#44; de acordo com os f&#225;rmacos oncol&#243;gicos utilizados e os fatores de risco dos doentes</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Risco de cardiotoxicidade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Doentes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208; Seguimento em consulta de c&#225;rdio&#8208;oncologia<br>&#8208; S&#243; excecionalmente fazem terap&#234;utica com potencial cardiot&#243;xico&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">BB&#58; beta&#8208;bloqueante&#59; FEVE&#58; fra&#231;&#227;o de eje&#231;&#227;o ventricular esquerda&#59; IECA&#58; inibidores da enzima de convers&#227;o da angiotensina&#59; SLG&#58; <span class="elsevierStyleItalic">strain</span> longitudinal global&#46;</p>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Doen&#231;a card&#237;aca estrutural&#44; insufici&#234;ncia card&#237;aca&#44; doen&#231;a coron&#225;ria ou arritmias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HTA n&#227;o controlada&#44; dislipidemia ou diabetes <span class="elsevierStyleItalic">mellitus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Altera&#231;&#245;es no ECG ou no ecocardiograma basal ou no seguimento&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Descida da FEVE<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>10&#37; com FEVE basal &#8805;<span class="elsevierStyleHsp" style=""></span>55&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SLG anormal &#40;&#62;<span class="elsevierStyleHsp" style=""></span>&#8208;19&#37;&#41; ou descida<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Troponina positiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dor retroesternal&#44; dispneia&#44; s&#237;ncope&#44; arritmias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HTA refrat&#225;ria &#224; terap&#234;utica&nbsp;\t\t\t\t\t\t\n
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              "identificador" => "bib0305"
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                0 => array:1 [
                  "referenciaCompleta" => "Causas de morte 2013 &#91;acessado 22 Nov 2015&#93;&#46; Edi&#231;&#227;o 2015&#46; Editor&#58; Instituto Nacional de Estat&#237;stica&#44; I&#46;P&#46; <a id="intr0005" class="elsevierStyleInterRef" href="http://www.ine.pt/">www&#46;ine&#46;pt</a>&#46;"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cancer statistics&#44; 2010"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Jemal"
                            1 => "R&#46; Siegel"
                            2 => "J&#46; Xu"
                          ]
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                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3322/caac.20073"
                      "Revista" => array:6 [
                        "tituloSerie" => "CA Cancer J Clin&#46;"
                        "fecha" => "2010"
                        "volumen" => "60"
                        "paginaInicial" => "277"
                        "paginaFinal" => "300"
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                          0 => array:2 [
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                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0315"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cancer treatment and survivorship statistics&#44; 2012"
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                          "autores" => array:3 [
                            0 => "R&#46; Siegel"
                            1 => "C&#46; DeSantis"
                            2 => "K&#46; Virgo"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.3322/caac.21149"
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                        "fecha" => "2012"
                        "volumen" => "62"
                        "paginaInicial" => "220"
                        "paginaFinal" => "241"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22700443"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiovascular complications of cancer therapy&#58; incidence&#44; pathogenesis&#44; diagnosis&#44; and management"
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                          "autores" => array:2 [
                            0 => "E&#46;T&#46; Yeh"
                            1 => "C&#46;L&#46; Bickford"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2009"
                        "volumen" => "16"
                        "numero" => "53"
                        "paginaInicial" => "2231"
                        "paginaFinal" => "2247"
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                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cardiac toxicity from systemic cancer therapy&#58; a comprehensive review"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Curigliano"
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                            2 => "H&#46;J&#46; Burnstein"
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                    ]
                  ]
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                      "doi" => "10.1016/j.pcad.2010.05.006"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20728696"
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                      "titulo" => "Reversibility of trastuzumab&#8208;related cardiotoxicity&#58; new insights based on clinical course and response to medical treatment"
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                      "titulo" => "Type II chemotherapy&#8208;related cardiac dysfunction&#58; time to recognize a new entity"
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                      "titulo" => "Cardiotoxicity associated with tyrosine kinase inhibitor sunitinib"
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                      "titulo" => "Intricacies of bevacizumab&#8208;induced toxicities and their management"
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                        "paginaFinal" => "501"
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                      "titulo" => "The utility of cardiac biomarkers&#44; tissue velocity and strain imaging&#44; and cardiac magnetic resonance imaging in predicting early left ventricular dysfunction in patients with human epidermal growth factor receptor II&#8208;positive breast cancer treated with adjuvant trastuzumab therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Fallah-Rad"
                            1 => "J&#46;R&#46; Walker"
                            2 => "A&#46; Wassef"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2010.11.063"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2011"
                        "volumen" => "57"
                        "paginaInicial" => "2263"
                        "paginaFinal" => "2270"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21616287"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identification of the molecular basis of doxorubicin&#8208;induced cardiotoxicity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Zhang"
                            1 => "X&#46; Liu"
                            2 => "T&#46; Bawa-Khalfe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nm.2919"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Med&#46;"
                        "fecha" => "2012"
                        "volumen" => "18"
                        "paginaInicial" => "1639"
                        "paginaFinal" => "1642"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23104132"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "MD Anderson Cancer Center&#46; Cancer and the heart programs&#46; &#91;acedido 16 Nov 2015&#93;&#46; Dispon&#237;vel em&#58; <a id="intr0010" class="elsevierStyleInterRef" href="http://www.cancerandtheheart.org/">www&#46;cancerandtheheart&#46;org</a>"
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Congestive heart failure in patients treated with doxorubicin&#58; a retrospective analysis of three trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;M&#46; Swain"
                            1 => "F&#46;S&#46; Whaley"
                            2 => "M&#46;S&#46; Ewer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/cncr.11407"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer&#46;"
                        "fecha" => "2003"
                        "volumen" => "97"
                        "paginaInicial" => "2869"
                        "paginaFinal" => "2879"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12767102"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anthracycline cardiotoxicity&#58; from bench to bedside"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46; Gianni"
                            1 => "E&#46;H&#46; Herman"
                            2 => "S&#46;E&#46; Lipshultz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2007.14.9401"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol&#46;"
                        "fecha" => "2008"
                        "volumen" => "26"
                        "paginaInicial" => "3777"
                        "paginaFinal" => "3784"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18669466"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic progressive cardiac dysfunction years after doxorubicin therapy for childhood acute lymphoblastic leukemia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;E&#46; Lipshultz"
                            1 => "S&#46;R&#46; Lipsitz"
                            2 => "S&#46;E&#46; Sallan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2005.12.121"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol&#46;"
                        "fecha" => "2005"
                        "volumen" => "23"
                        "paginaInicial" => "2629"
                        "paginaFinal" => "2636"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15837978"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Underestimating cardiac toxicity in cancer trials&#58; lessons learned&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;M&#46; Witteles"
                            1 => "M&#46; Telli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2011.40.4012"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol&#46;"
                        "fecha" => "2012"
                        "volumen" => "30"
                        "paginaInicial" => "1916"
                        "paginaFinal" => "1918"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22454419"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trastuzumab plus adjuvant chemotherapy for operable HER2&#8208;positive breast cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46;H&#46; Romond"
                            1 => "E&#46;A&#46; Perez"
                            2 => "J&#46; Bryant"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa052122"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2005"
                        "volumen" => "353"
                        "paginaInicial" => "1673"
                        "paginaFinal" => "1684"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16236738"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2&#8208;year follow&#8208;up of trastuzumab after adjuvant chemotherapy in HER2&#8208;positive breast cancer&#58; a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I&#46; Smith"
                            1 => "M&#46; Procter"
                            2 => "R&#46;D&#46; Gelber"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(07)60028-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet&#46;"
                        "fecha" => "2007"
                        "volumen" => "369"
                        "paginaInicial" => "29"
                        "paginaFinal" => "36"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17208639"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trastuzumab&#8208;related cardiotoxicity&#58; calling into question the concept of reversibility"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;L&#46; Telli"
                            1 => "S&#46;A&#46; Hunt"
                            2 => "R&#46;W&#46; Carlson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2007.11.0106"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol&#46;"
                        "fecha" => "2007"
                        "volumen" => "25"
                        "paginaInicial" => "3525"
                        "paginaFinal" => "3533"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17687157"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0405"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ErbB2 is essential in the prevention of dilated cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;A&#46; Crone"
                            1 => "Y&#46;Y&#46; Zhao"
                            2 => "L&#46; Fan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nm0502-459"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Med&#46;"
                        "fecha" => "2002"
                        "volumen" => "8"
                        "paginaInicial" => "459"
                        "paginaFinal" => "465"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11984589"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0410"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic value of troponin I in cardiac risk stratification of cancer patients under&#8208; going high&#8208;dose chemotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Cardinale"
                            1 => "M&#46;T&#46; Sandri"
                            2 => "A&#46; Colombo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000130926.51766.CC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation&#46;"
                        "fecha" => "2004"
                        "volumen" => "109"
                        "paginaInicial" => "2749"
                        "paginaFinal" => "2754"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15148277"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0415"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trastuzumab&#8208;induced cardiotoxicity&#58; clinical and prognostic implications of troponin I evaluation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Cardinale"
                            1 => "A&#46; Colombo"
                            2 => "R&#46; Torrisi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2009.27.3615"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol&#46;"
                        "fecha" => "2010"
                        "volumen" => "28"
                        "paginaInicial" => "3910"
                        "paginaFinal" => "3916"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20679614"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0420"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trastuzumab and Cardiotoxicity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Fiuza"
                            1 => "A&#46; Magalhaes"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:2 [
                        "titulo" => "Cardiotoxicity of Oncologic Treatments&#46;"
                        "serieFecha" => "2012"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Developed in collaboration with the Heart Failure Association &#40;HFA&#41; of the ESC"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012&#58; The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;J&#46;V&#46; McMurray"
                            1 => "S&#46; Adamopoulos"
                            2 => "S&#46;D&#46; Anker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehs104"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J&#46;"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "1787"
                        "paginaFinal" => "1847"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22611136"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2013 ACCF&#47;AHA guideline for the management of heart failure&#58; a report of the American College of Cardiology Foundation&#47;American Heart Association Task Force on Practice Guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46;W&#46; Yancy"
                            1 => "M&#46; Jessup"
                            2 => "B&#46; Bozkurt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e31829e8776"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation&#46;"
                        "fecha" => "2013"
                        "volumen" => "128"
                        "paginaInicial" => "e240"
                        "paginaFinal" => "e327"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23741058"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of myocardial deformation imaging to detect preclinical myocardial dysfunction before conventional measures in patients undergoing breast cancer treatment with trastuzumab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;L&#46; Hare"
                            1 => "J&#46;K&#46; Brown"
                            2 => "R&#46; Leano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ahj.2009.05.031"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Heart J&#46;"
                        "fecha" => "2009"
                        "volumen" => "158"
                        "paginaInicial" => "294"
                        "paginaFinal" => "301"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19619708"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Emerging anticancer therapeutic targets and the cardiovascular system&#58; is there cause for concern&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "X&#46; Peng"
                            1 => "L&#46; Pentassuglia"
                            2 => "D&#46;B&#46; Sawyer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCRESAHA.109.211276"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Res&#46;"
                        "fecha" => "2010"
                        "volumen" => "106"
                        "paginaInicial" => "1022"
                        "paginaFinal" => "1034"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20360265"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0445"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood pressure as a potential biomarker of the efficacy angiogenesis inhibitor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;I&#46; Levy"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/annonc/mdp018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Oncol&#46;"
                        "fecha" => "2009"
                        "volumen" => "20"
                        "paginaInicial" => "200"
                        "paginaFinal" => "203"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19211499"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0450"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood pressure rise following angiogenesis inhibition by bevacizumab&#46; A crucial role for microcirculation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;-J&#46; Mourad"
                            1 => "G&#46; des Guetz"
                            2 => "H&#46; Debbabi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/annonc/mdm550"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Oncol&#46;"
                        "fecha" => "2008"
                        "volumen" => "19"
                        "paginaInicial" => "927"
                        "paginaFinal" => "934"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18056916"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0455"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Initial assessment&#44; surveillance&#44; and management of blood pressure in patients receiving vascular endothelial growth factor signaling pathway inhibitors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;L&#46; Maitland"
                            1 => "G&#46;L&#46; Bakris"
                            2 => "H&#46;R&#46; Black"
                          ]
                        ]
                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jnci/djq091"
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                        "tituloSerie" => "J Natl Cancer Inst&#46;"
                        "fecha" => "2010"
                        "volumen" => "102"
                        "paginaInicial" => "596"
                        "paginaFinal" => "604"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20351338"
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                          "pii" => "S1699258X12002434"
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                          "issn" => "1699258X"
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            31 => array:3 [
              "identificador" => "bib0460"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of novel angiogenesis inhibitors for the treatment of cancer on the cardiovascular system&#58; focus on hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46; Nazer"
                            1 => "B&#46;D&#46; Humphreys"
                            2 => "J&#46; Moslehi"
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                      ]
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                  "host" => array:1 [
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                      "doi" => "10.1161/CIRCULATIONAHA.110.992230"
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                        "tituloSerie" => "Circulation&#46;"
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                        "paginaFinal" => "1691"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21986775"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0465"
              "etiqueta" => "33"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nebivolol&#44; but not metoprolol&#44; lowers blood pressure in nitric oxide&#8208;sensitive human hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46;E&#46; Okamoto"
                            1 => "A&#46; Gamboa"
                            2 => "C&#46;A&#46; Shibao"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/HYPERTENSIONAHA.114.04116"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension&#46;"
                        "fecha" => "2014"
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                        "paginaInicial" => "1241"
                        "paginaFinal" => "1247"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25267802"
                            "web" => "Medline"
                          ]
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                  ]
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              ]
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            33 => array:3 [
              "identificador" => "bib0470"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of antiangiogenic therapy&#8208;induced hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Jesus-Gonzalez"
                            1 => "E&#46; Robinson"
                            2 => "J&#46; Moslehi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/HYPERTENSIONAHA.112.196774"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension&#46;"
                        "fecha" => "2012"
                        "volumen" => "60"
                        "paginaInicial" => "607"
                        "paginaFinal" => "615"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22851729"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0475"
              "etiqueta" => "35"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The importance of endothelin&#8208;1 for vascular dysfunction in cardiovascular disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46; Bohm"
                            1 => "J&#46; Pernow"
                          ]
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                      ]
                    ]
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                  "host" => array:1 [
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                      "doi" => "10.1016/j.cardiores.2007.06.004"
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                        "tituloSerie" => "Cardiovasc&#46; Res&#46;"
                        "fecha" => "2007"
                        "volumen" => "76"
                        "paginaInicial" => "8"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17617392"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0480"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cardiac side effects of molecular targeted therapies&#58; towards a better dialogue between oncologists and cardiologists"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Ederhy"
                            1 => "H&#46; Izzedine"
                            2 => "C&#46; Massard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.critrevonc.2011.01.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Rev Oncol Hematol&#46;"
                        "fecha" => "2011"
                        "volumen" => "80"
                        "paginaInicial" => "369"
                        "paginaFinal" => "379"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21330149"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0485"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "2013 ESH&#47;ESC Guidelines for the management of arterial hypertension&#58; the Task Force for the management of arterial hypertension of the European Society of Hypertension &#40;ESH&#41; and of the European Society of Cardiology &#40;ESC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Mancia"
                            1 => "R&#46; Fagard"
                            2 => "K&#46; Narkiewicz"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.hjh.0000431740.32696.cc"
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                        "tituloSerie" => "J Hypertens&#46;"
                        "fecha" => "2013"
                        "volumen" => "31"
                        "paginaInicial" => "1281"
                        "paginaFinal" => "1357"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23817082"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0490"
              "etiqueta" => "39"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Radiation&#8208;induced heart disease&#58; pathologic abnormalities and putative mechanisms"
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                          "etal" => true
                          "autores" => array:3 [
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                            2 => "J&#46;B&#46; Kostis"
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                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3389/fonc.2015.00039"
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                        "tituloSerie" => "Front Oncol&#46;"
                        "fecha" => "2015"
                        "volumen" => "5"
                        "paginaInicial" => "39"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25741474"
                            "web" => "Medline"
                          ]
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                  ]
                ]
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              "identificador" => "bib0495"
              "etiqueta" => "40"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiation&#8208;related heart disease&#58; current knowledge and future prospects"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;C&#46; Darby"
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                            2 => "M&#46; Boerma"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.ijrobp.2009.09.064"
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                        "tituloSerie" => "Int J Radiat Oncol Biol Phys&#46;"
                        "fecha" => "2010"
                        "volumen" => "76"
                        "paginaInicial" => "656"
                        "paginaFinal" => "665"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20159360"
                            "web" => "Medline"
                          ]
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                  ]
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              "identificador" => "bib0500"
              "etiqueta" => "41"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of ischemic heart disease in women after radiotherapy for breast cancer"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;C&#46; Darby"
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                            2 => "P&#46; McGale"
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                      "doi" => "10.1056/NEJMoa1209825"
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                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2013"
                        "volumen" => "368"
                        "paginaInicial" => "987"
                        "paginaFinal" => "998"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23484825"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Distribution of coronary artery stenosis after radiation for breast cancer"
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                          "autores" => array:3 [
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                            2 => "H&#46; Garmo"
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "J Clin Oncol&#46;"
                        "fecha" => "2012"
                        "volumen" => "30"
                        "paginaInicial" => "380"
                        "paginaFinal" => "386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22203772"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Understanding radiation&#8208;induced vascular disease"
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                            2 => "D&#46; Manka"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
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                        "paginaInicial" => "1237"
                        "paginaFinal" => "1239"
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              "identificador" => "bib0515"
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                0 => array:2 [
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                      "titulo" => "Radiation&#8208;induced heart disease&#58; a clinical update"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21403872"
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                      "titulo" => "Cardiac complications of thoracic irradiation"
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                        "fecha" => "2013"
                        "volumen" => "61"
                        "paginaInicial" => "2319"
                        "paginaFinal" => "2328"
                        "link" => array:1 [
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                        "paginaFinal" => "740"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23847385"
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                    0 => array:2 [
                      "titulo" => "The prevention of cardiovascular disease in cancer survivors"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Tex Heart Inst J&#46;"
                        "fecha" => "2012"
                        "volumen" => "39"
                        "paginaInicial" => "190"
                        "paginaFinal" => "198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22740730"
                            "web" => "Medline"
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              "identificador" => "bib0535"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy&#58; a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging"
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                        0 => array:2 [
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                  "host" => array:1 [
                    0 => array:2 [
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                        "volumen" => "27"
                        "paginaInicial" => "911"
                        "paginaFinal" => "939"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25172399"
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                          "issn" => "07351097"
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                    0 => array:2 [
                      "titulo" => "Cardiovascular toxicity induced by chemotherapy&#44; targeted agents and radiotherapy&#58; ESMO Clinical Practice Guidelines"
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                      "Revista" => array:4 [
                        "tituloSerie" => "Ann Oncol&#46;"
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                    0 => array:2 [
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                          "autores" => array:3 [
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                            2 => "S&#46;V&#46; Lopez"
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                    ]
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                  "host" => array:1 [
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                      "Revista" => array:2 [
                        "tituloSerie" => "CTO"
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
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            49 => array:3 [
              "identificador" => "bib0550"
              "etiqueta" => "51"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cardiac monitoring during adjuvant trastuzumab&#8208;based chemotherapy among older patients with breast cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Chavez-MacGregor"
                            1 => "J&#46; Niu"
                            2 => "N&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2014.58.9465"
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                        "tituloSerie" => "J Clin Oncol&#46;"
                        "fecha" => "2015"
                        "volumen" => "33"
                        "paginaInicial" => "2176"
                        "paginaFinal" => "2183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25964256"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0555"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Myocardial protection during cardiotoxic chemotherapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;M&#46; Witteles"
                            1 => "X&#46; Bosch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.114.010486"
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                        "tituloSerie" => "Circulation&#46;"
                        "fecha" => "2015"
                        "volumen" => "132"
                        "paginaInicial" => "1835"
                        "paginaFinal" => "1845"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26553713"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0560"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiovascular side effects of cancer therapies&#58; a position statement from the Heart Failure Association of the European Society of Cardiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Eschenhagen"
                            1 => "T&#46; Force"
                            2 => "M&#46;S&#46; Ewer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurjhf/hfq213"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Heart Fail&#46;"
                        "fecha" => "2011"
                        "volumen" => "13"
                        "paginaInicial" => "1"
                        "paginaFinal" => "10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21169385"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0565"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation and management of patients with heart disease and cancer&#58; cardio&#8208;oncology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Herrmann"
                            1 => "A&#46; Lerman"
                            2 => "N&#46;P&#46; Sandhu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.mayocp.2014.05.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mayo Clin Proc&#46;"
                        "fecha" => "2014"
                        "volumen" => "89"
                        "paginaInicial" => "1287"
                        "paginaFinal" => "1306"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25192616"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0570"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ten principles of good interdisciplinary team work"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Nancarrow"
                            1 => "A&#46; Booth"
                            2 => "S&#46; Ariss"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1478-4491-11-19"
                      "Revista" => array:5 [
                        "tituloSerie" => "Hum Resour Health&#46;"
                        "fecha" => "2013"
                        "volumen" => "11"
                        "paginaInicial" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23663329"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0575"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Onco&#8208;cardiology&#58; the time has come"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46;T&#46; Yeh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Tex Heart Inst J"
                        "fecha" => "2011"
                        "volumen" => "38"
                        "paginaInicial" => "246"
                        "paginaFinal" => "247"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21748048"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0580"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of preexisting cardiovascular disease in patients with different types of cancer&#58; The Unmet Need for Onco&#8208;Cardiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;G&#46; Al-Kindi"
                            1 => "G&#46;H&#46; Oliveira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Mayo Clin Proc&#46;"
                        "fecha" => "2016"
                        "volumen" => "9"
                        "paginaInicial" => "81"
                        "paginaFinal" => "83"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0585"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESC core curriculum for the general cardiologist &#40;2013&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46;C&#46; Gillebert"
                            1 => "N&#46; Brooks"
                            2 => "R&#46; Fontes-Carvalho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/eht234"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J&#46;"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "2381"
                        "paginaFinal" => "2411"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23847131"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0590"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACC 2015 core cardiovascular training statement 4 &#40;COCATS 4&#41; &#40;Revision of COCATS 3&#41;"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;L&#46; Halperin"
                            1 => "E&#46;S&#46; Williams"
                            2 => "V&#46; Fuster"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2015"
                        "volumen" => "65"
                        "paginaInicial" => "1721"
                        "paginaFinal" => "1723"
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                      "titulo" => "Cardiovascular toxicity of anticancer&#8208;targeted therapy&#58; emerging issues in the era of cardio&#8208;oncology"
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                          "etal" => false
                          "autores" => array:2 [
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                    0 => array:2 [
                      "doi" => "10.1007/s11739-011-0744-y"
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                        "tituloSerie" => "Intern Emerg Med&#46;"
                        "fecha" => "2012"
                        "volumen" => "7"
                        "paginaInicial" => "113"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22161318"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0600"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cancer genetics and the cardiotoxicity of the therapeutics"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Lal"
                            1 => "K&#46;L&#46; Kolaja"
                            2 => "T&#46; Force"
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                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2012.05.066"
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                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2013"
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                        "paginaFinal" => "274"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23328609"
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                ]
              ]
            ]
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